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E-cigarettes, otherwise known as vapes, are devices that allow users to inhale nicotine in a vapour rather than smoke. They are recognised as a way for smokers to manage nicotine dependence in a less harmful way than tobacco smoking.

Health risks associated with vaping

The international scientific and medical community is generally in agreement that vaping is significantly less harmful than conventional smoking. However, it also cautions that the long-term risks of vaping are still unclear.

This uncertainty is largely due to the novelty of e-cigarettes, which were brought to market in the early 2000s, and did not become widespread until the mid-2010s. Not enough time, therefore, has passed for any studies to report on potential long-term effects of vaping.

Despite this, there is an early understanding of the kind of health problems that vaping is associated with.

Statements on risk from medical organisations

Many vape products contain nicotine. In 2018, Public Health England concluded that the risks of nicotine to human health were low. However, the World Health Organization has noted that nicotine can have adverse effects during pregnancy (PDF), and that it might contribute to cardiovascular disease and tumour formation.

The Royal College of Physicians noted that some cancer-causing substances present in tobacco smoke have also been detected in e-cigarette vapour. This raised the possibility that long-term use of e-cigarettes may increase the risk of lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, and other smoking-related diseases. It did, however, note that the extent of these risks was likely to be substantially lower than that of smoking.

Uncertainty about the long-term health risks has likely underpinned the NHS’ recommendation that vaping should only be used by adults as a smoking cessation tool. Professor Sir Chris Whitty, Chief Medical Officer for England, summarised this advice succinctly in May 2023; “if you smoke, vaping is much safer; if you don’t smoke, don’t vape”.

Illegal vapes

There is an additional risk posed by vapes that do not comply with regulatory standards. The sale and use of illicit e-cigarettes, which do not conform to the necessary product standards, place users at risk of ingesting unsafe levels of metals such as nickel, lead and chromium and other harmful substances.

Mental health and behavioural effects

As well as the possibility of physiological risks, researchers are considering the effects of vaping on mental health. One study identified an association between vaping and the incidence of mental health conditions in young people although a number of limitations to the study meant that its findings were not conclusive.

Questions are also being raised about vaping’s behavioural impact, namely, whether it acts as a “gateway” to smoking tobacco and whether it risks “renormalising smoking”, thereby undermining efforts to reduce smoking made in the last few decades.

Future research into vaping and health

The next steps in understanding the health effects of vaping include conducting more and longer-term studies involving people who vape.

Another area of research that will be of interest to policy makers is whether vaping helps to reduce smoking rates, and if it does, how much it might improve public health.


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