The Risks to Know as Smoking Declines and Vaping Rises

Nearly 10% of U.S. adults smoked cigarettes in 2024, a historic low. But at the same time, 7% reported using e-cigarettes, a number that has steadily climbed in recent years. 

The shift marks a turning point in tobacco use. Traditional smoking, long considered one of the leading preventable causes of death, continues to decline after decades of public health campaigns. But vaping is rising in its place, particularly among younger populations, reshaping nicotine use in a way many experts did not anticipate. 

The Changing Landscape of Nicotine Use 

For years, progress against cigarette smoking was seen as one of public health’s greatest success stories. Smoking rates have dropped dramatically from more than 40% of U.S. adults in the 1960s to under 10% today. 

But that progress is becoming more complicated. 

E-cigarettes, often marketed as a safer alternative or a tool to quit smoking, are now widely used across the country. In 2024 alone, millions of adults reported current e-cigarette use, with higher rates in younger age groups and rural communities. 

Even more concerning, many young adults who vape have never smoked traditional cigarettes at all. What began as a potential off-ramp from smoking is, for many, becoming a starting point. Public health experts warn that while cigarettes are declining, nicotine addiction is not disappearing. It is evolving. 

Dr. Ferrer’s Take 

Among pulmonologists, vaping is increasingly viewed not as a safer alternative, but as a new and rapidly developing health threat. 

“People assume vaping isn’t harmful because it’s seen as an alternative to cigarettes,” Dr. Gustavo Ferrer says. “But that doesn’t mean it’s safe.” 

In fact, based on his clinical experience and the growing body of research, he argues the opposite. 

Here is why, according to Dr. Ferrer’s experience and current research, vaping is just as harmful, if not worse, than smoking cigarettes. 

1. Lung damage and breathing problems 🫁

Vaping exposes the lungs to heated chemicals that can cause immediate irritation and inflammation. Patients may develop coughing, wheezing, and reduced lung function, and in more severe cases, conditions like EVALI. Unlike traditional smoking, which often takes years to show damage, these effects can appear much faster, especially in younger users. 

2. Stronger and earlier nicotine addiction 🚬

Many vapes deliver high concentrations of nicotine, often more efficiently than cigarettes. For teens and young adults, this is especially concerning. Nicotine can disrupt brain development, affecting attention, mood, and impulse control, while creating a strong and early dependency that can be difficult to break. 

3. Exposure to toxic chemicals ⚠️

Despite the perception that it is “just vapor,” e-cigarette aerosol contains harmful substances including formaldehyde, heavy metals, and ultrafine particles. These can penetrate deep into the lungs and may even damage DNA in lung cells, raising long-term concerns about cancer risk. 

4. Cardiovascular stress and heart risks 🫀

Nicotine affects more than the lungs. It increases heart rate and blood pressure and can damage blood vessels over time. Emerging research shows vaping can cause immediate cardiovascular strain and may contribute to long-term risks like heart disease and heart failure. 

5. A gateway to long-term nicotine use 🔄

Perhaps most concerning, Dr. Ferrer notes, is how vaping introduces nicotine to people who may have never smoked before. Early exposure, particularly in teens, increases the likelihood of long-term addiction and can lead to continued nicotine use or even transition to traditional cigarettes. 

Taken together, these risks challenge the idea that vaping is a safe alternative. 

Instead, Dr. Ferrer says, it is creating a new and faster-moving public health problem, one that is already impacting a new generation. 

What This Means Moving Forward 

The latest data reflects both progress and a new challenge. Fewer people are smoking cigarettes than ever before, but nicotine use remains widespread, just in a different form. 

While the long-term health effects of vaping are still being studied, early evidence suggests the risks are real and potentially significant. Cigarette use may be falling, but the rise of vaping shows the underlying issue has not gone away. It has simply changed form, and the full consequences are still unfolding.