The Percentage of Americans Who Understand That Vaping Is Less Dangerous Than Smoking Continues to Fall

Years of mealy-mouthed, misleading, and mendacious statements by activists, government officials, and journalists have taken a toll on the truth.



The percentage of Americans who recognize that vaping is less hazardous than smoking continues to decline, according to a recent analysis of data from two national surveys. The results suggest that years of mealy-mouthed, misleading, and mendacious statements on this subject from activists, government officials, and journalists have taken a toll on the truth, undermining a harm-reducing shift in nicotine consumption that former FDA Commissioner Scott Gottlieb called "a tremendous public health opportunity."

The new study, published online by JAMA Network Open on March 29, is based on data from the Health Information National Trends Survey (HINTS) and the Tobacco Products and Risk Perceptions Survey (TPRPS). Between 2012 and 2017, the authors report, the share of respondents who correctly perceived e-cigarettes as less dangerous than the conventional, combustible kind fell from 51 percent to 35 percent in the first survey and from 39 percent to 34 percent in the second. Meanwhile, the share who incorrectly thought vaping is just as hazardous as smoking rose from 46 percent to 56 percent and from 12 percent to 36 percent, respectively. The percentage who erroneously believed that vaping is more dangerous than smoking tripled in both surveys, reaching nearly 10 percent in HINTS and more than 4 percent in TPRPS.

This decline in understanding about the relative risks of smoking and vaping is especially striking because it happened during a period when the case for the harm-reducing potential of e-cigarettes became steadily stronger. In 2015 Public Health England endorsed an estimate that vaping is something like 95 percent safer than smoking. In 2016 the Royal College of Physicians concluded that "large-scale substitution of e-cigarettes, or other non-tobacco nicotine products, for tobacco smoking has the potential to prevent almost all the harm from smoking." Studies published in 2016 and 2017 showed that smokers who switch to e-cigarettes dramatically reduce their exposure to hazardous chemicals generated by tobacco combustion—as dramatically as smokers who switch to nicotine replacement products such as gum or patches (a finding confirmed by a recent study of Juul e-cigarettes, the dominant brand in the United States).

After Gottlieb took office in 2017, his agency announced its support for switching smokers to less hazardous forms of nicotine consumption, including e-cigarettes, which he said held great promise for reducing tobacco-related disease and death. A controlled, randomized clinical study published in January added support to that position, finding that e-cigarettes were nearly twice as effective in helping smokers quit as the nicotine replacement products that doctors and public health officials have been recommending for years. Despite these developments, smokers are less likely to recognize the lifesaving potential of e-cigarettes than they were in 2012, which means they are less likely to attempt the switch and more likely to start smoking again once they have tried vaping.

What happened? Part of the blame lies with government agencies, including the FDA as well as the CDC and the Surgeon General's Office, that continue to treat e-cigarettes as "tobacco products," even though they do not contain tobacco. When smoking declines while vaping rises, these agencies do not celebrate. Instead they express concern that overall "tobacco use" has not changed or is actually "rising," which is not true and implies that all these products pose essentially the same risks, which also is not true. In an effort to deter teenagers from vaping, these agencies exaggerate the dangers of e-cigarettes, deliberately obscuring the crucial point that vaping is far less hazardous than smoking.

E-cigarette alarmists and their allies in the press add to the confusion. Consider this HealthDay News story about the JAMA Open Network study. "Amid growing concern about the safety of e-cigarettes," reporter Steven Reinberg writes, "more American adults now believe vaping is just as dangerous as smoking cigarettes." They are clearly wrong to believe that, but you wouldn't know it from Reinberg's article, which consists mostly of quotes from anti-smoking activists who are perversely determined to muddy the truth.

"The more we learn about e-cigarettes, the more dangerous they look," says Stanton Glantz. "The fact that the public is perceiving that e-cigarettes are more dangerous over time is, in fact, an accurate perception. The idea that e-cigarettes are harmless is fading away, which is a good thing."

