With the Jury Out on Vaping, Clinicians Pause to Identify the Cons of E-Cigarettes

In 2001, Terrie Hall became the anti-smoking voice heard ’round the world, as the Centers for Disease Control and Prevention (CDC) debuted its renowned, albeit alarming, campaign aimed at young smokers — except it wasn’t her actual voice. She spoke slowly through a hands-free device that fit in a hole in her throat, the result of decades of smoking and 11 different cancer diagnoses. Hall put a face to the 480,000 Americans who die from smoking each year, and she is credited with the most powerful anti-tobacco narrative of the 21st century.

However, over the last several years, e-cigarettes — battery powered devices that heat up nicotine liquid for smoking — have re-exposed America’s youth to addiction. “Vaping” is the act of breathing vapor through an e-cigarette and was originally advertised as a way to quit traditional cigarettes, which are currently responsible for about 30 percent of all cancer deaths. Researchers from the Royal College of Physicians (RCP) conclude that “the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5 percent of the harm from smoking tobacco.” The RCP acknowledges that e-cigarettes would likely increase the risk of lung cancer, cardiovascular disease, and chronic obstructive pulmonary disease (COPD), but at much lower levels of risk. Their findings actually encourage current smokers to turn to e-cigarettes in place of traditional cigarettes, which the RCP believes contain significantly higher levels of carcinogens.

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“A Different Conversation”

However, some experts, like Georgetown University School of Nursing & Health Studies professor Sally Huey, DNP, APRN, FNP-BC, are concerned that published research on e-cigarettes doesn’t take into account those who vape as an entry into tobacco use. 

“The recent research is focusing on those who are quitting tobacco but not looking at populations who are taking up this habit and getting addicted to nicotine,” Huey said. “It is a different conversation when discussing smoking cessation or just vaping as a never smoker. Although it may be less harmful than tar-laden tobacco cigarettes, this is normalizing smoking as a habit again and may have an unwanted effect in the end.”

Additionally, a 2017 study contradicts previous findings, suggesting that e-cigarettes are just as potentially harmful as tobacco cigarettes — possibly even more so — when it comes to causing DNA damage. Researchers conclude that e-cigarettes are as likely to cause cellular mutations to human DNA — which is what leads to cancer — as traditional cigarettes. The extent of e-cigarettes’ damage depends on the amount of vapor a user inhales and whether or not the liquid contains nicotine and other additive substances. The study estimates that 20 puffs from an e-cigarette is equivalent to smoking one tobacco cigarette.


“The normalization of smoking by vaping may eventually encourage a whole new generation using these products because they are ‘cool’ and accepted in the mainstream.”

—  Sally Huey Georgetown University School of Nursing & Health Studies professor, DNP, APRN, FNP-BC


The CDC estimates that 250,000 young people who have never smoked traditional cigarettes have tried e-cigarettes. However, because e-cigarettes have only been in widespread use for a decade, researchers don’t have enough information to analyze their long-term health effects.

“It’s hard to imagine that they are as dangerous as tobacco, but I cannot say for sure without long-term data. It is a gamble to not address this potential health risk,” Huey said. “The normalization of smoking by vaping may eventually encourage a whole new generation using these products because they are ‘cool’ and accepted in the mainstream.”

Nurses Promoting Smoke Cessation

As the use of e-cigarettes continues to grow, there is an urgency for scientists to unanimously identify the harm of e-cigarettes, despite possibly being less harmful than traditional cigarettes. 

“Nurses are on the front lines, educating and promoting smoking cessation efforts to the public, and they must be well-informed of the harms and benefits associated with any suggested alternative to traditional tobacco use,” Huey wrote in her report, “Escape the Vape: Health Hazards of the Latest Nicotine Craze,” which was co-authored by fellow School of Nursing & Health Studies professor Margaret Granitto, MS, ANP-BC.

“I don’t think vaping is mentioned much when obtaining the patient history and doing risk assessment,” Huey said. “As health care providers, we need to be aware of this practice, particularly in our young patients, and discuss the known harms and potential problems of a nicotine addiction in their later years.”

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Citation for this content: Georgetown University School of Nursing & Health Studies’ Online FNP Program