Vaping: what are the health risks?

E-cigarettes: long-term use, often linked to the smoking of tobacco

Since electronic cigarettes (e-cigarettes) first appeared in the 2010s, their use has grown steadily. In France, more than six out of every 100 adults vape on a daily basis, i.e. more than 3 million people, according to Santé publique France's 2024 barometer. This practice, which is set to continue, has seen the development of an increasingly diverse product offering: a wide variety of devices, an extensive range of flavours, and the possibility for users to prepare their own e-liquids (DIY approach), by varying the ingredients and their proportions. 

Vaping is based on heating a liquid without combustion. However, the absence of combustion does not rule out exposure of the vaper to toxic substances. Given the sharp growth in this use, ANSES undertook a specific assessment of the health risks associated with vaping. This expert appraisal was based on:

• an analysis of the scientific literature;
• an assessment of the risks associated with the inhalation of certain substances;
• surveys of vaping practices in France, among the general population and certain specific populations, particularly adolescents.

Possible medium- and long-term health effects

As a reminder, the health effects of smoking tobacco are serious, proven and well-documented. With regard to vaping, analysis of the available scientific studies showed that it is associated with possible health effects in the medium and long term. More specifically, the Agency reached the following conclusions:

• the probable occurrence of cardiovascular effects, such as increased blood pressure, when the products contain nicotine;
• the possible occurrence of effects on the respiratory tract, the cardiovascular system and carcinogenesis, with or without nicotine;
• the possible occurrence of effects on the cardiovascular and respiratory development of the foetus exposed in utero, with or without nicotine.

Knowledge of vaping does not go back as far as that of tobacco, and it is difficult to study the distinction between the specific effects of vaping and those of smoking tobacco because of the histories of use, since almost all adult vapers are current or former smokers.

Risks associated with the inhalation of toxic substances

The expert appraisal assessed the risks associated with certain substances emitted and inhaled during vaping. ANSES conducted this assessment using the available data on several aldehydes (acetaldehyde, acrolein, formaldehyde, furfural, glyoxal, propionaldehyde), which are substances known for their toxic effects – particularly carcinogenic – and still found in the emissions of vaping products.

This assessment showed that the absence of combustion does not mean that aldehydes are not found in vaping emissions, and that inhalation of these substances poses a health risk to vapers. To reduce this exposure, the Agency:

• recommends that consumers be better informed of the risks associated with their practices;
• reminds manufacturers of their responsibility for the safety of vaping devices and liquids;
• supports tighter regulation of ingredients, by introducing restrictions on use or prohibiting those that pose a health risk.

Avoid any encouragement to vape among non-smokers and young people

In view of the identified risks, ANSES recommends avoiding any encouragement to take up vaping, particularly among non-smokers and young people, and guarding against the normalisation of e‑cigarettes in any way. Consumption among adolescents is largely driven by the latest trends and the appeal of certain fruit-flavoured vaping products. The possible presence of nicotine raises specific issues in terms of addiction.

The Agency reiterates the importance of effective enforcement of existing provisions banning the sale of vaping products to minors, and the advertising and promotion of these products.

Vaping to stop smoking: a temporary option

While the Agency warns against the risks associated with vaping, e-cigarettes can be considered as a temporary option for people who are finding it difficult to give up smoking. Vaping should be part of a smoking cessation programme, exclusively, alongside existing support schemes.

ANSES therefore stresses the importance of the role played by healthcare professionals (tobacco addiction specialists, general practitioners, nurses, pharmacists, etc.) in helping smokers and vapers, and recommends that they be given more information and training on vaping products.