Is vaping safer than smoking? The expert view on the health risks of e-cigarettes compared to tobacco

The number of people vaping in the UK has increased in recent years, with many of those looking to quit smoking swapping the traditional cigarette for e-cigarettes.

And it’s not just those looking to quit smoking taking up vaping, with non-smokers also adopting the habit.

Although the NHS signposts those looking to quit smoking to use e-cigarettes as one of the options, it notes that vaping is “not recommended” for non-smokers and young people because “it is not completely harmless”.

Following the news that one million smokers in England will be encouraged to swap cigarettes for vapes under a new “swap to stop” scheme, what does the science say on whether vaping is better for you than smoking, and are there any risks associated with it? We spoke to health experts to find out more.

‘If you don’t smoke then don’t vape, it’s not risk-free’

Vaping prevalence among adults in England is currently lower than smoking prevalence across all groups, but e-cigarette usage increased by around one percentage point from 2020 to 2021, rising to between 6.9% and 7.1%. This equated to about 3.1 to 3.2 million vapers.

In 2022, based on ASH-A data, so far adult vaping prevalence in England has risen to 8.3%.

According to 2021 STS data, the highest vaping prevalence was among current smokers, with a rate of 22% compared with 11.6% among former smokers and 0.6% among those who have never smoked.

New research from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London also recently found that the use of vaping products rather than smoking leads to a substantial reduction in exposure to toxicants that promote cancer, lung disease and cardiovascular disease.

The independent report was commissioned by the Office for Health Improvement and Disparities in the Department of Health and Social Care and represented the most comprehensive review of vaping risks to date.

The study found that although vaping is not risk-free, particularly for people who have never smoked, it poses a small fraction of the health risks of smoking in the short to medium term.

The findings are echoed by Deborah Arnott, chief executive at Action on Smoking and Health (ASH), who said it’s “important” that smokers are aware “that the evidence is clear that vaping poses a small fraction of the risk of smoking”.

She added: “If you smoke, then vaping can help you quit and is much less harmful than smoking”, noting that it’s the tar and carbon monoxide in cigarette smoke that poses a danger, not the nicotine. But she added: “If you don’t smoke then don’t vape, it’s not risk-free”.

Similarly, Cancer Research UK’s executive director of policy, Dr Ian Walker, said the King’s College report highlights a growing body of research “showing that e-cigarettes are far less harmful than smoking and can help people who smoke to stop”.

But he added that the study also shows that e-cigarettes “are not risk-free” and that there is “limited research into their long term health effects”.

Dr Walker said because of this, the charity “strongly discourages” those who have never smoked from using e-cigarettes, especially young people.

However, although the long term effects of vaping are still “unknown”, Dr Walker said the harmful effects of smoking are “indisputable”, as it causes around 55,000 cancer deaths in the UK every year.

Cancer Research UK supports balanced evidence-based regulation on e-cigarettes from the UK government which “maximises their potential to help people stop smoking”, while also “minimising the risk of uptake from people who have never smoked and young people especially”, Dr Walker added.

Rise in number of young people vaping

During Stoptober, which takes place during October and aims to help people to quit smoking, the Asthma + Lung UK charity is encouraging anyone who smokes cigarettes to “stamp out this deadly addiction” in order to “give their lungs a boost”.

Vaping, nicotine replacement therapy and help from your GP or stop smoking service can all help people quit, the charity’s policy manager Jon Foster said.

He added: “Emerging research suggests that vaping is a much less harmful alternative to smoking and can be an effective tool to help smokers stub out their cigarettes.

“However, let’s be clear, vaping isn’t risk-free and we would never advocate those who don’t smoke already to start vaping.”

He said it is also “concerning” to see a rise in youth vaping and that the charity wants to see action to prevent the marketing of these products in ways that appeal to children, especially on social media, with cartoon characters or images appealing to young people banned.

“It seems clear that enforcement of the age of sale is also a problem, as no one under the age of 18 should be able to buy these products,” Mr Foster added.

Data from NHS Digital recently revealed that the number of young people vaping has increased, with 9% of secondary school pupils aged 11 to 15 currently - either regularly or occasionally - using e-cigarettes in 2021. This was an increase from 6% in 2018, according to statistics.

A survey of children, carried out for ASH, found that over the last year a new generation of disposable vapes known as ‘puff bars’ – which contain nicotine – have come on to the market.

Although it is illegal to sell vapes to under-18s, social media platforms regularly carry posts from teenagers showing the new vapes and discussing flavours.

What are the risks associated with vaping?

Experts have said that although it’s safer for those who smoke to switch to vaping, those who don’t already smoke shouldn’t start using e-cigarettes. But what exactly are the risks associated with vaping?

Although the dangers of using e-cigarettes are still not fully known and more extensive research is needed into this, Abbas Kanani, pharmacist at Chemist Click, said if the end goal of quitting smoking is to curb a nicotine addiction, then vaping may not be for you.

E-liquid concoctions usually include some mix of flavourings, additives and nicotine, dissolved in an oily liquid base, Mr Kanani explained.

Nicotine is a “highly addictive” chemical found in the tobacco plant, which causes the brain to release adrenaline and “create a buzz of pleasure and energy” which can lead users to “crave the effects and become addicted”, he added.

Nicotine also raises blood pressure and spikes your adrenaline, “increasing the chances of having a heart attack,” said Mr Kanani.

The pharmacist explained he’s met a number of people who also developed oral thrush which was “most likely caused by vaping”.

Some ingredients in e-cigarettes can also cause a dry mouth, bad breath, sores and sometimes tooth decay, so vaping is “generally bad for oral health”, he noted.

Terry Murphy, national business development manager, NHS leadership coach and author at Radar Healthcare, said some smokers “turn to vape products” in a bid to quit cigarettes as it still provides nicotine, but with “less of the toxins” that come from tobacco.

However, he added that although vaping products are “less harmful than cigarettes”, they are “not harmless” and many people still find themselves dependent on them and struggle to quit them completely.

Although the King’s College London report marks a huge step forward into the research of the effects of vaping and shows e-cigarette usage is better than the health impacts of smoking traditional cigarettes, further research into the long-term effects of vaping is still needed - together with a crackdown on children vaping.