Are E-Cigarettes Less Harmful Than Cigarettes? Which Is More Dangerous?

In general, people often believe that e-cigarettes produce fewer toxins than those found in cigarette smoke. However, it is becoming increasingly clear that this framework is not enough to tell the full story about their impact on personal health. The latest evidence suggests that e-cigarettes may pose their own unique health risks, and comparing them only with cigarettes may not be the only relevant way to assess their effects on individual health. In fact, growing evidence of the potential health risks associated with e-cigarette use has led some researchers to question whether e-cigarettes are actually safer than combustible cigarettes. For more information, please refer to “Health Effects.”

Which Is More Harmful, E-Cigarettes or Cigarettes?

The recent outbreak of e-cigarette-related lung injuries also supports a cautious approach toward e-cigarettes. Although many cases in this recent outbreak of e-cigarette-related lung illness (see “Health Effects”) appeared to be linked to THC vaping products, and the CDC has identified vitamin E acetate as a chemical of concern, the agency has remained cautious in stating that it has not found a single definitive cause. It continues to recommend caution with all e-cigarettes while the investigation continues. At the very least, this outbreak dramatically illustrates the dangers of an unregulated market for inhaled substances that lacks premarket review for consumer safety.

We also note the frequently cited claim from Public Health England that e-cigarettes are 95% safer than traditional cigarettes. First, this analysis was originally conducted in 2013, before more recent studies on the health effects of e-cigarettes became available. In addition, further analysis of the original research found that the evidence supporting this figure remains unclear and not fully comprehensive, with additional concerns about author and funding conflicts of interest. Public Health England’s statement also does not acknowledge the reality that these products may have a negative net public health impact among people who have never used tobacco products, nor does it address the lack of clinical and long-term evidence demonstrating the safety of these products for humans, regardless of current smoking status.

Although a 2018 report from the U.S. National Academies of Sciences, Engineering, and Medicine found substantial evidence that exposure to toxic substances from e-cigarettes is much lower than from combustible cigarettes, more recent research suggests that this is not the end of the health story. It now appears that e-cigarettes may carry their own unique health risks, including risks to the respiratory and cardiovascular systems. Given that these products entered the market only recently, more research is needed to assess both the short-term and long-term health effects of e-cigarettes.

Can You Actually Use E-Cigarettes?

The evidence on the effectiveness of e-cigarettes as a smoking cessation tool also remains inconclusive. Before FDA review, the safest and most evidence-based quit-smoking strategy should include a combination of counseling, nicotine replacement therapy, and/or smoking cessation medications such as FDA-approved varenicline. In addition, while the basic technology behind e-cigarettes is generally similar, there is enormous variation across product categories, and there is no single “typical” e-cigarette. These products use different ingredients, different hardware, and deliver highly variable levels of nicotine and potentially toxic chemicals, including heavy metals such as cadmium, lead, nickel, tin, and copper. This variation makes it difficult to issue broad public health recommendations for the category as a whole and highlights the substantial, long-term need for premarket review of these products.

Consumers need to know consistently what they are getting and whether it is safe—especially with products designed to deliver chemicals through frequent inhalation. Growing evidence of the potential health risks and lung injuries associated with e-cigarette use has led researchers to question whether e-cigarettes are actually safer than combustible cigarettes.