The path to quitting cigarette smoking may not be as smooth as we would like. Vaping has been offered as one of them.

Cigarette smoking has been found to cause lung cancer, and legal battles over decades have been fought on either side, while people have died. True, the research found that cigarettes contain over 7,000 chemicals, and 69 of them can cause cancer. And then there’s the argument that not everybody who smokes develops lung cancer. A college professor in one of my classes tearfully told us about his younger brother dying of lung cancer. His brother had never smoked.

In fact, research shows that about one out of every three smokers will develop lung cancer. This would seem to some to be reason enough for people to continue to smoke if they wish, and to allow cigarette companies to continue to market their product.

New methods to assist smokers in weaning themselves from cigarettes have been marketed, and they include a variety of nicotine products. The results, however, seem to have been insufficient for too many, who may even have become addicted to these alternative products. Vaping was to be the new means to attack cigarette addiction, and it has kindled a new fire. Pro and con: consumers are left wondering whether it’s safe.

Modern public health faces an unexpected situation because e-cigarettes, which were initially seen as harm reduction tools, have generated more uncertainties than proven benefits. The basic concept of vapor inhalation instead of tobacco combustion seems logical, but scientific evidence indicates vaping creates its own set of health problems. These products may not cause cancer, but they may have other health consequences.

Researchers at the ATS (American Thoracic Society) meeting shared preliminary results about lung injury biomarkers and inflammation that occur when people use e-cigarettes. Research data indicate that vaping creates health problems even when used briefly, according to existing scientific literature.

Weighing the Promise: Possible Advantages of E-Cigarette Use

The public health discussion about e-cigarettes began for valid reasons that led to their introduction. The primary advantage of e-cigarettes stems from harm reduction because they prevent the formation of toxic substances, which arise from tobacco combustion, including tar, carbon monoxide, and heavy metals that cause most smoking-related illnesses.

Research indicates that e-cigarettes used with counseling help smokers decrease their combustible cigarette consumption but do not eliminate their nicotine dependence. Seemingly, people who transition from smoking to vaping experience temporary reductions in blood pressure and heart rate measurements because they avoid smoke combustion toxins. But vaping products are not without harmful substances, too, despite their advantages.

The advantages of vaping exist under specific conditions. Benefits depend on four essential factors: complete cigarette replacement, strict product regulations, low toxic emissions, and proven long-term safety.

The Risks, the Unknowns, and the Cautionary Signals

Multiple research studies have shown that vaping leads to higher occurrences of wheezing, coughing, and worsening asthma, particularly among young people. The limited time since vaping became widespread makes it difficult to establish links between vaping and long-term respiratory diseases such as COPD and lung cancer. Still, recent studies indicate e-cigarette users develop new respiratory conditions.

The 2022 systematic review demonstrated that vaping increases airway resistance, but results were inconsistent. Studies are also pointing to dangerous ingredients in vaping products that can trigger sudden lung injuries in vulnerable users.

The most consistent research evidence shows that vaping causes immediate heart rate elevation and blood pressure increases and stiffens arteries in users who consume both nicotine and non-nicotine e-liquids. Research through meta-analysis indicates that vaping produces detrimental effects on endothelial function because of oxidative stress and inflammation and vascular tone disturbances. Human and animal studies demonstrate that prolonged e-cigarette use leads to blood vessel dysfunction and elevated cardiovascular disease risk.

“Approximately 3,5 million participants, including 140,00 patients with COPD, summarize current evidence regarding the adverse health impacts of e-cigarette use on COPD in adults.” It is not without health consequences.

The neural effects of nicotine in e-liquids create a major concern because this substance functions as the main component in most e-liquid products, especially when affecting adolescents, fetuses, and pregnant individuals. The toxic effects of nicotine on developing brains lead to potential cognitive problems, mood instability, and substance dependence.

The inhalation of flavoring agents, volatile organic compounds, heavy metals, and ultrafine particulates each produces distinct health risks. A cumulative effect is seen in vaping individuals, and we cannot solely concentrate on nicotine or cessation of cigarette smoking any longer.

Research using animal models and cell experiments shows that e-liquid vapor can damage the blood-brain barrier while triggering inflammation in the brain and causing memory and learning problems even when nicotine is absent. We already have evidence that inflammation appears to be a major impetus in mood and psychiatric disorders, further adding to the concern regarding vaping.

The current scientific evidence on carcinogenic effects is still under development. Research does seem to indicate that e-cigarette users develop cancer-related biomarkers while vaping produces DNA-damaging substances, yet direct epidemiological evidence linking vaping to cancer incidence remains insufficient. Does this provide an “out” for vaping? Hardly, since the evidence appears sufficient for a warning on the product and a campaign to inform consumers.

The list of possible adverse effects includes damage to oral and nasal tissues, a weakened immune system, reproductive problems, and impaired wound recovery.

One of the problems related to research is that much of it has been short term and limited in the universe of cigarette or vaping product users. Such limitations mitigate for caution when considering any potential injurious device or ingredient. The numerous e-cigarette devices, power settings, e-liquid types, and user practices make it dangerous to predict outcomes. Research shows that people who have never smoked before using e-cigarettes face a higher risk of switching to traditional tobacco cigarettes in the future.

A Balanced Evaluation of E-Cigarettes

The available evidence leads to the adoption of a cautious approach when weighing the advantages against the disadvantages. Many smokers achieve their best health benefit by completely stopping their use of combustible cigarettes. The use of vaping products as a safer alternative requires strict regulations and limited usage under controlled conditions.

Pros:

The use of e-cigarettes reduces users’ contact with combustion-generated substances.

Research shows that e-cigarettes help people reduce their smoking and achieve abstinence.

The short-term use of e-cigarettes leads to better blood pressure readings and heart rate control.

The use of e-cigarettes reduces users’ contact with toxic substances that form when tobacco burns.

Cons:

The use of e-cigarettes leads to increased heart rate and blood pressure and stiffened arteries.

The use of e-cigarettes leads to respiratory problems which could result in chronic lung disease.

The combination of nicotine addiction and its negative effects on adolescent brain development.

The long-term effects of cancer and systemic harm from e-cigarettes remain unidentified.

The devices and liquids used in e-cigarettes show wide variations.

The combination of using e-cigarettes with traditional tobacco products creates a dual use pattern, which may lead to a gateway effect.

If there is one thing that has been emphasized over the past decades, it is that we need to be aware of gateway products that lead to stronger addictions

The most responsible approach for the future requires what course of action? The first choice for everyone should be complete abstinence from all substances. Users of e-cigarettes should aim to replace their entire smoking habit with e-cigarettes. Preventing youth vaping and ongoing monitoring and regulatory oversight should remain at the forefront of all e-cigarette policies.