Another deception: The harm of e-cigarettes is really greater than that of traditional tobacco? Disseminating false information through popular science is not advisable.

E-cigarettes, as a new type of tobacco substitute, have rapidly gained popularity worldwide in recent years. With the expansion of the market scale, the debate on the harm of e-cigarettes has become increasingly intense. A widely spread view holds that the harm of e-cigarettes far exceeds that of traditional tobacco, and some self-media even give it the title of "modern drugs". This "harm of e-cigarettes is greater than that of traditional tobacco" argument has been widely spread through various channels, causing social panic. However, when we analyze the existing scientific research data in depth, we will find that this view has obvious scientific flaws and belongs to typical "rumor-based popular science".

According to the "Global Tobacco Epidemic Report" released by the World Health Organization in 2024, there are approximately 1.1 billion smokers worldwide, and the number of people who die each year due to tobacco-related diseases exceeds 8 million. Meanwhile, the number of global e-cigarette users has reached 85 million, and the market size has reached 125 billion US dollars. In China, there are about 300 million traditional cigarette consumers and approximately 15 million e-cigarette users. Behind these huge figures lies a significant issue concerning public health.

Before discussing the comparison of the harms between e-cigarettes and traditional tobacco, we need to clarify the essential differences between the two. Traditional tobacco generates smoke through combustion, which contains over 7,000 chemical substances, including 69 known carcinogens. On the other hand, e-cigarettes produce aerosol through heating the liquid, with the main components being nicotine, propylene glycol, vegetable glycerin and flavoring. The most crucial difference lies in that traditional tobacco releases nicotine through combustion, while e-cigarettes avoid the generation of a large amount of harmful substances during the heating and evaporation process.

The updated research report by Public Health England in 2024 indicates that e-cigarettes reduce harmful substances by approximately 95% compared to traditional cigarettes. This conclusion is based on a systematic comparison of the content of harmful substances in the aerosols of e-cigarettes and cigarettes, especially for primary carcinogens such as benzo[a]pyrene and N-nitrosamines. This data is widely cited by authoritative institutions such as the Cancer Research UK and the Royal Society of Medicine in the UK.

The toxicological studies conducted by the Food and Drug Administration (FDA) of the United States also indicate that the content of toxic compounds in the vapor of electronic cigarettes is significantly lower than that in traditional tobacco. A study published in 2023 in "Toxicological Sciences" found through biomarker analysis that the levels of carcinogenic substances in the bodies of people who have used electronic cigarettes for a long time are 56% to 97% lower than those of people who have smoked traditional tobacco, approaching the levels of those who have never smoked at all.

However, this does not mean that e-cigarettes are "safe". E-cigarettes do pose health risks, but compared to traditional tobacco, their harmfulness is much lower. The latest research shows that the vapor from e-cigarettes contains metal particles, certain volatile organic compounds and flavoring components. Long-term inhalation may cause inflammatory responses and oxidative damage to the respiratory system. A study presented at the 2024 American Thoracic Society Annual Meeting indicated that long-term use of e-cigarettes may increase the risk of chronic bronchitis and asthma, although this risk is approximately 73% lower than that of traditional tobacco.

Why does the misconception that "electronic cigarettes are more harmful than traditional tobacco" arise? This is related to several highly magnified incidents by the media. The "EVALI" (pulmonary injury associated with electronic cigarette use) outbreak in the United States in 2019 led to 68 deaths and drew global attention. However, subsequent investigations confirmed that these cases were mainly related to illegal THC-containing (marijuana component) electronic cigarettes containing vitamin E acetate, rather than compliant nicotine electronic cigarettes. The Centers for Disease Control and Prevention (CDC) of the United States has made this clear, but the related clarification failed to receive the same level of public attention as the initial panic.

Some media reports mislead the public by taking isolated sentences out of context. For instance, a study found that the concentrations of certain specific compounds (such as some aldehydes) in e-cigarette aerosols might be higher than those in traditional tobacco. However, this conclusion ignores two crucial facts: Firstly, these studies are often conducted under non-practical usage conditions, such as extremely high power settings; Secondly, a high content of a single compound does not equate to a high overall toxicity. Assessing toxicity requires considering the combined effects of all harmful substances. A meta-analysis published in the 2024 edition of the "Tobacco Control" journal indicates that under normal usage conditions, the overall levels of all major harmful substances in e-cigarette aerosols are lower than those in traditional tobacco.

How do the actual risks of electronic cigarettes compare with those of traditional tobacco? According to the "Health Impact Assessment of Electronic Cigarettes" report released by the National Academy of Sciences, Medicine and Health Sciences of the United States in 2024, we can make comparisons from the following aspects:

In terms of cardiovascular disease risk, traditional tobacco increases the risk of heart disease by 2-4 times, while the risk of e-cigarettes is about 25%-30% higher than that of traditional tobacco. Studies have found that former smokers who switch to e-cigarettes have a 42% reduction in inflammatory markers levels after 6 months, and their average blood pressure drops by 5 mmHg.

In terms of lung cancer risk, the risk of lung cancer for those who smoke traditional tobacco is 15 to 30 times higher than that for non-smokers. Although the long-term cancer risk of e-cigarettes still requires more research, the existing data indicate that the exposure level of carcinogenic substances from e-cigarettes is approximately 95% lower than that from traditional tobacco, and theoretically, the cancer risk will also be significantly reduced. The model of the Cancer Research UK predicts that the lung cancer risk from long-term use of e-cigarettes may be only about 1/20 of that from continuing to smoke traditional tobacco.

In terms of respiratory system health, traditional tobacco is the main pathogenic factor for chronic obstructive pulmonary disease (COPD), while the research on electronic cigarettes regarding respiratory system is relatively new. The research conducted by the Royal College of Physicians of the United Kingdom in 2023 indicated that patients who switched from traditional tobacco to electronic cigarettes showed an improvement of 15%-23% in lung function test results within one year, and their symptoms of coughing and sputum reduction were approximately 60%.

