Electronic cigarettes (e-cigarettes), or what many refer to as vapes, are devices used by many former cigarette smokers, as they believe they are less harmful than traditional smoking. However, over time, even individuals with no prior history of smoking have increasingly begun using these devices. Particularly among young people, excessive use of these devices has become more rampant than ever, largely due to the growing vape businesses across several parts of the world.

The Philippines, for one, has seen an increase in e-cigarette use among the youth. Vape advertising materials are not helping curb this increase either, as vape devices now come in several flavors (even compelling ones like matcha, bubble gum, grapes, strawberry, and more) and are designed, presumably, to entice the youth. These devices can also be easily accessed anywhere, contributing to the rise of vaping among Filipinos. According to the Philippine Legislators' Committee on Population and Development’s 2024 report, the country has seen a stark increase in the use of these devices, especially among young people.

This increase has proven to be so alarming that the Department of Health (DOH) has called for a nationwide full ban on vape products, criticizing their misleading advertisements that portray these devices as a much safer alternative to traditional cigarettes. But how true is that?

As the world continues to evolve, smoking — a dangerous vice in itself — has somehow evolved too. E-cigarettes now come in different sizes and flavors, and some are even sold in convenience stores. They also do not smell like smoke at all compared to cigarettes, making them seem like a better alternative, especially for former cigarette smokers. However, one cannot help but raise the question: Is it really safer than traditional cigarettes, or have advertisements misled us to believe that it is?

E-Cigarettes or Vape Is Far from a Safer Option. What are the Health Risks?

Most people are aware of its risks, but some are not even sure to what extent. While the information is out there, determining whether it is a much better alternative remains far too complicated. According to the National Library of Medicine, e-cigarettes were first introduced to the U.S. market in 2006 and were marketed as a safer alternative to cigarette smoking. It did not take long for them to be introduced on a global scale, and they are still considered a relatively new method compared to traditional smoking. That said, heavy vape users have not yet reached an old age that would allow researchers to determine their long-term effects.

Dr. Lars Ben Hayahay, a professional in the field of Internal Medicine, said that comparing e-cigarette “to cigarette smoking's ocean of research” is somewhat comparable to “David and Goliath.” He added that e-cigarettes have not been around long enough to determine what kind of damage they might cause, especially for frequent users. Hayahay believes that “we need more studies” before we can really say vaping is the “lesser evil.” By that, he means that “we need to wait until the vapers become senior citizens.”

Can E-Cigarettes Help People Break the Smoking Habit?

Short answer: No. Since e-cigarettes also contain nicotine, they are highly addictive, making them a poor alternative for cigarette smokers who are attempting to quit smoking for good. Instead, users may end up addicted to vaping in the long run. According to Hayahay, this is one of the misconceptions about e-cigarettes — that they are less addictive than traditional cigarettes — when it is actually the other way around. The problem is that, as stated earlier, these devices have not been around for very long, and researchers have yet to discover their long-term effects on people.

“From my current understanding, vape does not have the usual cancer-causing ingredients of cigarettes like tar, acetaldehyde, formaldehyde etc., so from there you could deduce that it might be ‘safer,’ but we have yet to discover if the ingredients of vape could cause side effects in long term, because it has only been really out in the market for [roughly] 10 years compared to cigarette,” said Hayahay. “There are some medications that have been pulled out from the market because of side effects; we have yet to wait [and see] if vape has one.”

While it is still too early to determine its effects, Hayahay said that we can expect our bodies to react to any substance we introduce into them. He said, “I really do not want to go technical on this, but let's just say that the lungs' purpose in life is to inhale oxygen and exhale carbon dioxide. So if you introduce a foreign object (whether gas, liquid, or aerosol) to the lungs, it reacts to protect [itself] against it. So it calls on the immune system (like the army/police) to treat and neutralize the ‘irritant.’ During the process, it damages the surrounding healthy tissue, like crossfire. So whether you use cigarettes [and/or] vape, as long as it is not oxygen (or any essential gas), you expect the body [to react] to it.”

When asked how nicotine dependence differs between cigarettes and vaping devices, Hayahay said it “could be tricky,” but offered one explanation: the amount of nicotine people inhale. With cigarettes, people can usually keep track of how many sticks they have smoked. With vaping, however, it is much harder to determine the exact intake. Since vaping devices are far from traditional cigarette sticks, chances are people may be consuming more without realizing it.

“Think of it this way: in cigarettes (1 stick = to ‘x’ amount of nicotine), so you have a conscious understanding of how much you are taking per day. Like if you consume around 1 pack per day, [you know you’ve had about 20 cigarettes]. But in vaping, you don't really feel [or] see that you are consuming one stick. You just inhale and refill as much as you think you need. Since you can't quantify ‘how many sticks' you have been inhaling per day, you feel less... You feel [as though] you are on the healthier side,” he explained.

Vaping Is the “Lesser Evil” — For Now

While studies on the long-term effects of vaping are still limited, Hayahay believes that “it’s not really a ‘safer’ option,” but more like the “lesser evil.” He refuses to consider vaping a “medically acceptable” option for smokers who are trying to quit. Moreover, limited studies do not mean that there are no identified complications. According to the American Lung Association, excessive use of these devices could cause EVALI (e-cigarette or vaping product use-associated lung injury), and its effects on the lungs could be “fatal” and often require hospitalization.

First identified in 2019, EVALI’s common symptoms include chest pain, vomiting, fever, shortness of breath, headache, and more. Back in 2024, the Philippines recorded its first-ever vape-related death, involving a 22-year-old male who died of a heart attack caused by severe lung injury. The Department of Health linked his death to daily vaping for approximately two years. He had no known comorbidities and was considered healthy due to his sporty lifestyle, but doctors found that his lungs were severely damaged by vape chemicals.

Many people take up vaping as an alternative to cigarettes, believing that they are avoiding future tobacco hazards. However, with recent records of vape-related fatalities, no matter how few they may be, it is clear that these devices are far from safe. In 2020, over 60 deaths were attributed to EVALI, according to the Centers for Disease Control and Prevention. Calling vaping the “lesser evil” is still debatable at this point, since we have yet to determine the full extent of the damage it could cause to our bodies.

Stepping out on a journey to quit smoking for good is commendable, as it is a clear and brave sign that you are starting to take good care of your health. Making the decision to quit is never easy, as nicotine addiction can be both physically and mentally challenging to overcome. However, switching to vaping, with all its uncertainties and potential risks, might not be a better option. While some may view e-cigarettes as a “safer” alternative, the truth is that their long-term health effects are still largely unknown.

Fortunately, there are other, safer alternatives people can use, including over-the-counter patches, nicotine gums, and lozenges. These options provide controlled doses of nicotine to help manage withdrawal symptoms while gradually reducing dependence. Some known products include Nicorette and Quitine.

Hayahay believes vaping products should be regulated to the same extent as cigarettes. With the Department of Health’s proposal for a complete ban on vape products, the internal medicine specialist supports stricter regulations to protect public health, backing a total ban not only on cigarettes but on vapes as well. 

Dr. Lars Ben M. Hayahay is an Internal Medicine physician who completed his residency training at Quezon City General Hospital. He is a member of the Philippine Medical Association and the Philippine College of Physicians, an alumnus of the University of Santo Tomas, and has over six years of clinical experience.