Is Vaping Safe?

This chapter explores the evidence on the safety and risks associated with use of e-cigarettes. It starts by discussing why different conceptions of safety (relative versus absolute) lead to differences of opinion and messaging on the topic. The challenges of risk assessment are discussed, including the absence of long-term longitudinal studies, the problems with relying on cell or animal studies, and the heterogeneity of the product category and usage patterns. Evidence from toxicological, animal, clinical, observational, and population studies are discussed. The evidence on e-cigarette risks is presented by type of potential harm, including cardiovascular health risks, oncological risks, pulmonary risks, and those relating to immunology, reproductive health, and addiction. The threat of injuries, burns and poisonings are also described. This chapter also explores whether vaping leads causally to smoking. Particular attention is paid to the topic of youth vaping, including a discussion of its prevalence, the drivers of youth experimentation with e-cigarettes, the specific harms that vaping might expose this group to, and the degree to which e-cigarettes are displacing smoking among young people. The closing pages of this chapter critique the evidence that e-cigarettes are 95% safer than smoking and explore options for making them safer.