ReCent Medical News

Smoke and mirrors – unmasking the risks of vaping

September 2025

Image: bedya - stock.adobe.com

Vaping, or e-cigarette use, has become a significant global health concern over the last few years, with alarming increases in use particularly amongst our youth and young adults.[1][2][3][4]

Vaping trends and health risks: a global perspective

Whilst vaping has been advertised in the past as a safer alternative to tobacco smoking and promoted as a smoking cessation tool, the main drivers for vaping in many young users is out of curiosity or due to the influence of their peers.[1][4] The percentage of youth globally that have ever used e-cigarettes is reported to be 16.8%, with estimates closer to 30% in some countries such as Australia and Canada.[2][4][5] Even more concerning are the statistics indicating that the majority of young vapers are exposed to nicotine-containing vapes.[2][6] Non-smokers and young people that take up vaping seem to be more vulnerable to the associated health risks without the potential benefit of smoking cessation, and are, in fact, much more likely to start smoking regular cigarettes than those that do not vape.[7]

Vaping regulations and laws vary between countries, however, they are aimed at limiting vaping access and nicotine exposure in adolescents and ensuring e-cigarette use in adults is primarily to assist with smoking cessation or nicotine dependence, when clinically appropriate.

Estimates indicate that ~40% of the adult vaping population in the United States and 53% in the United Kingdom, are former smokers.[8][9] Although the use of nicotine containing e-cigarettes may assist people to give up cigarette smoking [10], an increasing proportion of people are dual users (meaning those that use both regular cigarettes and e-cigarettes).[11][12] The percentage of adult e-cigarette users that are dual users has been reported to be ~30% in the US, ~ 35% in Australia and 39% in the UK.[1][8][9] Concerningly, studies indicate that dual use is potentially even more harmful than exclusive cigarette smoking.[12][13]

Understanding the wide spectrum of vaping-related health concerns

Respiratory risks

Vaping has been linked to both short and long-term respiratory issues.

E-cigarette or Vaping Product Use-Associated Lung Injury (EVALI) typically presents as an acute or subacute inflammatory lung condition and has been commonly associated with vapes containing tetrahydrocannabinol (THC) and vitamin E acetate.[7] Although less likely, EVALI cases have been reported with the use of nicotine-containing vaping liquids as well.[7] EVALI includes a spectrum of clinical presentations, radiological findings and range of severity, often requiring hospitalisation and has been fatal in some cases.[14][15] Residual symptoms and abnormalities in lung function may persist even after recovery from the acute lung injury phase and recurrent EVALI or respiratory failure have been reported in some patients that continue to vape.[14][15] A recent study performed on healthy young adults in their twenties, with normal lung function tests, reported that those who vaped had reduced peak exercise capacity, similar to those that smoked tobacco cigarettes.[16] Furthermore, vaping has been linked to an elevated risk of chronic obstructive pulmonary disease (COPD).[13]

Cardiovascular concerns

Cardiovascular risks are also emerging, and research indicates that nicotine-containing vapes cause transient increases in blood pressure and heart rate.[7][13] Findings from a recent study suggest that the use of nicotine-containing vapes may be independently associated with an increased risk of developing heart failure, but these findings need to be validated with further research.[17] Whether exclusive vaping in individuals that have never smoked cigarettes independently contributes to stroke risk remains uncertain, however current vaping in former cigarette smokers is associated with an increased risk of stroke.[18] Dual users may also have a higher risk of both atherosclerotic cardiovascular disease and stroke compared to those who only smoke traditional cigarettes.[13][18]

Cognitive impacts

Studies report mixed findings but there may be an association between exclusive use of vaping and potential impacts on mood, memory, concentration and decision making. More research is needed to draw definitive conclusions, particularly in those that were previously non-smokers or naive to nicotine exposure and teenagers that are at a more vulnerable stage of their cognitive development.[19]

Cancer

A recent systematic review reported that acute e-cigarette exposure is associated with various biomarkers linked to cancer risk, however there was no conclusive evidence of increased cancer incidence in exclusive e-cigarette users due to lack of long-term population studies.[20]

