Vaping might seem safer than smoking, but the long-term risks are starting to show. Photo / 123rf
Experts explain why e-cigarettes are so harmful and how to beat the addiction.
In recent years, there have been growing concerns around the rise in vaping, particularly among young people. Around 18% of 11- to 17-year-olds have tried it, with almost 400,000 children in the UK admitting that they currently vape, according to a 2024 survey.
Vapes or e-cigarettes were originally devised as a safer alternative for chronic smokers, helping them to transition away from more harmful, conventional cigarettes. But it’s becoming apparent that their proliferation is also actively drawing in non-smokers, who are becoming steadily hooked on nicotine.
The UK Government last week joined other countries in enforcing its disposable vape ban which means it’s illegal for businesses to sell or supply them. But will it stop the rise in vaping and achieve a “smoke-free generation”?
John Patterson, the president of UK age verification company IKE Tech and an experienced veteran in the tobacco and vape industry, says no. “I think intention is there but the challenge is the execution,” he explains.
He highlights the rise of vapes with a refillable pod which “look exactly the same as the disposable [products] and maintain a lot of the features which are appealing to kids, including the different colours, crazy flavours, design and pricing”. He therefore believes the impact on youth vaping will be “minimal” as many simply turn to the reusable products instead.
Before the ban even began, researchers from University College London (UCL) believed disposable vape users were already switching to refillable and rechargeable devices in preparation, instead of giving up.
Doctors and scientists are continuing to explore the long-term effects of vaping. “There is growing evidence that e-cigarettes are harmful to health because some include carcinogens such as formaldehyde, [and] some have higher concentrations of nicotine than the cigarettes they are attempting to replace,” says Dr Cary Adams, the chief executive of the UICC. “Nicotine is also highly addictive, which makes users more susceptible to dependency, and more likely to smoke throughout their lifetime.”
People who vape as well as smoke have a greater risk of:
While vaping is still significantly better for your health than smoking, charities are particularly concerned because research is suggesting that a significant proportion of people both smoke and vape. According to the Action on Smoking and Health organisation, 39% of current vapers in the UK also smoke.
“It’s estimated that electronic cigarettes are 95% less harmful than conventional cigarettes,” says Dr Silvano Gallus, the head of the Laboratory of Lifestyle Epidemiology at the Mario Negri Institute for Pharmacological Research in Milan. “But studies are showing that a significant proportion of electronic cigarette users are dual users, and data suggests this leads to a greatly increased risk of disease.”
Last year, a major study in the prestigious New England Journal of Medicine called for a reassessment of the widely held assumption that vaping can prevent cigarette-related diseases, largely because of the risk of people becoming addicted to both. The study found that dual users had a greater risk of cardiovascular disease, stroke, chronic lung disease, asthma and oral disease compared with people who just smoked.
Gallus and others feel that because of this, there is a need for better strategies for helping people transition away from all forms of nicotine, including vapes.
So how can you go about quitting vaping? Last week, the first ever Cochrane review – a systematic examination of randomised controlled trials – was published, looking at the evidence for helping people quit nicotine-containing vapes, which is admittedly rather limited.
“From the data, it seems that it’s easier to stop vaping than it is to stop smoking, which is good,” says Sairah Salim-Sartoni, a health psychologist who spent 16 years working clinically in Britain’s National Health Service’s stop smoking services. “But we still don’t have any official guidance. I’d love to be able to give a blueprint for how to help people quit vaping, but we don’t have those studies yet.”
However, from tapering and distraction to apps and drug treatments, there are a number of strategies which can be used to try and break a potent vaping addiction.
1. Tapering
While many smokers use vaping as a way of transitioning away from conventional cigarettes, Salim-Sartoni says that it is possible to become completely nicotine-free. “A lot of the smokers I know do want to get rid of their dependence on using anything, and it takes time to do that,” she says. “The number one thing which people can try is to slowly reduce their nicotine strength.”
