To Vape or Not to Vape? That is the life-saving question…

To Vape or Not to Vape: That is the life-saving question…

Smoking kills about two out of every three people who smoke regularly. Vaping is not risk-free, but it is much less harmful than smoking. Despite this, many people misunderstand how the two compare. A 2024 survey found that most adult smokers in England believe vaping is just as harmful as smoking, or worse. Meanwhile, many teenagers underestimate how addictive and harmful vaping can be. Dr. Catherine East and colleagues wanted to know whether these mistaken beliefs could be corrected, and whether doing so would actually change people’s behavior.

Vaping devices heat liquid into an inhalable vapor without burning anything. Cigarettes burn tobacco, producing smoke packed with toxic chemicals that damage the lungs, heart, and brain, and cause cancer. Nicotine, found naturally in tobacco, is what makes cigarettes addictive, but it is not the main cause of smoking-related disease; the toxic by-products of burning tobacco are.

The researchers carried out a systematic review, meaning they searched five major research databases for studies published between 2007 and 2023 that tested health messages designed to change people’s beliefs about vaping’s harms. To qualify, a study had to measure people’s beliefs more than once, so any change could be tracked, and had to use numbers rather than opinions alone. They found 85 qualifying studies: 46 tested whether messages changed beliefs, and 39 tested whether those beliefs, in turn, changed real-world behavior, such as starting or stopping vaping or smoking. For young people aged 11 to 19, messages usually took the form of school workshops or advertisements warning that vaping is harmful and addictive. These messages successfully shifted beliefs in 12 of 14 studies, and in 8 of 9 studies, teens who came to believe vaping was harmful were less likely to vape. However, some of these same messages accidentally led young people to believe vaping was just as harmful as smoking cigarettes, which is not accurate. For adults, messages more often took the form of written materials explaining that vaping is harmful but less harmful than smoking. These messages changed beliefs in 24 of 32 studies. Adults who wrongly believed vaping was equally or more harmful than smoking were less likely to try switching to vaping to quit cigarettes, a pattern seen in five of six studies. Conversely, when adults received accurate information and their beliefs changed, that shift predicted actual use of vaping to quit smoking in 4 of 7 studies.

Taken together, the findings show that health messages work when they are accurate and reach the right audience, but they also reveal a delicate balancing act. The same simple, cautionary message that helps keep teenagers from starting to vape (“vaping is dangerous, stay away”) can discourage adult smokers from switching to a less harmful alternative. If young people instead hear messages suggesting vaping is harmless, they may be more likely to start. This means public health campaigns need to be carefully tailored to their audience rather than using one blanket message for everyone. The most encouraging finding is that mistaken beliefs can be corrected, and correcting them changes behavior. Public health messaging and healthcare professionals should clearly communicate that vaping carries real risks, while also making clear that those risks are substantially lower than the risks of smoking cigarettes.

The review has some limitations. Many included studies were not strongly designed, so results should be interpreted with some caution. Most only measured beliefs immediately after a message, not weeks or months later, so it’s unclear whether changes last. Nearly all studies came from the United States, so results may not directly apply to other countries with different vaping laws and attitudes. Because only published studies were included, some studies that found no effect may have been missed. Finally, only one researcher assessed study quality rather than two, raising some risk of error.

The study was conducted by Dr. Catherine East and colleagues from the universities of Brighton, Sussex, King’s College London, and University College London. Some authors also work with public health organizations, but none received funding from the tobacco or vaping industries; the research was funded by independent public health and research bodies.