What do we know about the health impacts of vaping and how it is addicting a new generation? This is what the largest ever review of e-cigarettes tells us.

Vaping is on the rise among young people and they are especially vulnerable to addiction. So, what does the most comprehensive review of the health impacts of e-cigarettes tell us about their effects, including on smoking uptake in youth, and whether they can help with quitting smoking?  

What is vaping? 

When a liquid is heated to create an aerosol by an electronic or e-cigarette, and that aerosol is inhaled, it is called ‘vaping’.  

Battery operated e-cigarettes or ‘vapes’ have been used by over two million people in Australia, despite being illegal unless on prescription. 

Use is more common among youth, particularly young males, and among smokers. 

What chemicals are in vapes? 

It is a falsehood that the substance inhaled through vapes is just water vapour.   

Vapes can contain a very wide range of e-liquids – the most common are propylene glycol (a synthetic food additive that belongs to the same chemical group as alcohol), vegetable glycerine, nicotine and flavours. There are currently more than 17,000 flavours available. This means that vapes can deliver hundreds of chemicals – some of them known to be toxic and many others with unknown effects.   

Nicotine is a key ingredient and one of the most addictive substances known. 

People using vapes are inhaling a complex cocktail of chemicals, including those from heating the e-liquid, those from the device and those from the chemical reactions between the e-liquid and the device.  

The main substances in e-cigarettes aerosol that raise health concerns are metals (such as chromium, nickel and lead), carbonyls (such as formaldehyde, acetaldehyde, acrolein and glyoxal), particulate matter and some flavourings.  

As outlined in the education campaign “Do you know what you are vaping”, some chemicals in vapes are also found in weedkiller, nail polish and insecticide.  

The comparison of smoking to vaping only applies to smokers. For non-smokers, the comparison should be between vaping and breathing air. Photo: Andrey Popov/stock.adobe.com

What are the health effects of vaping? 

The use of nicotine e-cigarettes increases the risk of a range of adverse health outcomes, particularly in youth, including taking up smoking and addiction.  

Almost all e-cigarettes deliver nicotine, which is extremely addictive. Addiction is common in people using vapes and young people are especially vulnerable to addiction, as their brains are still developing. For children and adolescents that can mean having difficulty sitting through a lesson or a meal with family. 

Addiction is a serious health issue and people addicted to vapes are going through repeated cycles of withdrawal, irritability, feeling bad and craving, until they vape to feel normal again.  

Other health issues include poisoning, especially in small children, nausea, vomiting and loss of consciousness caused by nicotine overdose, headache, cough, throat irritation, and burns and injuries, largely caused by exploding batteries.  

There is also indirect evidence of adverse effects on blood pressure, heart rate and lung functioning. 

Vapes also raise environmental issues. Most vapes used currently are disposable, creating environmental harms from complex e-waste, including lithium batteries and nicotine-contaminated plastic.   

While we know about some of the risks of vaping, the effects of e-cigarettes on major health conditions like cancer and cardiovascular disease are unknown. 

Does vaping help to quit smoking? 

Smoking is extremely harmful and quitting is the best thing a smoker can do for their health. Most people who quit smoking successfully do so unaided.  

There is limited evidence that nicotine e-cigarettes are effective to help people quit smoking. Currently the Royal College of General Practitioners recommends e-cigarettes only as a quit aid for people who have tried other methods unsuccessfully.  

More than half (53 per cent) of current e-cigarette use in Australia is by people who also smoke, 31.5 per cent is by past smokers and 15.5 per cent is people who have never smoked.  

E-cigarettes are likely to be harmful for non-smokers and for people who use them while continuing to smoke – the most common use pattern currently.   

They may be beneficial in smokers who use them to quit smoking completely and promptly.  

It is important to remember there is uncertainty about many of the health impacts of e-cigarettes and the overall balance of risks and benefits for quitting. 

Young non-smokers who use e-cigarettes are around three times as likely to go on to smoke regular cigarettes, compared to young people who do not use e-cigarettes. So vaping risks introducing a new generation to smoking. 

Most vapes are disposable, creating environmental harms from complex e-waste, including lithium batteries and nicotine-contaminated plastic. Photo: ANU

Is smoking worse than vaping? 

Smoking kills more than eight million people each year worldwide – in excess of 10 per cent of all deaths – and is responsible for more than 20,000 deaths annually in Australia.  

It is also responsible for around 50 per cent of deaths in Aboriginal and Torres Strait Islander peoples aged 45 and over.  

Even so-called “light smoking” of one to five cigarettes per day leads to a nine-fold risk of lung cancer, compared to never smoking.  

Given the extreme harms of smoking, it is likely that vaping is less harmful in terms of many important health outcomes, such as cancer, cardiovascular disease, chronic lung disease and premature death.  

For some health outcomes, such as addiction in children and adolescents and poisoning, e-cigarettes pose risks that may be similar to or worse than smoking. 

The comparison of smoking to vaping really only applies to smokers and indicates that smokers who use e-cigarettes to quit completely and promptly may benefit.  

For non-smokers, the comparison should be between vaping and breathing air. Vaping is clearly more harmful than breathing air.  

This information is based on the findings of a major 2022 ANU report on e-cigarettes, with additional peer-review and evidence from more than 400 studies and reports. The lead author of the study was Professor Emily Banks and it is the most comprehensive review of the health impacts of e-cigarettes of its kind to date.

Top image: fedorovacz/stock.adobe.com

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