Why People Are Swapping Vapes For Cigarettes Despite The Risks

“Cigarettes for me were a form of nicotine that I was able to have more ‘control’ over than vaping,” says Ellie*, 29, from New York. It isn’t just Ellie who thinks this. When vapes spiked in popularity, the marketing of them as a way to cut back on cigarettes pervaded. This messaging is even backed by the NHS, where the advice on nicotine vapes is that they are “one of the most effective stop smoking aids”. The FDA however, hasn't approved of vapes for this use in the U.S. The science repeatedly says they’re less damaging than cigarettes. And yet, people are now switching back to smoking in an attempt to cut out vaping for good. What’s more, they’re convinced it’s better for them.

There’s a disconnect between what the experts say and what smokers think about the health risks. Ellie is a prime example of this. “While cigarettes are indisputably dangerous and cancer-causing, I actually know what's in them, and the long-term effects are documented,” she says. “Because vapes are a newer invention, we don't yet know what the full risks are,” Ellie adds. She isn’t alone in her perspective. A survey on smoking in England, updated this month, found that current smokers believe vapes are “equally or more harmful” than cigarettes, despite the NHS again affirming that vaping more frequently than smoking doesn’t make them worse. New research from Action on Smoking and Health (ASH) concludes that vapes are being “underused” to quit smoking and that the public is “confused” about the health risks posed by vapes. Their data found that 63% of young people think vaping is as harmful or more harmful than smoking. Just last year, their survey showed 50% of people felt this way, so the public health disconnect is growing. Perceptions have shifted back in favour of cigarettes, not because people are misinformed and unaware of the cancer risks. They know them well. Instead, it’s the lack of decades long research on vapes that we have on cigarettes that’s swinging people away from vaping. 

Ellie’s smoking habit began, like many people, as a result of working around other smokers. “I realised while working at a restaurant that my coworkers who were smokers (which was most of them) were able to get ‘smoke breaks’ during their shifts that non-smokers were not given. It was both a way to be social with my coworkers during and after shifts, and gave me a reason to step outside for a moment during the work day.” Then as a sophomore in 2015, she swapped cigarettes for vapes for the next five years. 

The lure was strong, and strawberry-flavoured. “The thing about vaping is that unlike cigarettes, I could use them anywhere and everywhere. In bed before I fell asleep and immediately when I woke up, in the bathroom at work or restaurants, and while sitting at my desk when working from home, while sitting on the couch watching a movie with friends,” says Ellie. When she looked into it, she found that one Juul pod has the same amount of nicotine as around 20 cigarettes. At the height of Ellie’s addiction, she was “easily” going through a pod every day and a half or so — whereas during her first time as a cigarette smoker, she was smoking five or six cigarettes a day at the peak. Upon doing the maths, she became deeply concerned about the amount of nicotine she was consuming. “I had read studies about how long-term vaping can damage your blood vessels and cause ‘popcorn lung’ [editor’s note: Diacetyl is the risky ingredient linked to popcorn lung. In the UK it’s banned from vapes, but is still allowed in the U.S. Vaping without this ingredient does not cause popcorn lung]. After a friend posted about how they were hospitalised for possibly permanent damage to their blood vessels as a result of heavy vaping, I decided I wanted to stop, and used cigarettes to help me wean off.” Ellie shared some of her research with me, and it is alarming. There’s concern about the toxic metals contained within them, for example, and concerns around their regulation globally. These scares have contributed to the false idea that vaping is worse than smoking.

The new generation of nicotine-users are worried about the speed at which they run through a vape. So, after briefly fading from fashion among younger people, cigarettes now had a place in their eyes once more. Hazel Cheeseman, chief executive of Action on Smoking and Health, tells Refinery29 this trend is a serious concern. “While we may not have decades of data we have on smoking we have more than enough to know that smoking is so much more of a risk to your health,” Cheeseman says. “People are not ‘addicted to smoking’ or ‘addicted to vaping’ — they are addicted to nicotine. When people feel they vape more than they smoke, this is because the vape delivers nicotine in a different way to cigarettes [which is far less rapid], not because they are more addicted.” Cheeseman is clear that much more needs to be done to make sure people understand the risks better. Up to two thirds of long-term smokers die prematurely from smoking related illness. “If people believe cigarettes are a healthier choice they are completely misguided,” says Cheeseman.

