While vaping has become one of the most popular smoking cessation tools, there are still many media outlets and even government officials that misunderstand the technology and its impacts. Thankfully, there are countless studies being conducted that offer medical information on the health effects of vaping.

Unfortunately, there is little information on the long term health effects of vaping, because the technology has only been widely used in the last decade. Coupled with the fact that the majority of vapers are/were smokers, it is challenging to fully determine the health effects caused exclusively by vaping.

Understanding How Vaping Affects Overall Health

David T Levy from the Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center published this study in 2017. Researchers attempted to better understand how vaping can be used averted deaths in the USA caused by smoking. Over the course of the study, researchers examined the relative harms of e-cigarettes, compared with cigarettes, as well as examining the overall initiation, cessation, and switching of users. Ultimately, the study concluded that a strategy of replacing cigarettes with e-cigarettes would “yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm”.

*Potential deaths averted in USA by replacing cigarettes with e-cigarettes — David T Levy, Ron Borland, Eric N Lindblom, Maciej L Goniewicz, Rafael Meza, Theodore R Holford, Zhe Yuan, Yuying Luo, Richard J O’Connor, Raymond Niaura, David B Abrams*

Looking next at a 2016 study, researchers attempted to understand the health benefits of vaping, in relation to lung health, including respiratory infections and pneumonia. The research was conducted in relation to tobacco smoking and how vaping might reduce the risk caused by smoking. The conclusions garnered from the study found that while vaping is not 100% safe, it is at least 96% less harmful when compared to smoking and could substantially reduce the risks of respiratory infections and pneumonia.

According to the authors of the research paper, “e-vapour products are at least 96 % less harmful compared to combustible cigarettes and that cigarette smoking carries a heightened risk for respiratory infections and pneumonia, substantially reducing daily cigarette consumption in smokers by switching to e-vapour products is likely to produce significant health benefits.”

*Respiratory infections and pneumonia: potential benefits of switching from smoking to vaping — Davide Campagna, Maria Domenica Amaradio, Mark F. Sands & Riccardo Polosa*

Finally, a 2017 study on vaping attempted to analyze the impact of vaping on non smokers, by tracking the health markers of a group of vapers who have never smoked. This study tracked each participant’s health over the course of 3.5 years, focusing primarily on the heart, lungs, and circulatory system.

Over the course of the study, the researchers compared the participant’s health markers with a control group who had never smoked or vaped. The findings in this study indicated the health markers of the vapers were no different from the control group, though this still does not indicate any long term health effects.

According to the authors of the study, “Although it cannot be excluded that some harm may occur at later stages, this study did not demonstrate any health concerns associated with long-term use of [e-cigarettes] in relatively young users who did not also smoke tobacco,”

*Health impact of E-cigarettes: a prospective 3.5-year study of regular daily users who have never smoked — Riccardo Polosa, Fabio Cibella, Pasquale Caponnetto, Marilena Maglia, Umberto Prosperini, Cristina Russo, Donald Tashkin*

How Flavours and Technology Influence Vapers

Since the proliferation of vaping, many media outlets and government agencies have been quick to condemn the various flavours of e-liquid used by vapers. These arguments often criticize fruit, candy, and dessert based e-liquids, claiming they are intentionally enticing to children and adults should just use tobacco flavours or flavourless liquids.

 In an attempt to better understand these criticisms, two papers were published in 2017, which aimed to confirm that the majority of adult vapers prefer these flavours, opposed to the tobacco flavours that most non-vapers assume ex-smokers would like.

The first study utilized a survey conducted in 2016 of almost 21,000 frequent American vapers. Within the data, the researchers found that almost all participants preferred fruit and dessert flavours — this included “dual users” (people who vape and smoke)

*Changing patterns of first e-cigarette flavor used and current flavors used by 20,836 adult frequent e-cigarette users in the USA — Christopher Russell, Neil McKeganey, Tiffany Dickson, Mitchell Nides*

The second study utilized the largest-ever survey of American vapers, with 69,000 adult vapers participating in the study. This paper reached a similar conclusion as the first, with over 80% of participants (who were both former and never smokers) saying they preferred fruit or dessert/pastry/bakery flavours. Of the participants who were vapers and never smokers, the research concluded that just 7.7% preferred tobacco e-liquids.

*Patterns of flavored e-cigarette use among adult vapers in the United States: an internet survey Konstantinos Farsalinos, Christopher Russell, George Lagoumintzis, Konstantinos Poulas*

Is Vaping a Viable Smoking Cessation Tool?

Despite the numerous claims made by vapers that the technology has helped them quit smoking, there are still countless critics that insist vaping does not actually help people quit smoking. In terms of scientific research, there have been several prominent studies that support vaping as a viable smoking cessation tool.

In one of these studies — titled “E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys” — researchers found that vaping gives smokers a reason to quit and vaping has accounted for a considerable number of smokers successfully quitting smoking.

According to lead researcher/author Shu-Hong Zhu, “use of e-cigarettes was associated both with a higher quit rate for individuals as well as at the population level; driving an increase in the overall number of people quitting.”