Erika Sward, assistant vice president for national advocacy at the American Lung Association, says it's "foolish" (Reinberg's word) to consider the relative risks of vaping and smoking, because "cigarettes are the most deadly consumer product on the market," which is precisely why it is important to consider the relative risks of vaping and smoking. "The narrative that e-cigarette companies have been pushing since 2009 that these are a safer alternative, that they may help you quit, has been in the Big Tobacco playbook going back to the 1950s," she says. "There is no safe tobacco product, including e-cigarettes."

The issue, of course, is not whether e-cigarettes are "harmless" or "safe" but whether they are less harmful than combustible tobacco cigarettes, and on that point there is no credible disagreement. The authors of the JAMA Open Network study assume as much, which is why they emphasize "the urgent need to accurately communicate the risks of e-cigarettes to the public," saying such communication "should clearly differentiate the absolute from the relative harms of e-cigarettes." Reinberg fails abysmally at that task, leaving readers with the impression that no one really knows whether smokers can reduce the health risks they face by switching to e-cigarettes. That message is not just dishonest but potentially deadly.

NEXT: Attorney General Barr Prefers Marijuana Federalism Over the Current Confusing Mess

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  1. Do gooders doing more harm than good.

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  2. Sounds like someone is getting the vapers.

  3. I’m just gonna assume the percentage of people who understand the relative risk of vaping vs. inhaling automobile exhaust or vaping vs. cooking over a hot stove is even lower.

  4. A lot of this has to do with the efforts of the Truth Initiative and their obnoxious anti-vaping adds. One point they keep pushing is that one Juul pod contains as much nicotine as 20 cigarettes. However, as far as I can tell from looking on line, one Juul pod should take as long to consume as 20 cigarettes.

    1. Yeah. One Juul pod is advertised as being roughly equivalent to a pack of smokes. That’s a selling point, not a danger. Unless you open them up and drink the stuff.

      1. Unless you open them up and drink the stuff.

        Even then, assuming the pods don’t contain additives that may be toxic or degrade into toxins, it’s really more of a problem if you drink several and/or are a human of significantly diminished proportions relative to adults.

        1. So opening and drinking the contents of a Juul pod is contraindicated if you’re Peter Dinklage?

          1. Probably taste better than a Tide pod too?

          2. It’s contra-indicated if you don’t want to die. Even if nicotine is no worse than caffiene when dose adjusted, it’s still possible to OD on it.

            1. A cigarette is 2 mg of nicotine so a juul pod at the equivalent of 20 cigs is 40 mg of nicotine.

              The best actual medical data we have for estimating LD 50 for nicotine comes from the case of a man who tried to commit suicide by consuming 6 GRAMS of pure nicotine* and survived.

              * where he got 6 grams of pure nicotine from I have no idea.

    2. Either way, it’s bullshit goalpost moving. Nicotine has nothing (or little) to do with the cancer-causing aspects of cigarette smoking. It’s not the nicotine that causes cancer, it’s the smoke!

      1. This is true. Nicotine addicts you but it’s relatively harmless on its own. Think caffeine. From all I’ve read, vaping does have potential health hazards, but they are significantly less than smoking tobacco, unless you count the fact that you look like a douche when you vape.

    3. Indeed, I see their ads, and they make me mad enough to want to punch out the screen. “The Truth”.

      More like “The Bullshit”.

    4. And Tobacco Companies are forced per the lawsuit to pay for those excruciatingly obnoxious ads! The money the states collect from The Master Settlement Agreement was astronomical so of course they want you to keep buying cogarettes. The vaping thing being ‘bad’ they say is just a the warm-up for another lawsuit. They had the CDC conjure the completely farcical “second hand smoke” nonsense research study because the government needed victims to win the suit. Smokers volunteered to start smoking. (‘research study’ is a hoot, it was like a 4th graders weekend assignment)
      Doug Stanhope said of the second hand smoking ban “Do you know anyone that became hooked on nicotine because of second hand smoke?!

  5. After how the government handled things like salt, fat and second-hand smoke why should we trust them on vaping? Just because they have the power to destroy?

