“The levels of exposure to cancer causing and other toxicants are drastically lower in people who vape compared with those who smoke. Helping people switch from smoking to vaping should be considered a priority if the Government is to achieve a smoke-free 2030 in England.”
Dr Debbie Robson, a Senior Lecturer in Tobacco Harm Reduction King’s IoPPN and one of the report’s authors
29 September 2022
Vaping substantially less harmful than smoking, largest review of its kind finds
New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London has 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, commissioned by the Office for Health Improvement and Disparities in the Department of Health and Social Care, represents the most comprehensive review of the risks of vaping to date. It found that, while 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 report reviewed many aspects of vaping, including who is vaping and what products, the effects on health (both absolute and compared with smoking) and public perceptions of harm. The authors examined studies of biomarkers of exposure (measures of potentially harmful substance levels in the body) as well as biomarkers of potential harm (measures of biological changes in the body) due to vaping or smoking.
The strongest evidence, and where there was a greater volume of research, came from biomarkers of exposure. An exploration of the available studies found that levels of tobacco specific nitrosamines, volatile organic compounds and other toxicants implicated in the main diseases caused by smoking were found at significantly lower levels in vapers. Among vapers, overall levels of nicotine were lower or similar to smokers.
When comparing biomarkers between people who vape and people who don’t smoke or vape, they were often similar, but in some cases there was higher exposure when vaping. The investigators therefore concluded that whilst less harmful than smoking, vaping is likely to sustain some risks particularly for people who have never smoked.
While the investigators are clear on the benefits of vaping vs smoking, they found that public perceptions are lagging behind. In 2021, only 34% of adults who smoked accurately perceived that vaping was less harmful than smoking, while only 11% of adult smokers knew that nicotine wasn’t the primary cause of the health risks connected to smoking tobacco.
Vaping is seeing increasing popularity among adults. According to the latest data from the Action on Smoking and Health (ASH) Smokefree GB Adult survey, current vaping prevalence is 8.3% in 2022, compared with 7.1% in 2021 and 6.3% in 2020.
Vaping has also increased among young people. Data from the ASH Smokefree GB Youth survey of 11-to 18-year-olds in England show that current vaping prevalence (including occasional and regular) is 8.6% in 2022, compared with 4.0% in 2021 and 4.8% in 2020. Use of disposable vaping products has increased substantially over the last year. Vaping among young people who have never smoked remains very low at 1.7%.
“Smoking is uniquely deadly and will kill one in two regular sustained smokers, yet around two-thirds of adult smokers, who would really benefit from switching to vaping, don’t know that vaping is less harmful. However, the evidence we reviewed indicates that vaping is very unlikely to be risk-free. So we strongly discourage anyone who has never smoked from taking up vaping or smoking.”
Professor Ann McNeill, a professor of tobacco addiction at King’s IoPPN and the report’s lead author
Dr Jeanelle DeGruchy, Deputy Chief Medical Officer for England said, “Every minute someone is admitted to hospital in England due to smoking. Every eight minutes someone dies a smoking-related death. This important study is the latest in a series which carefully pulls together the science on vaping to help reduce the damage from smoking.
“Vaping is substantially less harmful than smoking so the message is clear, if the choice is between smoking and vaping, choose vaping. If the choice is between vaping and fresh air, choose fresh air. Quitting smoking is one of the best things you can do for your health, please give it a go this Stoptober.”
Nicotine vaping in England: An evidence update including health risks and perceptions can be found here.
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In this story
Professor of Tobacco Addiction
Senior Lecturer in Tobacco Harm Reduction
Professor of Addictions Public Health
Research Associate
Research Fellow
Research Assistant