Vaping is substantially less harmful than smoking, according to a major review of nicotine products, but action is needed to tackle the sharp rise in e-cigarette use among children.
Researchers at King’s College London said smokers who switched to vaping would experience a “substantial reduction” in their exposure to toxic substances that cause cancer, lung and cardiovascular disease, but they strongly urged non-smokers not to take up either habit.
Ann McNeill, a professor of tobacco addiction at King’s and lead author on the study, said smoking was “uniquely deadly”, killing half of all regular, long-term smokers, but that a survey in England found two-thirds of adult smokers were unaware vaping was less harmful.
“Vaping poses only a small fraction of the risks of smoking in the short to medium term, however, this does not mean vaping is risk-free, particularly for people who have never smoked,” she said.
Dr Debbie Robson, a co-author of the report, said helping people switch from smoking to vaping must become a government priority to achieve the goal of a smoke-free England by 2030.
The independent report, commissioned by the Office for Health Improvement and Disparities, in the Department of Health and Social Care, is the most comprehensive review of the health risks of vaping to date. The researchers drew on more than 400 published studies from around the world, many of which looked at signs of harm or levels of toxic substances in the body after smoking and vaping.
Most studies reported short- or medium-term effects from smoking or vaping, such as raised levels of nicotine and specific cancer-causing compounds, meaning the scientists gained little insight into potentially more serious long-term health effects that arise after years of using the products.
While two-thirds of adult smokers in England believe vaping is as harmful or more harmful than smoking, the report found that levels of toxic substances, such as nitrosamines, carbon monoxide and volatile organic compounds, were the same or lower in vapers compared with smokers. Levels were lower still in people who did not use any nicotine products.
Among adults in England, smoking has fallen as vaping has increased, but the same trend is not playing out among younger people. According to the report, smoking among 11- to 18-year-olds stood at 6.3% in 2019 and 6% in 2022, while vaping rose from 4.8% to 8.6%. In the past year, rates of vaping have doubled among 16- to 18-year-olds, but the most striking rise was in newer, disposable vapes, which are now used by more than half of young vapers, up from 7.8% last year.
It is illegal to sell vapes to under-18s, but secondary schools have reported a surge in vaping among pupils, largely driven by disposable vapes that can cost £5 each and come in flavours such as gummy bears, cotton candy, waffles and doughnut.
The authors called for better law enforcement to prevent shopkeepers and other suppliers selling vapes to children, and for beefed up regulations to tackle the “dramatic increase” in young people using disposablevapes.
“The advertising, packaging and marketing of disposable products to young people should be investigated and, where appropriate, proportionate action taken to reduce appeal to young people,” they write.
The report warns, however, that deterrents need to be designed carefully so they do not discourage smokers from making the switch.
Lion Shahab, a professor of health psychology and co-director of the Tobacco and Alcohol Research Group, at University College London, called the report “the most rigorous, comprehensive and up-to-date piece of work” ever published on the topic in the UK.
“We should ensure that adult smokers get the right support, which includes provision of accurate information about the reduced risk of vaping and how it can help them stop smoking, while also offering educational material to young people who would have never smoked, to discourage them from starting to vape, in addition to better reinforcement of age of sale and advertising restrictions,” he said. “If this balance can be struck, e-cigarettes can play a powerful role in consigning smoking cigarettes to the history books in the UK.”
