There is controversy surrounding safety claims and the perceived benefits of Vaping compared to Smoking. Scientists look at evidence of Acute vs. chronic effects on health, this needs to be reasonably specific and link to disease.

‘…the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco…’

‘There has been an overall shift towards the inaccurate perception of EC being as harmful as cigarettes […] in contrast to the current expert estimate that using EC is around 95% safer than smoking.’

Is this claim justified? Not quite, evidence suggests a more likely risk reduction of 60-80%. 

‘Some smoking-related health effects are irreversible.’

‘Health outcomes confounded with past smoking behaviour of most EC users.’

‘95% risk reduction = 6.6 million fewer deaths’

‘60% risk reduction = 1.6 million fewer deaths’

We may never know exact level of harm reduction of e-cigarette use compared with smoking.

Extracts from presentation by Lion Shahab, PhD University College London UK E-Cigarette Summit 2017

‘To assess the carcinogenic potential of different nicotine aerosols (e-cigarettes) scientists use data on tobacco smoke as a basis for comparing relative risk.

There are known carcinogens in tobacco (1,3-Butadiene, Acrylonitrile, Acetaldehyde, Acrylamide, Benzene). Analysis of tobacco products has produced a list of 93 chemical compounds, including:

75 carcinogens
25 respiratory toxicants
12 cardiovascular toxicants

There are toxicants found specifically in e-cigarettes (Formaldehyde, Acetaldehyde).’

Presentation by Ed Stephens, UK E-Cigarette Summit 2017

‘… nicotine (NRT) alone causes acute endothelial dysfunction, although to a lesser extent than smoking a cigarette of the same nicotine yield.’

‘… coffee exerts an acute unfavourable effect on the endothelial function in healthy adults…’

‘There is a risk-continuum among harm reduction products, with e-cigarettes (new generation) emitting lower levels of toxins compared to THPs (Tobacco Heating Products)

The absolute difference in toxic emissions from tobacco cigarettes is much higher than the absolute difference between harm reduction products – smokers should make informed decisions’

Presentation by Dr Konstantinos Farsalinos, Researcher, Onassis Cardiac Surgery Center, Greece, UK E-Cigarette Summit 2017

‘Smoking abstinence by using e-cigarettes may improve respiratory function and symptoms’

‘No data about e-cigarettes use in smokers with pre-existing disease’

‘Very little is known about the health impact of long-term vaping’

‘Challenges: The large majority of EC users are smokers or ex-smokers . . . and research takes time’

Presentation by Prof. Riccardo Polosa, Institute of Internal Medicine, University of Catania, Italy, UK E-Cigarette Summit 2017

Statistics from evidence gathered in the UK, shows that there has been a decline in tobacco smoking, and an increase in people making attempts to quit and being successful in quitting. This proves that consumers are finding out for themselves what the benefits are of vaping compared to smoking.

There are opportunities and challenges for analytical chemistry in supporting the continued development and use of safe and consistent dosage formulations as alternatives to tobacco products. Almost all scientific data on health risks associated with the use of e-cigarettes is coming from the manufacturers. More evidence is needed (particularly in terms of long-term effects) to determine the harm levels of Vaping and how this relates to the harm reduction compared to smoking.

E-cigarettes (ECs) deliver a controlled amount of Nicotine as an aerosol vapour inhaled by the user. The amount of Nicotine taken into the lungs will vary depending on how the user is puffing on the EC and whether or not they are doing it in a confined space with or without other vapers or outside.

There is a trend for vapers that have been vaping for a longer period to go for ECs with more flavor and less nicotine.

Extracts from NHS: vapers-may-inhale-more-toxins-lower-strength-e-cigarettes – June 2018

‘When using the low-nicotine liquids, people generally feel a greater urge to vape.’

‘They overcompensated for the lower strength by puffing more frequently and for longer, and by increasing the power of their vaping devices when they were able to.’

‘The nicotine content of the liquid, the type of device used and the user’s puffing behaviour all influenced their nicotine exposure.’

‘Typically, e-cigarette users often choose lower-nicotine devices over time – but if they switch too soon, it may cause them to take compensatory measures like longer puffs or increasing the power of their device.’

‘If you’re trying to quit smoking and want to try e-cigarettes, it may be a good idea not to jump straight to low-nicotine products.’

Extract from E-cigarettes: an evidence update A report commissioned by Public Health England – Aug 2015

‘A study measuring nicotine residue on surfaces in houses of smokers and vapers reported only negligible levels from vaping – 169 times lower than from smoking.’

Nicotine is addictive. Most smokers use tobacco regularly because they are addicted to nicotine. Addiction is characterised by compulsive drug-seeking and use, even in the face of negative health consequences. The majority of smokers would like to stop smoking, and each year about half try to quit permanently. This is why smokers are being encouraged to change over to using e-cigarettes instead.

Long-term, the benefits of e-cigarette (EC) use outweighs the continuation of an addiction to a substance that  does carry health risks.

Extracts from E-cigarettes: an evidence update A report commissioned by Public Health England – Aug 2015

‘Policy implications:

E-cigarette (EC) should not routinely be treated in the same way as smoking. It is not appropriate to prohibit EC use in health trusts and prisons as part of smoke free policies unless there is a strong rationale to do so.’

‘Key Messages:

Encouraging smokers who cannot or do not want to stop smoking to switch to EC could help reduce smoking related disease, death and health inequalities.

SPICe Briefing E-cigarettes: FAQs Angus Evans and Jude Payne – Nov 2014

There is no evidence that EC are undermining the long-term decline in cigarette smoking among adults and youth, and may in fact be contributing to it.

Despite some experimentation with EC among never smokers, EC are attracting very few people who have never smoked into regular EC use.

Extracts from E-cigarettes: an evidence update A report commissioned by Public Health England – Aug 2015

In terms of the ‘Normalisation Effect’ the study by ASH (2014b), found that most children using e-cigarettes had already smoked tobacco cigarettes.