With their DayGlo packaging, LED lights and sweetly scented smoke, vapes are hard to ignore; in fact, in summer 2023, they feel ubiquitous. Heading to the park for a barbecue? Odds are you’ll spot a highlighter-esque e-cigarette dangling from someone’s mouth. Walking down your local high street? Count the vape shops. After-work drinks? Spot your vaping colleagues huddled in the smoking area (or, if they’re prepared to brazen it out, taking a drag indoors).

Vapes were introduced to the UK market less than two decades ago; now, there are estimated to be more than 4 million adult vapers in the UK, according to public health charity Action on Smoking and Health (ASH). They’re particularly popular, it seems, with Gen Z. Research from insights agency Statista found that 27% of surveyed 18-19 year olds and 19% of 20-24 year olds vaped at least occasionally. Disposable e-cigarettes tend to be a Gen Z go-to: from January 2021 to January 2022, the use of disposable vapes in 18-year-old vapers rose from just 0.89% to 56.7%.

As their popularity has increased, controversies have raged. Vaping has polarised opinion among medical experts and worried environmental activists: a report from the Bureau of Investigative Journalism found that two disposable vapes are being thrown away every second in the UK, adding up to an estimated 10 tonnes of lithium in landfill every year, enough to make around 1,200 electric car batteries. 

This week alone, you might have spotted the news that Glastonbury has banned disposable vapes for the first time (“they pollute the environment and can be hazardous at waste centres”, the festival’s guidance reads) or heard NHS chief executive Amanda Pritchard calling for a crackdown on youth vaping after figures showed that the number of under-20s admitted to hospital with “vaping-related disorders” last year had almost quadrupled compared to 2020. Or perhaps you read about the report from medical researchers at the George Institute for Global Health, which called for “a complete ban on e-cigarette advertising”.

So, what do we know about the health implications? “When we’re talking about vaping, it’s really important that we also talk about smoking,” says Dr Katherine East, research fellow in the Nicotine Research Group, part of King’s College London’s Institute of Psychiatry, Psychology and Neuroscience. “We know that around half of lifelong smokers will die prematurely as a result of their smoking. And what the data tells us is that vaping is substantially less harmful than smoking,” she adds. “When we look at a range of different toxicants that people are exposed to, levels of those toxicants are much lower among people who vape compared to people who smoke.”

Cigarettes contain hundreds of chemicals, but this rises to thousands (more than 5,000, according to Cancer Research UK) when they are burned. “If you burn anything, combustion is involved, and things become harmful,” says Professor Lion Shahab, professor of health psychology and co-director of University College London’s Tobacco and Alcohol Research Group. “A very well-known example of this is if you ever burn toast, you expose yourself to volatile organic compounds that are carcinogenic and harmful,” he explains. With e-cigarettes, “there’s no combustion going on”, so there is no tar or carbon monoxide released. 

Shahab says: “[There is] good quality evidence from randomised control trials and also on population studies [to show] that e-cigarettes are very effective at getting people to stop smoking completely.” And the government has doubled down on this approach: back in April, the Department of Health and Social Care announced a ‘swap to stop’ scheme, which will provide almost one in five smokers in England with a vape kit. It’s a world first, and it is rooted in the idea of harm reduction, Shahab explains. “You want to get people away from the most harmful product… and then eventually just stop using any kind of nicotine-containing products.”

Both Shahab and East, however, stress that vaping is not without risks. Also, it is hard to predict the potential long-term repercussions. “The complicating factor when it comes to saying anything with great certainty is that, unfortunately, most of the diseases that are caused by smoking – lung cancer, for instance – take about 20 to 40 years to develop once you start using [cigarettes],” Shahab says. “So because e-cigarettes haven’t been around long enough, it’s difficult at this stage to say with 100% certainty that it will reduce the risk of these diseases.” Common side effects include headaches, shortness of breath, coughing and throat and mouth irritation, according to the NHS.

What about the environmental impact? Disposable vapes are often made from single-use plastic, with batteries containing heavy metals (like the aforementioned lithium), which can leak and even pose a fire risk. Whether a ban on disposable vapes at festivals like Glastonbury will make a difference is not entirely clear, though. East suggests: “It’s important that regulations for vapes are proportionate to those for cigarettes… The disposal of cigarette butts is incredibly problematic from an environmental perspective as they also contain plastic. Since the vast majority of people who vape also currently or used to smoke [cigarettes], Glastonbury festival may end up with many more cigarette butts on the ground than disposable vapes.” An e-cigarette recycling station, she adds, might be a useful alternative. 

As East notes, most vapers are current or former smokers: the number of ‘never’ adult smokers, as ASH calls them, who currently vape regularly is low (1.3%). You might also have seen headlines warning of an “epidemic” of vaping among children, drawn to vaping by the bright colours and fun flavours (it’s currently illegal to sell vapes to under-18s in the UK). If you look at the most recent statistics from ASH, there was “no significant change between 2022 and 2023 in the proportion of 11- to 17-year-olds currently vaping or smoking” – however, the proportion of children experimenting with vaping did grow by 50% year on year, from one in 13 to one in nine.

Just over half (51%) of current vapers in the same age group said that the e-cigarette they use most often always contained nicotine, which is highly addictive and can harm the developing teenage brain; worries about the impact on the younger generation prompted the Australian government’s recent crackdown, banning the importation and sale of all e-cigarettes (labelled as containing nicotine or not) for recreational use. “You can get them as a [smoking] cessation tool, but you have to get [them] prescribed,” Shahab explains.

There is currently advertising regulation in place, he adds, that stops nicotine products being marketed to appeal to younger people - but it can be “very tricky” to enforce, as “a lot of the marketing occurs via social media, such as TikTok, which is difficult to regulate”. One especially concerning loophole, allowing vaping companies to give free samples to children, is set to be closed as part of Rishi Sunak’s attempts to cut down on youth vaping, a move that the Independent British Vape Trade Association (IBVTA) said they applauded, adding that “no self-respecting business should ever have considered exploiting [the loophole]”. 

Sunak also announced the formation of an “illicit vape enforcement squad”, as well as measures to further clamp down on ads targeted at kids. But what else might help? East recently worked on a study which found that standardising vape packaging by getting rid of branded imagery “seems to reduce appeal to youth” by around a quarter, but “didn’t discourage adults from wanting to try vapes”. That’s important, she explains, because it means that adult smokers wouldn’t be deterred from trying vapes to quit smoking. Dr Ali Kermanizadeh, lecturer in clinical biochemistry and toxicology at the University of Derby, suggests that more research into “the potential toxicological effects of humectants, flavourings and related products [in vapes] after the heating process” will be an “important” next step too, along with investigating the effects on consumption “on the extra-pulmonary organs and systems, in particular the cardiovascular [or circulatory] system”.

The heated debate around this very modern phenomenon looks unlikely to cool off any time soon. Perhaps the biggest question is whether the availability of vapes is helping smokers out of addiction or getting a fresh cohort hooked on nicotine. 

Images: Getty