    1. I was an early switcher to ecigs nearly 10 years ago after smoking for nearly 20 years. I don’t have a cough anymore, not clearing my throat constantly, and even can run 5 miles. So I would say these people are full of shit. Does that mean I will live to 100 now or not die of some nasty illness? Probably not, but I feel better today, so that’s what matters.

  6. Meh.

    Codeine treatment is a substitute for cocaine users to help them break the habit. But it’s still not good for them, and no one pushes it as a neutral habit on it’s own, and anyone that tried to market a codeine habit as a neutral thing would be rightly tarred-and-feathered.

    Vaping and cigarettes are the same. Vaping might not be as bad as cigarettes, but you shouldn’t be pushing it as a neutral option. And yet, pushing it as a neutral option is exactly what nicotine companies have been doing for years.

    So quite simply, so long as nicotine companies see e-cigs and vapes as the next cigarette, a way to secure their businesses for decades to come, and advertise accordingly, you will continue to have people that will treat them as though they are literally pushing drugs on people and trying to sell to kids.

    TLDR; bad-faith actors prompt bad reactions.

    1. It is truly remarkable that in a rather decent sized comment, you managed to prove the author’s point, all while contending the opposite.

      And BTW: I noticed you did a little bait and switch in your description. It is no longer the “tobacco companies”. It is now the “nicotine companies”. You do realize that almost all the harm from cigarette smoking comes from inhaling the chemicals contained in the tobacco leaves, NOT THE NICOTINE. Yes nicotine can be habit forming, and a bit addictive perhaps. But it isn’t the nicotine that causes all the health problems associated with smoking cigarettes. E-cigarettes (which BTW: generally don’t have any tobacco in them) give the nicotine uptake, but without all the things that make regular cigarettes so bad.

      And no one is saying vaping is a “neutral option”. But it is CLEARLY a far better option than smoking traditional cigarettes.

      1. “It is no longer the “tobacco companies”. It is now the “nicotine companies”. You do realize that almost all the harm from cigarette smoking comes from inhaling the chemicals contained in the tobacco leaves, NOT THE NICOTINE.”

        Only half true. While there are other compound either naturally contained in tobacco or added to it by the cigarette companies, the most dangerous chemicals smoking will expose you to are combustion byproducts.

        1. that are more dangerous than nicotine, which in terms of toxicity is only marginally worse than caffeine.

          1. I don’t disagree. I should have stated it better. I was trying to emphasize the burning of tobacco, but I didn’t do a good job on the burning part.

      2. And no one is saying vaping is a “neutral option”.

        I will. If sitting in traffic inhaling auto exhaust, inhaling the vaporized products of a kitchen stove, inhaling whatever random compounds might be vaporized out of the water at your local beach is considered neutral from a moral/legal/health perspective then vaping, assuming clean and/or known ingredients, is a neutral option.

        Saying it’s not a neutral option because potential risks can be identified doesn’t mean it’s not a neutral option, especially when the person saying it’s not a neutral option is a bad-faith actor in the first place.

      3. “Big Tobacco” evolved with the times. It’s not a “bait and switch” to acknowledge this.

        And no one is saying vaping is a “neutral option”.

        So are you unaware of the advertising campaigns, or just in denial about them?

        1. Given the are many other products widely advertised with proven concerns greater than that of gaping, I fail to see your point. I know you believe you know what is best for everyone, and you state that indirectly and frequently. For you to take some sort of moral high ground simply because someone else might find pleasure in something you do not believe to be acceptable is your problem and no one else’s.

          1. Gaping equals vaping. Thanks for the correction, Apple.

          2. I fail to see your point

            My incredulity that BearOdinSon thinks “no one is saying vaping is a ‘neutral option’.” really wasn’t subtle.

    2. Drug companies sell nicotine gum and nobody is giving them a hard time about it.

      1. That was kind of my point.

        If e-cigs and vaping were just used as cessation tools, you wouldn’t have anyone freaking out about them.

        1. Bullshit. Because they aren’t controlled by those nannies that know better than is of course there would be a racket over them.

