Introduction
Vaping was once promoted as a safer alternative to smoking. However, emerging evidence indicates that electronic cigarettes (e-cigarettes) may pose equal or even greater health risks compared to traditional cigarettes, particularly among youth. Unlike conventional tobacco products, vape liquids often contain a complex mix of chemicals, heavy metals, and flavouring agents that can bypass detection and regulation. Their sleek designs, enticing flavours, and the misconception of being “less harmful” have made vapes a gateway to nicotine addiction for a new generation.
In Malaysia, the removal of nicotine from the Poisons Act in 2021 created a legal loophole that allowed unregulated vape products to proliferate. Although the Control of Smoking Products for Public Health Act 2024 was gazetted to address this issue, enforcement remains challenging. The health costs of inaction are escalating and may soon surpass the damages caused by traditional cigarettes.
What Makes Vaping More Dangerous Than Cigarettes
1. Rapid Uptake Among Youth and Stronger Addiction
Vapes appeal to adolescents with thousands of flavours, sleek devices, and a strong presence on social media platforms. Many vape products contain higher nicotine concentrations than traditional cigarettes, delivered via nicotine salts that are more readily absorbed and less irritating, enabling deeper and longer inhalation (Benowitz & Fraiman, 2022).
In Malaysia, data from the National Health and Morbidity Survey (NHMS) 2022 indicated that 14.9% of adolescents aged 13–17 were current e-cigarette users, with a higher prevalence among males (23.3%) compared to females (6.2%) (Institute for Public Health, 2022). Alarmingly, nearly half of these users initiated vaping before the age of 14.
2. Exposure to Unregulated Chemicals and Aerosolised Toxins
While cigarettes have known contents, vapes deliver poorly characterised chemical cocktails. Scientific studies have identified harmful substances in vape aerosols, including formaldehyde, acrolein, lead, cadmium, and nickel. These compounds can cause DNA damage, inflammation, and systemic toxicity (Olmedo et al., 2018).
Additionally, some compounds in vape aerosols, such as vitamin E acetate and benzyl alcohol, have no history of safe inhalation use and have been implicated in severe lung injuries.
3. Acute Lung Injuries Not Observed in Cigarette Smokers
Traditional cigarette smoking is associated with chronic lung diseases developing over the years. In contrast, vaping has been linked to acute, life-threatening lung injuries, such as E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI), occurring after weeks or months of use. Patients suffer respiratory failure requiring ventilation, and some have died (Chand et al., 2023). Such rapid-onset pulmonary toxicity is virtually unheard of with cigarette smoking.
4. Systemic Health Effects Beyond the Respiratory System
Vaping has demonstrated harmful effects across multiple organ systems, including the gastrointestinal tract, brain, oral cavity, kidneys, and reproductive system. Studies indicate that vaping alters brain structure and impairs memory, attention, and mood, especially in adolescents (Lopez-Ojeda & Hurley, 2024). Animal models have shown that vaping disrupts intestinal barriers and triggers inflammation (Sharma et al., 2022).
5. Increased Risk of Smoking Initiation and Dual Use
Rather than replacing cigarettes, vapes are creating a new generation of dual users, individuals who smoke and vape. Adolescents who vape are more than three times as likely to start smoking cigarettes (Soneji et al., 2017). This trend undermines the potential harm reduction benefits of vaping and perpetuates nicotine addiction.
6. Unproven Efficacy as a Smoking Cessation Tool
While some trials suggest that nicotine-containing e-cigarettes may aid smoking cessation, real-world studies show mixed results. A Cochrane review noted low certainty of evidence for sustained cessation and highlighted a high risk of relapse and dual use (Hartmann-Boyce et al., 2022). Most adult vapers do not quit smoking; instead, they continue using both products.
7. Environmental and Secondhand Exposure Risks
E-cigarette waste, including cartridges, pods, and lithium batteries, contributes to environmental pollution. Aerosol residues accumulate on indoor surfaces, exposing non-users, especially children and pregnant women, to passive vaping. The World Health Organisation has declared secondhand exposure to e-cigarette aerosol unsafe (Jankowski et al., 2019).
Conclusion
Scientific evidence confirms that vaping poses serious health risks across the respiratory, cardiovascular, neurological, and gastrointestinal systems. Youth are disproportionately affected, and the claimed benefits of vaping, especially for smoking cessation, are not supported by strong data. Enforcement difficulties undermine regulatory measures, and the mounting health and environmental consequences are a concern. A comprehensive ban on vape products is a necessary and urgent public health action.
References
• Benowitz, N. L., & Fraiman, J. B. (2022). Clinical pharmacology of electronic nicotine delivery systems (ENDS): Implications for benefits and risks in the promotion of smoking cessation. Journal of Clinical Pharmacology, 62(1), 1–14. https://doi.org/10.1002/jcph.1982
• Chand, H. S., Muthumalage, T., Maziak, W., & Rahman, I. (2023). Pulmonary toxicity and the pathophysiology of electronic cigarette, or vaping product, use associated lung injury. Annals of the American Thoracic Society, 20(2), 177–185. https://doi.org/10.1513/AnnalsATS.202209-796ST
• Hartmann-Boyce, J., McRobbie, H., Lindson, N., Bullen, C., Begh, R., Theodoulou, A., Notley, C., Rigotti, N. A., Turner, T., Butler, A. R., & Hajek, P. (2022). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, (11). https://doi.org/10.1002/14651858.CD010216.pub7
• Institute for Public Health. (2022). National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey Highlights. https://iku.gov.my/images/nhms-2022/Report_Malaysia_nhms_ahs_2022.pdf
• Jankowski, M., Brożek, G., Lawson, J., Skoczyński, S., & Zejda, J. E. (2019). E-cigarettes are more addictive than traditional cigarettes—A study in highly educated young people. International Journal of Environmental Research and Public Health, 16(13), 2279. https://doi.org/10.3390/ijerph16132279
• Lopez-Ojeda, W., & Hurley, R. A. (2024). Vaping and the brain: Effects of electronic cigarettes and e-liquid substances. The Journal of Neuropsychiatry and Clinical Neurosciences, 36(1), A41–A45. https://doi.org/10.1176/appi.neuropsych.20230184
• Olmedo, P., Goessler, W., Tanda, S., Grau-Perez, M., Jarmul, S., Aherrera, A., Chen, R., Hilpert, M., Cohen, J. E., Navas-Acien, A., & Rule, A. M. (2018). Metal concentrations in e-cigarette liquid and aerosol samples: The contribution of metallic coils. Environmental Health Perspectives, 126(2), 027010. https://doi.org/10.1289/EHP2175
• Sharma, A., Lee, J. S., & Dela Cruz, C. S. (2022). E-cigarettes compromise the gut barrier and trigger inflammation. iScience, 25(2), 103818. https://doi.org/10.1016/j.isci.2021.103818
• Soneji, S., Barrington-Trimis, J. L., Wills, T. A., Leventhal, A. M., Unger, J. B., Gibson, L. A., Yang, J., Primack, B. A., Andrews, J. A., Miech, R. A., Spindle, T. R., Dick, D. M., Eissenberg, T., Hornik, R. C., Dang, R., & Sargent, J. D. (2017). Association between initial use of e-cigarettes and subsequent cigarette smoking among adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics, 171(8), 788–797. https://doi.org/10.1001/jamapediatrics.2017.1488