Using e-cigarettes (vaping) has been promoted as a much safer alternative to smoking cigarettes. However, a new head-to-head comparison of actual disease in e-cigarette users compared to cigarette smokers published in Public Health Reports shows that this assertion is wrong.
This new analysis of 124 studies on the association of e-cigarette use with disease outcomes in the general population demonstrates that for some diseases there is no detectable difference in the odds of disease for current e-cigarette users compared to cigarette smokers. For other diseases the risks of e-cigarette use, while lower than cigarette smoking, are still much higher than what is claimed by e-cigarette advocates and assumed by the US Food and Drug Administration and others.
Specifically, the evidence as of January 1, 2025 showed that the Odds Ratios (OR) for actual diagnosed disease were not delectably different for e-cigarette users compared to cigarette smokers for metabolic dysfunction and oral disease and are lower for cardiovascular disease, stroke, asthma, COPD, and fetal growth. The odds ratios comparing e-cigarette use to smoking for cardiovascular disease (OR = 0.76), stroke (OR = 0.62), asthma (OR = 0.84), COPD (OR = 0.55), oral disease (OR = 0.89), and fetal growth (OR = 0.62 [with very low confidence]), while lower than for cigarette use, are 3 to 10 times the 15% risk that the FDA and the 5% risk that Public Health England have quoted.
The odds of disease associated with dual use (use of e-cigarettes and cigarettes), a common behavior among adults, is higher than for just smoking for all outcomes except fetal growth. This finding is important for people considering e-cigarettes as a smoking-cessation aid: other studies show that for every smoker who successfully quits with e-cigarettes 2-4 become dual users, resulting in an overall increase in disease risk compared to just continuing to smoke.
E-cigarette use among nonsmokers is also associated with increased risk for most diseases. For example, the odds of disease are increased by 24% for cardiovascular disease, 45% for COPD, and 53% for oral disease compared to nonusers.
Author Stanton Glantz, PhD, a retired UC San Francisco professor of medicine, observed, “It is long past time to use actual disease effects (as opposed to exposure to a few toxins in cigarette smoke) when assessing e-cigarettes safety. While not quite as bad as cigarettes, they are nearly as bad, which is very dangerous. Accounting for dual use, they are as bad or worse.”
Coauthor Andre Luiz Oliveira da Silva, PhD, Health Regulatory Specialist at Brazil’s Agência Nacional de Vigilância Sanitária (Brazilian Health Regulatory Agency, ANVISA) summed up the paper as indicating that “tobacco company advertisements promoting e-cigarettes to reach a future without cigarettes would likely be a future with levels of disease and death not so different from today.”
The paper notes that it is important for scientific, medical and policy making to be based on current data, noting that 81% of the studies were published during or after 2020. It closes with the recommendation that, “Health care providers and public health authorities should stop promoting e-cigarettes as a meaningfully safer alternative to cigarette smoking.”
The paper, “Comparison of e-Cigarette and Cigarette Use and Dual Use Associations with Disease: Updated Systematic Review and Meta-Analysis” (Public Health Reports 2026;0(0). doi: 10.1177/00333549251403349) updates an earlier analysis of 107 papers available as of October 2024. The new paper reaches similar conclusions, although some details changed.
Public Health Reports is the official journal of the Office of the U.S. Surgeon General and the U.S. Public Health Service published through an agreement with the Association of Schools and Programs of Public Health.
If you cannot access the paper through the links above, contact me and I will send a free copy.
Stanton Glantz blog 