    3. Vaping can be totally benign, depending entirely on the substance you put into the e-cig. There is no such thing as harmless cigarettes. They are absolutely not the same.

    4. Vaping and cigarettes are the same. Vaping might not be as bad as cigarettes, but you shouldn’t be pushing it as a neutral option.

      Wrong, vaping and cigarettes are nothing alike besides they both deliver nicotine, just like Nicorette Gum. Vaping is 95% safer than traditional cigarettes. Just because you say something doesn’t make it true.

      I know of no one pushing it as a “neutral option”, it should be pushed to smokers who want to quit, not never smokers or kids. However if kids do try vaping it is much better for them than cigarettes. The constant drumbeat of “vaping bad” by people like you has led us to where 56% of people in the US believe a product estimated by Public Health England to be 95% safer than cigarettes is actually worse, causing them to not try to quit a habit they (and you) know is killing them.

      May you and those like you who propagandize the public into believe a lie so people won’t quit smoking burn in hell.

      1. What EE meant about Vaping and cigs being “the same” is that they were analogous idea of codeine being a substitute for cocaine use. It was a little muddled and came off like he/she was saying “they’re the same when compared to each other” but I don’t think that was the intent.

        1. Thanks Paul, I will walk that back, may you be in a beige, neutral purgatory. I still believe it should be pushed as a better option, although not completely neutral. Also, snus should be pushed as a better option, if not completely neutral. I agree with Mad.Casual above that there are worse things in our everyday lives that are worse for a person than actively vaping, but no one gets the vapors over that.

        2. What EE meant about Vaping and cigs being “the same” is that they were analogous idea of codeine being a substitute for cocaine use.

          I disagree with the analogy in virtually any but the most Sylvia Plath, fundamentals of biochemistry, “we’re all gonna die and too much of anything, including life, will kill us” sense. I can name a handful of people we all know who died of cocaine, codeine, or various drug overdoses. We’d all be pretty hard pressed to name a single person, by name, who’s died of a nicotine overdose. In order to say codeine to treat cocaine addiction is the same as vaping and cigarettes, you have to ignore the relative differences in chemistry and the delivery method(s) as well as the underlying risks. Which is to say you have to pretty much ignore everything we’re talking about, including the fact that the specific delivery methods pose the varying amounts of risk, and just believe him when he says they’re the same. It’s like saying that low-speed motorcycle accidents kill you just as much as high speed car accidents is the same as being shot with a nerf gun vs. shot with a firearm. After all, killed in a vehicle collision is killed in a vehicular collision it the same as shot with a gun is shot with a gun.

          It’s reversing the ‘difference in degree, not kind’ argument such that it’s nonsense; because they are only different in degrees, they can’t be different in kind.

          1. I will be pedantic and point out the is no upper limit to the dosing of opioids. The same can not be said of of nicotine.

            That said, I will wait until vaping is implicated as a cause of death before getting too worried (it’s been about 10 years now. Certainly there should be at least one.).

            Side note- The bottles of high concentration nicotine that shops use to mix their own have poison and hazardous labels stickers on them. Got a kick out of that.

          2. I will go as far as to say this: Quick onset administration of a drug has higher addiction potential than gradual administration, because the hind brain has an easier time associating the action with the effect if the effect is immediate.

            But in as much as nicotine addiction is relatively harmless if you take tobacco out of the equation, who cares? Personally, I’m addicted to caffeine, and it’s not exactly ruining my life.

            I just drink a lot of tea.

      2. How about this: Let’s not PUSH anything. And let’s not PUSH AGAINST anything.

        I know several people who switched from smoking to vaping, and good on them. I know several other people who started vaping without smoking.

        So fucking what? Others started smoking weed. Others started drinking beer and then (OMFG!) hard liquor. Still others down a six pack of monster energy drinks each day. Who fucking cares? It is their body, let them do with it what they want. Let parents deal with their kids. My brother quit smoking, because he could get some juul or vibe or wtf ever product in the local convenience store. Now the government is trying to shit all over that- he can go to the same store to buy cancer sticks, but it is getting harder to buy vapes.

