Cigarettes, Cigars and Vaping: Which Habit Puts You Most at Risk?

A Q&A on the comparative dangers of smoking and vaping

Makers of electronic cigarettes claim they are safer than tobacco products, and consumers are buying in. Since hitting the U.S market in 2007, e-cigarettes have exploded in popularity. But how do cigarettes, cigars and e-cigarettes really stack up when it comes to your health?

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Much is still unknown about e-cigarettes, especially in the long-term. To help sort fact from hype, head and neck surgeon Brandon Prendes, MD, answers questions about the dangers of smoking and what we know so far about e-cigarettes.

Q: How do e-cigarettes work?

A: E-cigarettes come in a variety of shapes and sizes. But all devices operate in the same way. A battery powers a coil, which heats a liquid that nearly always contains nicotine. This produces a vapor that users inhale, just as with a traditional cigarette.

This process, called vaping, resembles smoking, but no actual combustion occurs. E-cigarettes deliver nicotine without the tar and smoke of a traditional tobacco cigarette. But the user still receives a dose of nicotine directly into the lungs and bloodstream.

Q: Is vaping any safer than smoking cigarettes or cigars?

A: Cigarettes are still the No. 1 preventable cause of death in the United States.

“Cigarette smoking is the most well-researched of the three nicotine delivery systems and undoubtedly poses serious and significant health risks, which have been clearly defined,” Dr. Prendes says. “These include increased risk for head and neck, lung, esophageal, pancreatic and urologic cancers, as well as vascular, cardiac, pulmonary disease and wound healing issues.”

He says the overall health risk of e-cigarettes appears lower than that of traditional cigarette smoking.

He adds, however, “The long-term health risks and addiction risks associated with vaping are currently unknown, including the effect of e-cigarettes on lung health and cancer risks. More research must examine any health effects of inhalation.”

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Q: Why is more e-cigarette research needed?

A: In addition to the long-term health risks of vaping — which researchers can only study over time — several other questions remain unanswered.

Research links chemicals found in e-cigarette vapor, such as formaldehyde, with head and neck cancers, Dr. Prendes says.

Common chemicals in certain e-cigarettes, as well as in their flavorings, meet the Food and Drug Administration’s (FDA) definition of generally recognized as safe. But that FDA designation applies to oral ingestion.

“These substances have unknown health effects on the lungs and need more study,” Dr. Prendes says. 

Q: How do cigars compare with cigarettes and vaping?

A: Some cigar smokers don’t inhale and/or don’t smoke as frequently as cigarette smokers. This may suggest that cigar smoking is somehow safer. But that is not true.

“Cigar smoking carries similar health risks to cigarette smoking,” Dr. Prendes says.

Research links it to oral, esophageal, pancreatic, laryngeal and lung cancers, coronary artery disease and aortic aneurysm.

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“Most of these risks are still elevated even in smokers who don’t inhale,” he says.

In relation to vaping, he says, “There is no research to my knowledge comparing these two delivery systems specifically, but it is a widely held view among physicians and authorities that combustible tobacco use — which includes cigars — is more hazardous to health than e-cigarette use.”

Q: Can e-cigarettes help smokers quit?

A: There is some evidence that e-cigarettes help smokers give up tobacco, Dr. Prendes says. And some smokers prefer e-cigarettes over traditional nicotine replacement therapies like patches and gum. But, with the lack of long-term data, doctors should still recommend the conventional therapies first, he says. 

“If patients have tried all of these methods and are still unable to quit combustible tobacco products, then e-cigarettes may provide assistance to some patients to help them quit,” he says.

Q: What’s the bottom line on the risks of cigarettes, cigars and e-cigarettes?

A: While Dr. Prendes and most experts, including those at the Centers for Disease Control, agree that e-cigarette use poses lower health risks, nicotine in any form is dangerous. Pregnant women and those who have a heart condition are particularly vulnerable and should avoid cigarettes, cigars and vaping.

Dr. Prendes’ best advice is that if you don’t smoke or vape, don’t start. If you are a smoker or a vaper, get help to kick the habit to improve your health in the long-term.

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