*E-cigarette use and associated changes in population smoking cessation: evidence from US current population surveys – Shu-Hong Zhu, Yue-Lin Zhuang, Shiushing Wong, Sharon E Cummins, Gary J Tedeschi*

Does Vaping Contain Dangerous Levels of Formaldehyde

If you’ve been a vaper for a while, you may remember the 2015 formaldehyde scare caused by a research letter written to the New England Journal of Medicine. This research letter claimed that e-cigarettes emitted dangerous levels of formaldehyde and was an incredibly dangerous practice. The study was immediately challenged by the scientific and vaping community.

A replication study was completed that detailed how the original study utilized machines that took “dry puffs,” something that is incredibly unpleasant. Due to this, it’s unlikely to be done purposefully by vapers, reducing the impact due to lower frequency.

“In fact, such testing of e-cigarettes is not very different from overcooking food to the point of becoming an inedible piece of charcoal and then assuming that consumers would consume it and be exposed to the resulting carcinogenic compounds in their daily routine,” wrote lead author Konstantinos Farsalinos. “Accepting that e-cigarettes are less harmful than smoking, such an omission could result in unintendedly misleading smokers into thinking that there is little to be gained by switching to e-cigarettes.”

*E-cigarettes emit very high formaldehyde levels only in conditions that are aversive to users: A replication study under verified realistic use conditions – Konstantinos E. Farsalinos, Vassilis Voudris, Alketa Spyrou, Konstantinos Poulas*

Does Vaping Serve as a Gateway to Teenage Smoking?

One reasonable concern is that vaping could serve as a gateway to teenage smoking. According to research from the CDC, since the advent of vaping, teen smoking has plummeted to the lowest level ever. According to the study, 4.2 percent of 12th graders smoked in 2017, compared to 24.6 percent in 1997.

According to a paper published in 2017, two tobacco control veterans suggested that vaping is not only leading to a reduction in teen smoking, but is also serving as a deterrent for potential tobacco users.

According to the authors, “while research exists to support either side of the argument, we conclude, currently, that youth use of e-cigarettes is unlikely to increase the ranks of future cigarette smokers… Is it possible we could have our cake and eat it too? Perhaps, especially if sensible comprehensive harm reduction policies can earn a place in modern tobacco control efforts.”

*Adolescents and e-cigarettes: Objects of concern may appear larger than they are – Lynn Kozlowski and Kenneth Warner*

This sentiment was further bolstered by a 2018 study that examined a 2018 National Academies of Sciences, Engineering, and Medicine Report that found evidence the vaping is closely associated with an increase in youth smoking. In the study, the authors examined the temporal relationship between vaping and youth smoking, using multiple data sets to examine whether or not vaping promotes smoking initiation in the United States.

To complete this study, the researchers used data on smoking and vaping among youth and young adults and conducted a trend line analysis of deviations from long term trends. Ultimately, the study concluded that “the aggregate effect at the population level appears to be negligible given the reduction in smoking initiation during the period of vaping’s ascendance.”

*Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check – David T Levy, Kenneth E Warner, K Michael Cummings, David Hammond, Charlene Kuo, Geoffrey T Fong, James F Thrasher, Maciej Lukasz Goniewicz, Ron Borland*

Additional Vaping Research

While we’ve outlined some specialized research papers, there are still plenty of comprehensive studies that have examined vaping as a whole, and have weighed the risks and benefits. Listed below are some of the best examples, two of which were conducted by British organizations. In each of these studies, researchers found that vaping poses far less risks when compared to smoking.

National Academies of Sciences, Engineering and Medicine

A robust report that offers a comprehensive and systematic review of literature that evaluates evidence about e-cigarettes and health. This report highlights the necessary research for the future and provides improvements to improve the quality of the research garnered from this study.

Public Health Consequences of E-Cigarettes (2018)

Health England

This Public Health England (PHE) written report serves as an update to the country’s 2015 evidence review on e-cigarettes. In this report, researchers examined the effectiveness of e-cigarettes as a smoking cessation tool, the use of e-cigarettes by young people, perception of relative harms, and much more.

E-cigarettes and heated tobacco products: evidence review (2018)

Royal College of Physicians

This in-depth analysis of tobacco harm reduction focuses on the role e-cigarettes play and outlines the potential risks involved. It ultimately shows that while vaping is not 100% safe, it has the potential to prevent tobacco related deaths and disability.

Nicotine without smoke: Tobacco harm reduction (2016)

Tobacco Prevention & Cessation 

This comprehensive research paper examined the smoking/vaping behaviours of vape shop customers and the reasons they use vape shops. The paper contains a wide array of data offered by customers, and gives insight into reasons for vaping, smoking status, and preferences of customers.

Examining the Smoking and Vaping Behaviors and Preferences of Vape Shop Customers (2016)

Public Health Research & Practice 

This research paper examines the risks of passive or second-hand vapor created by electronic cigarettes. The conclusions of the paper found that e-cigarette vapor could lead to some potential health risks but this risk is significantly lower when compared to conventional cigarette smoke.

A systematic review of the health risks from passive exposure to electronic cigarette vapour (2016)

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