A new report has found that while e-cigarettes could offer health benefits to adult smokers if they switch to them from conventional cigarettes, these devices may also be bringing teens into the smoking fold, making them more likely to develop a tobacco cigarette habit.  

The National Academy of Sciences Engineering and Medicine (NASEM) report, published Tuesday, is the most comprehensive review to date of existing e-cigarette research. The report’s authors evaluated more than 800 scientific studies and drew dozens of conclusions about the relative risks and benefits of these devices, and the act of using them (known as “vaping”).

The authors concluded that e-cigarettes contain fewer toxic substances at far lower levels than regular cigarettes. But they also found that teenagers who use e-cigarettes are more likely to try conventional cigarettes.

More On E-cigarettes

“E-cigarettes cannot be simply categorized as either beneficial or harmful,” said David Eaton, chair of the committee that wrote the report, and a dean at the University of Washington, Seattle. “In some circumstances, their adverse effects clearly warrant concern. In other cases, they offer an opportunity to reduce smoking-related illness.”

Many crucial questions remain unanswered: It’s too soon to tell the long-term health risks of e-cigarette use—whether e-cigs increase the risk of cancer, cardiovascular disease, or respiratory illness the way that conventional cigarettes do.  But based on what’s known so far, the report’s authors drew a couple of broad conclusions. 

E-Cigs May Help Adult Smokers

The report found conclusive evidence that completely replacing conventional cigarettes with e-cigs could reduce users’ exposure to toxins (including carcinogens). E-cigs do contain and emit numerous potentially toxic substances, the authors wrote. But overall, exposure to toxins is significantly lower with e-cigs than with regular cigarettes, they found.

The evidence that e-cigs can actually help people quit smoking regular cigarettes was far less certain. The authors called that data “limited.” And they called on researchers to determine “with more precision” the answer to that important question. “If e-cigarette use by adult smokers leads to long-term abstinence from combustible tobacco cigarettes,” the authors wrote, “the benefit to public health could be considerable.”  

Young Vapers Are at Risk

The report found substantial evidence that teenagers and young adults who try e-cigarettes are at a greater risk of progressing to conventional cigarettes than those who don’t. The authors also found that while e-cigs appear to be less addictive than conventional cigarettes, there is substantial evidence that e-cig users can still get hooked on them.

Consumer Reports medical director Orly Avitzur, M.D., says that these specific findings are troubling. "More research is needed to look at the long-term effects of e-cigs,” she says. “But what we do know today is that some users will become smokers, and that will put them at risk of developing emphysema, lung cancer, heart disease, and a number of other serious ailments."

Protecting Teens

Data from the Centers for Disease Control and Prevention (CDC) indicates that public health campaigns aimed at educating young people, combined with policies that severely restrict access, have succeeded in dramatically curbing youths’ use of traditional cigarettes. After decades of both strategies used in combination, youth tobacco smoking is at a historic low, according to the CDC’s 2017 National Youth Tobacco Survey.

But, as the NASEM report noted, even as they reject traditional cigarettes, more than 11 percent of all high school students have used e-cigs in the past month. A recent report from the CDC linked the use of these devices by youths to marketing by e-cig makers. These companies offer a range of kid-friendly e-liquid flavors like “unicorn milk” and “I love donuts.” And critics say that e-cig advertisements employ the same strategies the tobacco industry used to sell regular cigarettes to previous generations.

Experts say the key to keeping teenagers away from cigarettes or e-cigs is to talk to them. Jonathan Klein, M.D., M.P.H., a professor of pediatrics at the University of Illinois at Chicago, who has written on the topic of teen vaping, notes that if you can help adolescents get through high school without vaping, they're less likely to try e-cigs or regular tobacco later in life.