So your teenager is vaping e-cigarettes – should you worry?

Mike Mozart, CC BY

E-cigarettes and other vaping products are on track to out-sell cigarettes by the end of 2023. And more and more young people are trying e-cigarettes. So what do you need to know about them? Are they less harmful than using cigarettes or other burned tobacco products?

What are e-cigarettes?



Old cigarette, meet e-cigarette. NeydtStock/Shutterstock

Why do young people use e-cigarettes?

A 2014 national high school survey finds more monthly vapers than monthly smokers: 17% of US 12th-grade students report using e-cigarettes in the past 30 days compared to 14% for tobacco cigarettes. We also know that patterns of infrequent, non-daily use of various tobacco and nicotine products may be increasing among young people. But trying e-cigarettes does not automatically lead to daily use.

Young people might also be influenced to try e-cigarettes because of how they are priced and promoted. They can be cheaper than traditional cigarettes and may be perceived as safer. Other features, like flavors can also support use in all age groups.

As e-cigarettes become more popular and more visible, young people will start trying and using these products. And because products keep changing, they will often try different kinds of e-cigarettes.


Is vaping safer than smoking?

The best evidence to date shows that using e-cigarettes is very dramatically less dangerous than cigarette smoking. Death from all causes within the ages of 25 to 79 is three times higher for smokers than never smokers. Compared to smoking, long-term health effects of e-cigarettes have been judged as likely “much less, if at all, harmful to users or bystanders.”

The 2014 Surgeon-General Report concluded that “The burden of death and disease from tobacco use in the United States is overwhelmingly caused by cigarettes and other burned tobacco products; rapid elimination of their use will dramatically reduce this burden.”

Recent reports suggest that vapers should be cautioned about how they use high-voltage devices because they can produce high levels of the carcinogen formaldehyde. But that, however, is not one of the common ways people use e-cigarettes. High voltage devices and long puffs can produce a bad taste that is avoided.

Burned cigarettes contain many carcinogens: the FDA lists 79 “harmful or potentially harmful” carcinogens in tobacco products and tobacco smoke.

Keep in mind that reports of a product being “not safe” in some way does not necessarily mean that it cannot overall be much safer than another product.

Are e-cigarettes a gateway drug? Teen with e-cigarette via Dawn Gilfillan/Shutterstock

Are e-cigarettes a gateway drug?

The specter of some drugs being gateways to more dangerous drugs has preoccupied drug policy, and this is no different when it comes to tobacco products. E-cigarettes have been feared as possible gateways to cigarettes. If vaping has been acting largely as a gateway to cigarettes, one would expect to see more cigarette smoking with the rise in vaping. This has not happened. Smoking has continued to decline. Cigarette smoking by young people is the most powerful cause of smoking by adults.

In a broad sense, the world is full of products that can look like gateway products. The use of BMX bikes on dirt tracks by children could be gateways to the use of motorcycle dirt bikes by adults. But do the products cause the linkage or are individual tendencies more responsible for associations?

Much research on drug gateways supports a “common liability model” more than drug-based causal models. The Common Liability Model holds that characteristics (for example, liking to take risks) within individuals can be responsible for drug-use associations.



What should you do if your teen smokes?

If you are faced with committed teenage smokers (who are probably also using other prohibited substances like drugs or alcohol), perhaps the best you can do is foster switching to e-cigarettes. Of course, do explore their interest in getting help with quitting smoking from quit-lines. For less-involved users of e-cigarettes who do not smoke regular cigarettes, encourage that regular use be avoided and that nicotine use be limited as much as possible.


If you have teenagers who already both smoke and vape, encourage that they work to avoid cigarettes completely, and vaping could help them do so.

This article has been updated to correct mortality data for smokers.