Bite-sized learning: Vaping myths and facts

Confusion about vaping may be preventing some people from giving up smoking. General practice nurses can help by putting the risks in the right order and supporting a complete switch away from cigarettes.

Introduction

Smoking remains one of the biggest avoidable causes of ill health and early death. General practice nurses (GPNs) see the consequences every day, yet we also meet people who want to stop but are frightened of vaping. When misinformation keeps someone smoking, it is not harmless misinformation.

What's the problem?

The 2026 ASH survey does not support the idea of an ever-growing 'vaping epidemic'. Adult vaping rose from 1.7% in 2012 to 10.3% in 2026 and has levelled off since 2024. Meanwhile, adult smoking has more than halved since 2008 (Table 1).

Most current vapers have smoked: 60% are ex-smokers and 32% still smoke. Yet 28% of smokers have never tried vaping. Just over half (52%) of smokers, and 52% of surveyed health and social care staff, wrongly believe vaping is as harmful as or more harmful than smoking.¹

What does the evidence tell us?

NICE includes nicotine-containing e-cigarettes among effective stop-smoking options, particularly with behavioural support.² A 2025 Cochrane review found that nicotine e-cigarettes help more people stop smoking for at least six months than nicotine replacement therapy.³ Population-level estimates suggest that their use in quit attempts has contributed to around 30,000–50,000 additional successful quits each year in England since 2013.¹ A comprehensive government evidence review also concluded that vaping poses only a small fraction of the risks of smoking.⁴ For GPNs, the message is clear: for someone who smokes, trying a vape is a reasonable, evidence-based option.

Why combustion matters

The major difference is combustion. Cigarettes burn tobacco and produce smoke containing thousands of chemicals, including many toxic and carcinogenic substances. Vapes heat a liquid and do not produce tobacco smoke. Nicotine can create dependence, but it is the smoke, rather than nicotine, that causes most smoking-related death and disease.⁴ That is why switching completely from cigarettes to vaping substantially reduces harm.

Keeping the risk in proportion

Vaping is not risk free, but for someone who smokes the biggest health gain comes from stopping smoking. In everyday practice it also needs to be considered alongside other important health risks, including high blood pressure, diabetes, physical inactivity and poor diet. For nurses, the key is to keep the conversation proportionate: talk honestly about vaping, but do not allow concern about it to distract from addressing the risks that are most likely to cause harm.

Myths we hear in practice

Myth 1: Vaping is just as harmful as smoking. It is not risk free, but it exposes people to far fewer toxicants. Compare it with the cigarette the person is smoking, not with fresh air.

Myth 2: Nicotine causes cancer. Nicotine can cause dependence, but most smoking-related deaths and disease come from burning tobacco. Fear of nicotine can also put people off NRT and other effective quitting options.

Myth 3: Vaping only swaps one addiction for another. Nicotine without tobacco smoke is not the same as smoking. Remove combustion first; nicotine can be reduced later.

Myth 4: Smoking and vaping means vaping has failed. Dual use can be a bridge, but complete replacement remains the goal. Ask which cigarettes are hardest to give up and whether nicotine strength or device choice needs adjusting.⁵

Myth 5: People should stop vaping quickly… but not if this makes a return to smoking more likely. Vaping can continue for as long as it helps someone remain smoke free.⁶

Myth 6: Vaping causes ‘popcorn lung’. The name came from an investigation in 2000 after workers at a microwave popcorn factory in Missouri developed bronchiolitis obliterans, a rare and serious lung disease. Exposure to butter flavouring chemicals, including diacetyl, was implicated. Diacetyl is found in cigarette smoke but is banned as an ingredient in UK-regulated nicotine vapes and e-liquids. There are no confirmed cases of popcorn lung linked to vaping.⁷

What about young people and never-smokers?

Vapes should not be used by young people (nor should they smoke) or be promoted to people who have never smoked. Current use among never-smokers remains low: 1.5% of adults and 1.4% of 11–17-year-olds.^1,8

However, if a young person already smokes, switching completely to vaping is much less harmful than continuing to smoke. Stopping both is best, but cigarettes remain the much more harmful option.

Regulated and unregulated vapes

UK-regulated nicotine vapes must meet safety and quality requirements. The latest Cochrane review found no evidence of increased serious short-term harm when regulated nicotine vapes were used to help people stop smoking, although longer-term evidence is still needed.³ Vaping is not risk free, but for someone who smokes it is much less harmful than continuing to smoke.

Illegal or unregulated vapes are different. We cannot be confident that their contents, nicotine strength or safety meet UK standards, and the Cochrane review specifically warns that illicit products may have different harm profiles. Nurses can encourage people who vape to buy from reputable UK retailers and, if concerned, check that the product appears on the MHRA list of notified products.⁹

Stopping vaping

Many people stop vaping after they have quit smoking; among those who used a vape to quit, the average duration of vaping is around three years.¹ If someone wants to stop vaping, the priority is to avoid a return to cigarettes. This matters: 19% of people who have tried to quit vaping using a particular method reported using cigarettes as a quit aid.¹ The National Centre for Smoking Cessation and Training (NCSCT) advises assessing the risk of relapse and, when someone is ready, stopping gradually or in one step.⁶ For some people, particularly those vulnerable to relapse, continuing to vape is preferable to returning to smoking.

Top 5 patient messages

1. If you smoke, switching completely to vaping is much less harmful and can help you quit.
2. The goal is no cigarettes or tobacco. Dual use can be a step, but complete switching brings the greatest benefit.
3. Nicotine can cause dependence, but tobacco smoke causes most of the serious harm.
4. Use enough nicotine to control cravings, especially at the beginning.
5. Keep vaping for as long as it helps you stay smoke free.

Conclusion

A well-informed GPN can cut through alarming headlines without claiming that vaping is harmless. Put the risks in the right order and help somebody leave cigarettes behind.

References

1. Action on Smoking and Health (ASH). Use of vapes and other novel tobacco and nicotine products among adults in Great Britain; 2026. https://ash.org.uk/resources/view/use-of-e-cigarettes-among-adults-in-great-britain

2. NICE NG209.Tobacco: preventing uptake, promoting quitting and treating dependence. Last updated 4 February 2025. https://www.nice.org.uk/guidance/ng209

3. Lindson N, Livingstone-Banks J, Butler AR, et al. Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews 2025; Issue 11: CD010216. https://doi.org/10.1002/14651858.CD010216.pub10

4. Office for Health Improvement and Disparities. Nicotine vaping in England: 2022 evidence update. 2022. https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update

5. National Centre for Smoking Cessation and Training. Vaping: a guide for health and social care professionals. Last reviewed January 2025. https://www.ncsct.co.uk/publications/Vaping_briefing

6. National Centre for Smoking Cessation and Training. Supporting clients who want to stop vaping. Updated February 2026. https://www.ncsct.co.uk/publications/Support_stop_vaping

7. NHS. Better health. Vaping myths and facts. https://www.nhs.uk/better-health/quit-smoking/ready-to-quit-smoking/vaping-to-quit-smoking/vaping-myths-and-the-facts/

8. Action on Smoking and Health (ASH). Use of vapes and other novel tobacco and nicotine products among young people in Great Britain. 2026. https://ash.org.uk/resources/view/use-of-e-cigarettes-among-young-people-in-great-britain

9. MHRA. Database of e-cigarettes. https://cms.mhra.gov.uk/ecig-new