        I am all for informing people of the risks inherent in any vice. There is no such thing as a neutral option in anything- there is a cost for everything. But that isn’t what is happening here. Activists and political busybodies are launching a scorched earth scare campaign expressly aimed at misinforming the public so that they won’t engage in some icky habit they detest. And attempts to legitimize this nonsense with claims like “it’s still dangerous” or “those evil nicotine corporations” misses the real principle that should be used: individuals ought to have the information and freedom necessary to make decisions they see fit to make.

      3. Diane correctly identified what I meant by “the same”. I was comparing/contrasting the relationship, not the items.

        That said, the worst I said about e-cigs themselves (as opposed to the companies making them) is that they’re not neutral. Which you seem to agree with seeing as you asserted that of course no one would claim that.

        Which is to say… don’t confuse a scraping of a chair for a drumbeat.

    5. I don’t see anywhere in your message where you indicate the specific, verified dangers of vaping vs cigarette smoking. Your message seems to be about the skepticism of corporations making money on a product- regardless of the dangers or lack thereof of that product.

      1. I don’t see anywhere in your message where you indicate the specific, verified dangers of vaping vs cigarette smoking.

        Correct. Because that only matters if one is a replacement for the other. Like codeine therapy, like nicotine gum, and so-on.

        But that’s not how e-cigs/vapes/whatever are being marketed and sold. And that is why these companies are generating such extreme reactions.

        As far as my “message” goes, it was more of “you reap what you sow”. I don’t care one way or the other, but I can recognize the cause and effect that got us here.

    6. Feh. Nicotine is just a stimulant, adjusted for dose it’s no more dangerous than a cup of tea.

      Inhaling it isn’t the best approach from an addiction standpoint, but since being addicted to nicotine is fairly harmless once you get tobacco out of the picture, who cares?

    7. Codeine is not OTC and neither is cocaine and both have nothing to do with nicotine only all the bad info comes from government. They have “educated” the public for decades and nobody takes the time to even google something and find facts. You won’t I am sure so I think you should be rightly tarred-and-feathered.
      And amazing how the expert opinions spews out of those who have not used “illegal” drugs. Or an alcoholic blathering on about hating “tweakers” until I could just scream. Alcohol is the deadly fucking substance that has done more damage than any drug. It makes people act retarded as hell. Heroin death is RARE. Alcohol makes heroin death possible but they do not tell you that do they! Alcohol kills all by itself. Heroin rarely does.
      Opioid -opiate…pick one, what is the crisis? Opioid…
      BTW drug laws are all based 100% in racism. Period. That is a fact.

  7. The high cost of freedom of speech. Suck it, Nazis.

  8. Vaping and cigarettes are the same. Vaping might not be as bad as cigarettes

    I was gonna recommend reading your post as an alternative to being beat over the head with a hammer but I’m not convinced your post is of any relative benefit.

    1. Yes, I get that bit was poorly worded. I was comparing the relationship between cigarettes and e-cigs to the relationship between cocaine and codeine?.
      ?On second thought, it might be heroine and codeine. It’s used in replacement therapy for one of ’em, just not sure which one exactly.

  9. “There is no safe tobacco product, including e-cigarettes.”

    e-cigarettes are not a tobacco product.

    1. Notice the mendacious assholes are quite literally incapable of discussing this issue without twisting the language, constantly moving the goalposts, etc.

      This is, to me, ample proof of what I have suspected all my adult life: these people don’t give one single fuck about harm, harm reduction, or even the lives of smokers. Their concern is the intolerable fact that someone, somewhere is enjoying a vice which the mendacious assholes have decided to forego.

      This is nothing more than legislatively mandating an aesthetic preference, and those who endorse it should be pilloried, shunned, and censured.

      1. They are indeed Puritans, but don’t under-estimate the focus on harm. But they pursue this not so much to help others as to indulge themselves in:

        1. Virtue signalling.
        2. Personal rewards from being “caring”.
        3. Establishing status, as in the all-knowing wise ones over the helpless plebes.