The greatest public health value of electronic cigarettes may lie in their potential as alternatives to traditional tobacco and as aids for quitting smoking. The United Kingdom is a representative country that has incorporated electronic cigarettes into its official smoking cessation strategies. Data shows that its effectiveness is remarkable. According to statistics from the National Health Service (NHS) of the UK, the success rate of using electronic cigarettes as an aid for quitting smoking is 59.7%, which is much higher than that of nicotine replacement therapy (NRT) at 34.4% and no-aided smoking cessation at 7.5%. Countries such as New Zealand and Canada have also adopted similar strategies, incorporating electronic cigarettes as harm reduction tools into their tobacco control frameworks.

In China, the situation is more complex. The revised "Regulations on the Implementation of the Tobacco Monopoly Law of the People's Republic of China" in 2021 included electronic cigarettes under tobacco monopoly management, and the national standard GB41700-2022 for electronic cigarettes was implemented in 2022. According to statistics from the State Tobacco Monopoly Administration, there are currently about 1,500 electronic cigarette enterprises in China, with an annual sales volume of approximately 45 billion yuan. Domestic specialized research shows that only about 27% of Chinese electronic cigarette users smoke them to quit smoking. This proportion is much lower than 68%-73% in European and American countries, indicating that electronic cigarettes in China are more regarded as fashionable products rather than tools for quitting smoking.

The issue of teenagers' use of e-cigarettes is also a focus of concern for all parties. A survey released by the Chinese Center for Disease Control and Prevention in 2024 showed that the usage rate of e-cigarettes among people aged 15-24 was 4.5%, among which 71.3% used traditional tobacco simultaneously. Data from the US Centers for Disease Control and Prevention indicated that the usage rate of e-cigarettes among high school students in the US dropped from 27.5% in 2019 to 10.3% in 2023. Although the data fluctuated, the consensus on protecting teenagers from the influence of nicotine products has been formed.

The health impacts of nicotine itself are often confused as well. Although nicotine is addictive, it is not the main component of traditional tobacco that causes cancer and diseases. Professor John Britton, the director of the National Addiction Research Centre in the UK, pointed out: "The health risks level of nicotine is comparable to that of caffeine, while the tar and carbon monoxide produced by tobacco combustion are the real killers." This is why nicotine replacement therapies (such as nicotine patches and gum) are widely accepted as safe methods for quitting smoking.

Regarding the issue of second-hand smoke from electronic cigarettes, a study published in the journal Environmental Science & Technology in 2024 indicates that the concentration of harmful substances in the vapor of electronic cigarettes in the air is approximately 90%-99% lower than that of traditional tobacco, and the evaporation rate is also faster. Although it is not completely harmless yet, its environmental pollution level is significantly lower than that of traditional tobacco.

In the face of scientific data, the claim that e-cigarettes are "more harmful than traditional tobacco" is clearly untenable. Such "rumor-spreading-style popular science" not only misleads the public but also may prevent smokers from turning to less harmful alternatives, indirectly maintaining the high harmfulness of traditional tobacco.

Of course, a rational view of e-cigarettes also needs to avoid going to the other extreme – promoting them as completely harmless health products. E-cigarettes do have certain health risks, especially for those who have never used nicotine products before. The advice from Cancer Research UK is perhaps the most balanced: "For smokers, switching to e-cigarettes can significantly reduce health risks; for non-smokers, especially teenagers, it is best to avoid using any nicotine products at all."

The regulatory strategies of various countries towards e-cigarettes also reflect this balanced approach. The UK actively promotes e-cigarettes as a smoking cessation tool, but strictly restricts marketing aimed at minors; New Zealand incorporates e-cigarettes into its "Ending Tobacco" strategy; while countries like China and the US adopt a more cautious regulatory stance, emphasizing the prevention of e-cigarette use among teenagers. These differences also reflect the varying understandings of balancing tobacco control and e-cigarette harm reduction among different countries.

The attitudes of medical experts towards e-cigarettes are gradually converging into a consensus. In its official statement in 2024, the American Society of Clinical Oncology stated: "Although e-cigarettes should not be regarded as harmless products, for those who are unable to quit smoking through other means, switching from traditional tobacco to e-cigarettes may reduce health risks." The German Cancer Research Center advocates "differential regulation", that is, adopting different levels of strict control measures for traditional tobacco and e-cigarettes, reflecting their different levels of harm.

The experiences of ordinary users on social media also provide valuable references. A user with 50,000 followers on Weibo shared: "I successfully quit smoking traditional cigarettes after using electronic cigarettes for 15 years. After one year, the results of my physical examination improved significantly, and my lung function recovered a lot." Of course, there were also negative comments: "After trying electronic cigarettes, I ended up using both products simultaneously, and my nicotine intake actually increased." These real experiences remind us that everyone's situation may be different, and electronic cigarettes are not a universal solution suitable for everyone.

Exploring the comparison of the harms between e-cigarettes and traditional tobacco is not to advocate the use of any nicotine products, but to conduct rational discussions based on scientific evidence. In the field of public health, accurate and balanced information is particularly crucial. Whether it is the "rumor-spreading-style popular science" that exaggerates the harms of e-cigarettes or the commercial marketing that completely ignores their potential risks, neither is conducive to the public making wise choices.

The most ideal situation would be to refrain from using any tobacco or nicotine products at all. However, for smokers who are already addicted, choosing less harmful alternatives might be a realistic way to mitigate health risks. Public health policies need to strike a balance between the ideal goals and the practical feasibility, and this balance must be based on science rather than emotions.