Vaping vs Smoking: What are the Actual Health Differences?

Clarifying misunderstandings about the safety of vaping and smoking.

Reviewed by Kaja Perina

Key points

• Vaping isn’t “safe”; research links it to lung disease, seizures, and mental health risks.
• Second-hand vape aerosols contain numerous toxins and metals, posing risks similar to second-hand smoke.
• One disposable vape can contain as much nicotine as 25 packs of cigarettes, or more.
• Quitting vaping may be harder than quitting cigarettes, given the appealing flavors and strong nicotine hit.

This past fall I was at my son’s little league baseball game; a group of 7–8-year-olds, surrounded by parents and grandparents cheering them on.

In between innings a few of the parents stepped away, walking to the opposite side of the parking lot to light up a cigarette. They don’t want to miss the game, but they’re being considerate: we all know that second-hand smoke is harmful to kids. They’d probably also get some side-eye from other parents, concerned about their kids but also not appreciating the smell.

Then, I notice a father standing and vaping right behind the other team’s dugout, taking a hit every few minutes. He doesn’t seem concerned about vaping so close to the kids or the other parents. More importantly, no one around him seems that concerned about his behavior, either.

It dawned on me that, in this moment, I was witnessing a microcosm of public opinion on smoking vs. vaping: one is well-known and viewed as clearly harmful to children, while the other is more unknown and billed as “not so bad.” The truth is that second-hand vape aerosols contain numerous toxins and carcinogens, which are certainly harmful to others who breathe it. But this information isn’t widely known, and it leads to a vast public misunderstanding about smoking, vaping, and the relative health risks of each.

So, forgive the pun, but: let’s clear the air.

Recent studies show that there are one to two-thousand harmful chemicals in vape aerosols that can be breathed in second-hand. Vaping was originally introduced as a “safer” alternative to smoking; and by some standards, it is less toxic than smoking cigarettes: as there are over 7000 chemicals (and tar), in cigarette smoke, vaping has the edge there. But the risks to the person vaping, as well as to other people (especially children) in close proximity breathing the aerosols, are still significant.

And if you weren’t smoking beforehand, vaping has no health benefits and is actively harmful: to start, you’re going from clean lungs to inhaling thousands of toxins, carcinogens, and even metals (including uranium, lead, nickel and cadmium). Making matters worse, it’s difficult to know exactly which toxins you’re inhaling: vape liquid is not regulated, so the label on the vape may not actually reflect what’s inside. Moreover, the coils in vapes can flake, leading to inhalation of an unknown quantity and types of metal particles.

All these toxins are also present in second-hand vaping aerosol, which makes it an especially risky behavior around children. And while children exposed to second-hand vaping do absorb less nicotine than second-hand smoking, less exposure is still an exposure: another recent study found that young exposed to second-hand vaping are at greater risk for asthma and other respiratory diseases than those who are breathing in smoke-free air.

Although the dangers of smoking are well-known, the dangers of vaping can be just as severe, although are less commonly understood by the public. Most people are aware that vaping has been linked to lung disease – EVALI – but vaping has also been directly correlated with increased risk of other serious health issues including (but not limited to) seizures, mental illnesses, and acute poisoning. And while a complete switch from smoking to vaping reduces exposure to chemicals, recent studies have found that a partial switch (where someone switches between vaping and smoking) is linked to worse cardiovascular outcomes than smoking alone.

Suffice to say, the idea that vaping is “safer” than smoking should come with an enormous asterisk: the more research we do, the more we understand that vaping is still not safe by any means. And, it is worth noting that much of the research we can refer to now, while recent, had also been conducted with data collected from 3-5 years ago; during this time, the potency of nicotine in each vape has tripled, the quantity of liquid in each vape has quintupled, and the cost has reduced by 70%. This means it has become substantially easier to become addicted with the increased potency, high capacity, and lower price.

For reference, a 5% nicotine vape with 5,000 puffs has the same amount of nicotine as 25 packs of cigarettes. As difficult as it is to quit smoking (less than 10% of people who attempt to quit smoking succeed because nicotine is so addictive), it is potentially even harder to quit vaping because it's more addictive with greater nicotine potency, more convenient to use for extended periods with increased capacity, and more pleasant to use by replacing the taste of tobacco with appealing synthetic flavors.

As vaping continues to increase in popularity (especially in the younger 18-24 demographic), we must be mindful to reduce public exposure to second-hand aerosols. The idea that vaping is safe (and particularly the misperception that it is safe to use around children) must be challenged. The same considerations that apply towards smoking and second-hand smoke should be applied to vaping and second-hand vaping.

If you or someone you care about currently vapes or smokes and would like to quit, here are some excellent resources for how to seek support and treatment:

• This is Quitting is a free, text-based support program created by Truth Initiative, and was recently found to increase the probability of a successful quit attempt by 35%.
• Consult your physician about whether you are a candidate for nicotine replacement therapy (NRT). NRT is an FDA-approved method for quitting smoking and vaping for individuals 18 and up, and the American Academy of Pediatrics recommends that pediatricians consider it for adolescents, as well.
• Therapists who specialize in substance use problems can help you understand the psychology behind vaping and how to build a plan for a successful quit attempt. Look for therapists who have a special credential or training as a substance use specialist.
• The CDC has created excellent resource lists for quitting vaping for both adults and teens.
• You can receive live support from the National Institute of Health by calling 1-800-QUIT-NOW, or chat with support staff online using this link.

If you are seeking support for yourself or a loved one, please know that all of these resources are judgment-free; respectful of individual choices and intended to empower informed decision-making.

Misinformation has led to significant confusion about whether vaping is “safe” or “healthy,” and obscured the fact that growing evidence shows it poses serious health concerns both to users and those exposed to second-hand aerosols. Raising awareness about the science-supported implications of vaping is one of the most important steps we can take in empowering users to make informed choices that protects them and the health of those around them.