She describes one particular patient who went from smoking to vaping and then eventually nicotine-free, through tapering down in steps, for example from 20mg/ml nicotine to 18mg/ml, 12mg/ml, 9mg/ml, 6mg/ml, 3mg/ml and then to zero.
“That is very feasible, and there’s different ways you can do that,” she says. “You could either vape less often, or go to a nicotine pouch or a nicotine replacement therapy gum, and then slowly reduce your intake.”
However, she says that it’s important to make sure that as you reduce your nicotine strength, for example through switching to lower strength vapes, you’re not vaping more often. “Unfortunately sometimes when people try and reduce their nicotine strength, they just vape more and more because they’re [subconsciously] still trying to get to the level they had before, and they actually end up consuming more nicotine,” she says.
2. Identify your triggers
Dr Sharon Levy is a Harvard Medical School associate professor who also heads the addiction medicine division at Boston Children’s Hospital. She says the initial symptoms of nicotine withdrawal persist for somewhere between two and four weeks after completely stopping vaping. However the cravings last significantly longer, up to two months for most people, although they tend to fade over time.
“Making it through the first three months after quitting is a major milestone,” says Dr Levy. “Though unfortunately people are not entirely out of the woods at that point because they are still at risk of being triggered if they are stressed, in a situation that they’d previously associated with nicotine use, or if they see other people using nicotine.”
Because of this, Levy recommends meeting with a behavioural therapist to help identify triggers which you can recognise and avoid, as well as working on healthy stress management techniques.
“When someone becomes addicted to a substance, it’s as if their brain mistakes the substance use as a behaviour that’s critical for survival,” she says. “So it takes a lot of money and energy for them to prevent themselves from defaulting to using it. Behavioural health counsellors can help people to unlearn this automatic defaulting.”
3. Set boundaries
A key component of behavioural management is not only identifying your triggers but setting boundaries.
“They’re very similar tactics you would use for stopping smoking that you can apply to vaping as well,” says Salim-Sartoni. “You can set rules for where you do and do not vape, so basically saying I’m only using my vape when I’m outside, but the home and car, I do not vape. Lower the nicotine, extend the time between vaping and set rules for where you do and don’t vape.”
Because this isn’t always easy, Salim-Sartoni says that finding “a buddy” who is also attempting to quit vaping can provide a vital support network which can make the whole process of setting boundaries much easier.
4. Distraction
Finding a way to distract the brain is a key aspect of breaking any substance addiction. Salim-Sartoni says that there are all kinds of methods you can use to disengage your brain from the nicotine cravings, such as going to drink water, going to the toilet, playing a game on your phone or going for a walk.
One surprisingly effective means of distraction is having a boiled sweet. “The glucose receptor is very close to the nicotine receptor,” says Salim-Sartoni. “And so the nicotine receptor feels that it’s had something. The science steadily emerged to show this, but in our stop smoking clinics, we realised early on that people were eating a lot of sweet stuff when they were trying to quit, and this is why.”
As well as text message services, Levy says that there are a number of freely available apps and chatbots such as This is Quitting, which provide regular tips and encouragement, which have been shown to be effective in increasing quit rates.
6. Drug therapies
For more powerful nicotine addictions, there are also pharmacological therapies such as the prescription drugs varenicline and cytisine. Varenicline binds to the nicotine receptors in the brain and blocks them, preventing the nicotine in vapes from binding to them, and so reducing withdrawal symptoms and cravings. Cytisine mimics the effects of nicotine and so tricks the brain into thinking it has ingested nicotine, which also reduces cravings.
Finally, Salim-Sartoni emphasises that the most important thing of all for people looking to quit vaping, particularly ex-smokers, is that they don’t return to smoking cigarettes again.
“Smoking is uniquely deadly, and some people can’t stop nicotine or don’t want to,” she says. “If that’s the case, then it is much better that they switch to e-cigarettes, particularly with the Government’s ambition to reduce smoking rates in the UK to 5% or less by 2030.”
Strength is more than brute force, and the female body is proving it across every field.