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The obvious advantage is the lower health risk. For someone who likes to consume nicotine or engage in the physical act of smoking, smoking might be preferable to abstinence, even with its great costs. But vaping or use of other smoke free products is probably better still, all costs and benefits considered, providing most of the benefits with very little of the health cost.
The evidence that smoke-free tobacco products are low-risk is based primarily on decades of research on smokeless tobacco use. Despite the popular myths, extensive epidemiology shows that smokeless tobacco causes no detectable risk for any disease.
This does not mean it is completely harmless (though that possibility is consistent with the evidence), but it does mean that any risks must be very small.
We obviously lack epidemiology about long-term e-cigarette use (and probably always will for any particular type of e-cigarette, since the products are changing so fast). But we have ample evidence to be confident of the low risk: We have the evidence about the low risk of smoke-free nicotine from smokeless tobacco. The other exposures resulting from vaping – inhaling the carrier chemicals and tiny quantities of contaminants – are well studied in other settings. This allows us to conclude that the risk from vaping is down in the range of the risk from using smokeless tobacco (details not included in this document; they are available elsewhere). We have further reassurance about this conclusion from the real-world experiences of hundreds of thousands of vapers who have used the products for years, and from numerous formal studies of acute effects, which show e-cigarettes do not cause any unexpected consequences in the short run. This is the same evidence and reasoning that caused the U.S. FDA to conclude that long-term use of NRT products poses no substantial risk.
While there are undoubtedly differences in health effects among low-risk alternatives to smoking, they are quite small and speculative. The net risk from all such products is so close to zero that substituting them for smoking reduces risk about as effectively as not using tobacco products at all. E-cigarettes may not be quite as low risk as smokeless tobacco. High-quality closed systems, which contain only well-studied ingredients and highly controlled heating systems probably are. Open systems are not quite as “clean,” with a wider variety of e-juice ingredients, the option of higher temperature heating (which produces more contaminants in the vapour), and a huge variety of hardware components. This has resulted in alarmist claims about the vapour from open systems, particularly when operated in completely unrealistic ways. But the reality is that the quantities of potentially harmful chemicals produced remain small (much closer to quantities found in room air than the quantities created by smoking). It is important to keep in mind the absolute magnitude of the plausible range of risk. Even if a particular e-cigarette configuration doubles or triples the health risk compared to that 99% reduction in risk, it is still a tiny fraction of the risk from smoking. There is nothing to suggest it could be any higher than this, leaving the risk down in the range of that from other everyday hazards, like transport or eating junk food. If such a product, rather than some slightly cleaner alternative, is the satisfying alternative that can replace smoking for a given individual, then the net benefit is obvious. Indeed, if someone merely likes it a lot better, those benefits can justify the costs; we all take small health risks all the time in order to pursue other preferences.
The availability of interesting e-liquid flavours makes vaping more enjoyable, which is welfare improving in itself. But beyond that, many vapers find that interesting flavours are critical for quitting smoking. E-cigarettes that try to imitate the taste of smoking, which includes a large portion of cigalikes, seldom do a convincing job of it. It leaves many smokers feeling that e-cigarettes are an altogether inferior substitute, so why bother? We might like to think that the health benefits alone would overcome that, but people often do not act on that basis. Ex-smokers who tried to switch to e-cigarettes but kept returning to smoking often report that finding an alternative flavour that they liked was what made vaping better than smoking, resulting in their complete switch. Moreover, after using flavours that do not resemble tobacco smoke for a few months, most vapers who try a cigarette report that it tastes terrible and so never consider switching back.
There is a common myth that interesting flavours are designed to attract underage consumers. But there is no evidence – literally none at all – to support the claim that these flavours are particularly attractive to teenagers. There is, however, overwhelming evidence that adult vapers prefer interesting flavours and that many quit smoking only because of them.
E-cigarettes do not produce odour and residue like cigarette smoke. Someone who is vaping efficiently and politely (allowing most of the aerosol droplets to deposit in their lungs, rather than taking big quick puffs to try to maximise what they exhale) exhales almost none of the vapour, and there is no “sidestream” emission like you get from a smouldering cigarette tip. Thus, the emissions are minimally invasive and, as a separate point, pose no health threat to bystanders (the details of that are not included here but appear elsewhere). Most non-users find the smell of nearby vaping to be mildly pleasant, thanks to the nice e-juice flavours, unlike most nonsmokers’ opinions of the smell of nearby smoking or the outgassing from the clothes of a smoker. There are places where vaping might be obtrusive, of course (restaurants, public transportation, enclosed spaces, and formal meetings come to mind), and proprietors have the option of forbidding people from vaping in theses places if they choose. But in bars, offices, and many other spaces where people might want to vape, it is no more aesthetically obtrusive than holding a cup of coffee or eating.
Thanks to the minimal aesthetic impact and lack of health impact on bystanders, vaping is socially acceptable in many places where smoking is not. Not having to step outside of one’s office or a bar to vape is a big advantage over smoking, and is an important motivation for many smokers deciding to try e-cigarettes. In addition, the option of quickly pulling out an e-cigarette and taking one or two puffs – delivering only as much nicotine as is desired at the moment, rather than having to light and smoke a whole cigarette – offers substantial advantages for many people.
While there is more to be learned about this, it appears that vaping is far less captivating than smoking. Many ex-smokers who thought they would never manage to quit smoking have switched to vaping and then discovered, after a few months, that they could take it or leave it, or at least abstain for long periods. They often choose to keep vaping because they like it and know it is lower risk, but feel they could stop any time they wanted. Most experienced vapers report that they have substantially reduced their total nicotine intake, starting out high while quitting smoking, but preferring less after a period of exclusive vaping.
Increasingly, reports are beginning to show that electronic cigarettes are less addictive than tobacco cigarettes.
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