It’s a damning reality, but one that isn’t seeming to impress itself on people, who truly believe cigarettes have helped them. Jenny*, 27, who lives in London, thinks vapes made her “way more addicted to nicotine” compared with when she socially smoked cigarettes, having been an on and off smoker since her teenage years. Like Ellie, she would vape at any given opportunity at home or out of the house. Jenny began to notice she was becoming short of breath at the gym. Though aware of the risks attached to cigarettes, she’s found it easier to have periods where she completely stops smoking compared with when she vaped. At the start of this year, Jenny decided to quit for two and a half months. Now that it’s festival season, she wants to socially smoke again. But the kicker for her though, is cigarettes haven’t become a daily habit like vaping grew to be. “I see it now as a treat,” says Jenny. “Switching back to cigarettes has given me a better relationship with my smoking. I've seen friends who never touched cigs now be in a complete state of panic and distress when they lose their Lost Marys. It's insane. The fact we can do it anywhere, just makes it far too accessible.” And while it’s less of a concern than the health side of things, Jenny adds: “You look impossibly unchic having a vape”.

Mistrust of vapes, in the UK at least, seemed to gain momentum in some circles when the disposable vape ban came into effect in June this year. Lewis*, 31, from London, previously smoked, quit, started to vape, then decided to switch back in line with the ban. “It seemed like a good moment to finally kick the habit,” he says. “Plus a lot of my friends used this arbitrary date too, so there was strength in numbers.” When socialising, Lewis says he needs something to “break up” the night. “The pub setting is the most challenging, with the combination of beer, friends, and outdoor space. It’s just too tempting, and I saw the occasional fag as a much less unhealthy and expensive than chugging three to four vapes a week.” Although he too knows the risks of cigarettes, he found quitting in the past easy so isn’t worried about that side of things. “I much prefer vaping. It's tastier, doesn't make your clothes smell, and for me it’s much more addictive, so I'm not concerned I'll become a full-time smoker as I genuinely don't like it as much,” says Lewis. Since smoking cigarettes, Lewis says his “vape cravings” have lessened and that he’s barely thought about them. “I know the science says vaping is less harmful, however there are still a lot of unknowns, especially related to heavy metals, microplastics, and the long term effects. Most people aren’t chain-smoking one after another. So for me, it’s definitely a ‘healthier’ choice considering that I smoke much less than I vaped.” Currently, he smokes five to 10 cigarettes a week and plans to keep an eye on it so the habit doesn’t grow. He’s also considered snus (a smokeless tobacco people place under their lip), but that doesn’t always react well with him.

The people I’ve interviewed aren’t stupid: they know the risks, they never were chain-smokers, they think there’s nuance missing from the advice for people like themselves with more socially-led habits. Dr Deborah Lee, of Dr Fox Online Pharmacy, says that yes, it’s true that cigarettes contain less nicotine than many vapes. “Some vapes contain 40 mg of nicotine — 400-600 puffs [in the US, in the UK 20 mg is the limit]. This is equivalent to smoking one to two packs of cigarettes. Illegally sold vapes may contain even higher amounts of nicotine. So, converting from vapes to cigarettes would result in less nicotine exposure, depending on how many cigarettes are smoked.” But, Lee makes it clear this isn’t where the health piece ends. “When you light a cigarette, tobacco is burning, and you inhale cigarette smoke into your lungs which contains over 5000 noxious substances including over 50 known carcinogens. E-cigarettes and vapes deliver nicotine without exposure to the harms of cigarette smoke.” Nicotine is the lesser evil, and yet it’s what many smokers tend to focus on. 

Vaping isn’t perfect, though, and it doesn’t come without its own risks to a person’s health. Lee shares that a 2020 review concluded that vaping has a similar effect on respiratory and cardiac function as smoking. “Over time, vaping causes constriction of the smaller airways and damage to the lung epithelium like smoking. Vaping also increases blood pressure and causes arterial stiffness.” Essentially, more research is needed. For a generation of people used to getting answers at the tap of a search bar, the lack of data isn’t helping faith in vaping over smoking. “While research shows the most successful ways to stop smoking involve behavioural treatment programs with nicotine replacement products (which can include vapes), varenicline and bupropion, a 2017 meta-analysis of 38 studies found that smokers were 28% less likely to quit if they used e-cigarettes. Other studies have had similar results,” Lee adds. 

This is where people are turning to what feels best for them personally. Ellie says going back to cigarettes helped her quit vapes in just a few days. “If it was freezing cold or rainy outside, I'd find myself not willing to go out for a cigarette. Cigarettes helped me lessen the oral fixation as I can’t smoke them at my desk, and I feel satisfied with smaller hits of nicotine spaced throughout the day. I can’t imagine ever going back to vaping. The convenience of it made my addiction feel stronger and more constant than anything I’d experienced before. While I could easily finish a Juul pod in a day or so, I couldn't possibly smoke 20 American Spirits in 24 hours without feeling seriously ill.” There’s no data on how effective smoking can be to quit vapes, but Ellie is giving it a try nonetheless. She wants to quit everything before turning 30.