As evidence supporting vaping grows, so does misinformation about the relative risk of the products. Widespread misperceptions could prevent smokers from switching to the safer alternatives that could substantially reduce their exposure to toxicants.
The way health authorities communicate about vaping can influence whether smokers understand, reject or embrace safer alternatives. As evidence supporting vaping as a smoking-cessation tool continues to strengthen, researchers are increasingly recognising that consumer perceptions and experiences are themselves important public-health outcomes.
This is where consumer-reported outcome measures (CROMs) can add valuable insight. As discussed recently in a GFN Science Lab session featuring Christelle Chrea, CROMs are designed to capture what consumers think, feel, and do when using tobacco and nicotine products. They include straightforward descriptive measures, such as frequency and patterns of use, alongside psychometric measures examining concepts such as perceived risk, dependence, satisfaction and attitudes.
That distinction is particularly important in vaping. A product can have a substantially different risk profile from cigarettes, yet if smokers believe the two products are equally dangerous, they may have little incentive to switch.
Risk perception is becoming a public-health problem
Recent British data illustrate the scale of the problem. The 2026 Action on Smoking and Health (ASH) survey of more than 13,000 adults found that 54% of respondents believed vaping was as harmful as or more harmful than smoking. Among smokers who had never vaped, the proportion was even higher, at 61%. Sadly, only 29% correctly recognised that vaping is less harmful than smoking.
This matters because perceptions of relative risk can influence behaviour. Someone who believes switching from cigarettes to vaping merely exchanges one form of serious harm for another may reasonably conclude that there is little reason to make the change. Yet the evidence base does not support treating smoking and vaping as equivalent.
Research has consistently shown that vapes are significnatly safer than cigarettes since they do not burn tobacco or produce tar and carbon monoxide, two major components of tobacco smoke. It has also been noted that vaping carries only a small fraction of the risk of smoking, while acknowledging that it may not be risk-free and that the long-term effects are not yet fully known. That distinction—risk-free versus lower-risk—is central to effective tobacco harm reduction.
When caution creates confusion
Recent changes to NHS wording, caught by the sharp eye of tobacco policy researcher Clive Bates, have nevertheless raised questions about whether increasingly qualified language could unintentionally reinforce public uncertainty. Bates highlighted that NHS guidance previously described vaping as “far less harmful than cigarettes”, before changing the wording in July 2026 to “likely to be far less harmful”. Earlier NHS Better Health material similarly used the phrase “substantially less harmful” before later shortening it to “less harmful”.
Acknowledging scientific uncertainty is not inherently wrong. Vaping has not existed in its current form for several decades, and continued research into long-term effects is entirely appropriate. The problem arises when caution obscures the magnitude of the difference between vaping and smoking.
Simply saying that one product is “less harmful” than another provides almost no information about the size of the difference. A product could theoretically be 5%, 50% or 95% less harmful and still satisfy that description. For smokers deciding whether to switch, that distinction is not semantic—it could be life-changing.
The cessation evidence is becoming harder to ignore
The strongest argument for clear risk communication is the growing evidence that nicotine vapes can actually help smokers quit. The latest Cochrane living systematic review, incorporating evidence available through March 2025, included 104 studies involving more than 30,000 adults who smoked. It found high-certainty evidence that nicotine e-cigarettes increase smoking-cessation rates compared with nicotine replacement therapy (NRT). The review estimated a relative risk of 1.59 compared with NRT, translating to approximately four additional quitters for every 100 people treated.
Cochrane also found that nicotine e-cigarettes probably outperform non-nicotine vapes.
Importantly, the review found no evidence of serious harm from nicotine e-cigarettes, although the authors emphasised that larger, longer studies are still needed to assess long-term safety. This evidence is consistent with earlier Cochrane network meta-analysis findings, which placed nicotine e-cigarettes alongside varenicline and cytisine among the most effective pharmacological approaches to smoking cessation.
The details behind the numbers
CROMs can help bridge the gap between clinical evidence and real-world behaviour. Researchers can measure whether someone has stopped smoking, but understanding why they switched (or why they returned to cigarettes) requires examining perceptions, satisfaction, dependence, product preferences and the subjective experience of using the alternative.
For example, ASH’s 2026 data show that 60% of current adult vapers in Great Britain are former smokers, representing approximately 3.3 million people. Another 1.7 million current vapers continue to smoke. Those figures demonstrate both the potential and the complexity of vaping as a harm-reduction intervention. Switching completely away from combustible tobacco is the key objective, but consumers’ experiences with nicotine delivery, flavours, convenience and cravings can influence whether that transition succeeds.
Clear communication is essential for harm reduction
Exaggerated risk perceptions can undermine the very behaviour public-health policy seeks to encourage. The NHS itself says that people who switch completely from smoking to vaping reduce their exposure to toxins associated with cancer, lung disease, heart disease and stroke.
That message does not require claiming that vaping is harmless. It requires communicating relative risk accurately and proportionately. For tobacco harm reduction to work, smokers need to understand not simply that vaping is “different” from smoking, but why the difference matters. CROMs can help researchers understand whether public-health messaging is achieving that goal.
As smoking continues to cause millions of preventable deaths worldwide, communicating uncertainty should not inadvertently create uncertainty about what is already well established. For an adult who would otherwise continue smoking, moving completely from combustible cigarettes to a regulated nicotine alternative represents a meaningful reduction in exposure to the toxic products of combustion.
The challenge for policymakers and health authorities is therefore not to eliminate every expression of uncertainty. It is to ensure that caution does not become confusion—and that confusion does not keep smokers smoking.