  10. Less dangerous is meaningless bunk. Nicotine is dangerous and a known carcinogen, end of story.

    1. a known carcinogen

      This is flat wrong. There are no data indicating it causes cancer directly and the only studies showing it “causes” cancer indirectly hypothesize mechanisms that would mean exercising regularly and generally being in good shape cause cancer.

      1. Saw this article get shilled against because Reason can’t stop being vaping apologists, but if you talk to actual doctors (I have 3 in my family, 2 of them are neuropathologists and 1 of them is director of autopsy for a major hospital), they can direct you to resources. They’ve known for a while now that nicotine itself is carcinogenic. Of course it isn’t identical to tobacco itself, but it’s not a harmless chemical that “just” gets you addicted. Read this study, check out the citations in other studies, and start going down the rabbit hole from there. Nicotine causes cancer too.


        1. “Saw this article get shilled against because Reason can’t stop being vaping apologists…”

          Certainly two researchers for the Norwegian Institute for Cancer Research would have no vested personal interest in seeing the number of “carcinogenic” compounds increased. From the abstract of the paper you linked: “Recent studies have shown that nicotine can affect several important steps in the development of cancer, and SUGGEST that it MAY cause aggravation and recurrence of the disease.” (emphasis mine). That is not nearly the same as (to quote you): “They’ve known for a while now that nicotine itself is carcinogenic.” Stop it.

          1. If that’s your basis then you are a troll because you’re rejecting the validity of every single study conducted about carcinogens. You’re not going to find cancer research from non-cancer related entities and experts.

            Also, only reading the abstract and willfully ignoring the full body of research is peak trolling and cherry picking. If you read the actual study and look into the medical science, nicotine, by itself, is DIRECTLY CAUSING the creation of carcinogens at a concentration that can cause cancer. People used to think nicotine only generated TSNAs (tobacco-specific nitrosamines) when it reacted with tobacco itself (hence the name), but now these nitrosamines are being detected in e-cigarettes as well.

            If a substance creates nitrosamines, a known carcinogen, how can you not call said substance carcinogenic?

    2. Nope. Nicotine is not the cancer-causing agent in tobacco smoking, it’s the smoke that causes cancer. The repeated, mechanical irritation of the lung tissues forcing them to be in a state of constant self-repair is what causes cancer. *looking at you marijuana smokers*

      1. It’s not just that, tobacco actually produces chemicals in the leaves that cause cancer, it’s one of its biological defense mechanisms. That’s why chewing tobacco causes mouth and throat cancer, and tobacco workers sometimes get skin cancer from handling it.

        REALLY nasty plant, as these things go!

    3. Idiot

  11. It’s always amazing that the same people/government types that profess to “fucking love science” are also almost always the ones who have the most misguided ideas on various scientific topics and are hopelessly lost when it comes to statistics and probability.

    1. Nearly every American Spirit smoker thinks their cigarettes are either healthier or near harmless

      1. H is for hipster, H is for healthier. FACT.

    2. I see quite a bit of relativist fallacy whenever this vaping debate comes up on Reason. People saying shit like “95% safer” instead of using a nominal measure of danger. I’m sure getting shot in the head is 95% safer than getting nuked, but that’s a pretty meaningless relative comparison.

      1. I’m sure getting shot in the head is 95% safer than getting nuked

        LOL. Criticizes relativist fallacy… fails at relativist fallacy.

        1. I pointed out the failed logic of using percentages to quantify danger with a simple example that I literally say is “a meaningless relative comparison” and that’s how you respond? Yeah, you’re just a troll.

      2. Everything you just said is so stupid and vapid I can’t take the time to explain to you exactly how fucking idiotic you are.

        Fuck off, slaver.

      3. Wow. So..you can use the term “relativist fallacy” as if you are all grown up, but then you show that you are completely clueless when it comes to reality, or even your own example.

      4. Wow. So..you can use the term “relativist fallacy” as if you are all grown up, but then you show that you are completely clueless when it comes to reality, or even your own example.

    3. You do realize that none of them understand science, right? The current wave of science lovers is not a cause but effect of embracing the climate change issue as a justification for massive government control.

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