Toxins

The risk of exposure to toxic chemicals or illicit substances is another major concern. Chemical analyses of vaping liquids have found a variety of prohibited compounds and various chemicals exceeding legal limits.[3][21] Alarmingly, some products labelled as nicotine-free have been found to contain nicotine, while others labelled with inaccurate nicotine concentrations, raising serious concerns about product transparency and consumer safety.[3][21] Acute toxicity from inhalation of nicotine containing vapes can occur especially in children and teenagers and may lead to seizures.[7] Accidental ingestion of nicotine containing vape liquids can cause nicotine poisoning and can be fatal.[7] Illicit substances such as nitazene, a very potent synthetic opioid, have been increasingly detected in illegal and unregulated vape liquids and can lead to opioid overdose, dependency or withdrawal.[22]

Considerations for the life insurance industry

Evolving medical evidence and underwriting implications

Although the long-term health risks associated with vaping are not yet fully understood, the medical evidence is evolving and raises significant concerns for a range of adverse health outcomes.

In the interim, a cautious approach is suggested when underwriting individuals who exclusively vape or use e-cigarettes. Based on the associated risks, it would seem reasonable to consider applying standard smoker premium rates as a default approach.

Careful consideration of the overall cardiovascular risk profile may be required for dual smokers, as they may present an even greater morbidity risk than exclusive cigarette smokers.

Tailored risk assessment and vaping profiles

Alternatively, a more tailored vaping risk assessment could be adopted. Where available, information regarding the content of the vaping liquid and reason for use would be useful to determine the associated risks. For example, the risks associated with vaping medicinal cannabis would differ in a scenario where there is a clear clinical indication and the individual is closely monitored by their prescribing healthcare practitioner, as compared to the risk profile of a recreational user vaping unregulated cannabis products. Any risks associated with the underlying medical condition requiring treatment with medicinal cannabis should also be taken into account.

Claims impact and long-term monitoring

Considering the impact of vaping on various organ systems, this may translate into vaping related claims across all products – including critical illness, disability or death claims.

From a claim’s perspective, physical recovery timelines and response to rehabilitation may potentially be impacted by delayed wound healing, prolonged inflammation and reduced exercise capacity, due to the effects of nicotine vaping (similar to smoking).[16][23]

As with any new trend or health-related behaviour, gathering longitudinal data takes time and due to the relatively recent popularity in vaping we will only be able to fully appreciate the impacts on major health outcomes, such as heart attack, stroke, heart failure and cancer in years to come.

For now, the message is clear: vaping is not a harmless habit.

Author

Dr Yvette Pheiffer

Medical Officer

Hannover Life Re of Australasia

References

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Australian Institute of Health and Welfare (2024). Young people’s use of vapes and e-cigarettes, AIHW, Australian Government. Accessed 16 June 2025 under https://www.aihw.gov.au/reports/smoking/young-peoples-vapes-e-cigarettes
Caitlin Jenkins, Fraser Powrie, Celine Kelso, Jody Morgan. Chemical Analysis and Flavor Distribution of Electronic Cigarettes in Australian Schools, Nicotine & Tobacco Research, Volume 27, Issue 6, June 2025, Pages 997–1005, https://doi.org/10.1093/ntr/ntae262
Salari, Nader et al. The global prevalence of E-cigarettes in youth: A comprehensive systematic review and meta-analysis. Public health in practice (Oxford, England) vol. 7 100506, 16 May 2024, doi:10.1016/j.puhip.2024.100506
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Aberegg, Scott K et al. Clinical, Bronchoscopic, and Imaging Findings of e-Cigarette, or Vaping, Product Use-Associated Lung Injury Among Patients Treated at an Academic Medical Center. JAMA network open vol. 3,11 e2019176. 2 Nov. 2020, doi:10.1001/jamanetworkopen.2020.19176
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Nitazenes causing severe opioid overdoses in NSW. Available at: https://www.health.nsw.gov.au/aod/public-drug-alerts/Pages/nitazenes-causing-severe-opioid-overdose-may2024.aspx Last accessed 27 June 2025. © State of New South Wales NSW Ministry of Health. For current information go to www.health.nsw.gov.au
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