- A new PLOS One study found only 21.4% of healthcare providers and trainees recognised vapes as less harmful than combustible cigarettes.
- Most participants, 60.2%, believed vapes were just as harmful or more harmful than smoking.
- The study also found widespread confusion about nicotine, with 25.9% wrongly believing it causes most smoking-related cancer and 42.8% wrongly believing it causes most smoking-related cardiovascular disease.
- Researchers said better education is needed so healthcare providers can give evidence-based advice on smoking cessation and harm reduction.
Most healthcare providers and medical trainees do not recognise that vapes are less harmful than cigarettes, according to a new US study.
The study, published in PLOS One, surveyed 598 healthcare providers and trainees at an academic medical centre in Pennsylvania, including physicians, physician assistants, nurse practitioners, nurses, respiratory therapists and students.
It found that only 21.4 per cent of participants identified vapes as less harmful than combustible cigarettes. By contrast, 60.2 per cent believed they were just as harmful or more harmful than smoking, while 18.4 per cent said they were much more harmful.
The findings suggest that confusion about nicotine may be feeding wider misunderstanding about reduced-risk alternatives to cigarettes.
Although 91.5 per cent of respondents correctly identified nicotine as the substance that makes people want to smoke, many also wrongly attributed the main disease risks of smoking to nicotine itself.
More than one in four believed nicotine causes most smoking-related cancer, while 42.8 per cent believed it causes most smoking-related cardiovascular disease.
In fact, smoking-related disease is driven largely by the toxins produced when tobacco is burned, rather than by nicotine alone. The study states that nicotine is a key driver of dependence, but “it is not the principal cause of these smoking-related diseases”.
The authors also noted that vapes deliver nicotine without combustion, resulting in “an overall significantly lower exposure to harmful chemicals compared to traditional cigarette smoke”.
Nicotine confusion linked to vape misunderstanding
The study found a clear link between misunderstanding nicotine and misunderstanding the relative risks of vaping.
Participants who disagreed that nicotine was the main cause of smoking-related cancer or cardiovascular disease were more likely to recognise that vapes are less harmful than cigarettes.
The reverse was also true. Those who wrongly believed nicotine caused most of the cancer and cardiovascular disease associated with smoking were more likely to believe that vapes were equally or more harmful than cigarettes.
The researchers said this was important because healthcare providers are often trusted sources of advice for smokers trying to quit. They wrote: “Inaccurate beliefs regarding nicotine harms persist among healthcare providers and are associated with beliefs about e-cigarette harms.”
Nurses were most likely to hold inaccurate beliefs
The study found differences between professional groups. Registered nurses were the group most likely to agree that nicotine causes most smoking-related cancer and cardiovascular disease.
The report showed 44 per cent of registered nurses agreed that nicotine in cigarettes is the substance that causes most cancer caused by smoking, compared with 22 per cent of physicians and advanced practice providers, 18 per cent of students and 22 per cent of respiratory therapists.
The same chart showed that 62 per cent of registered nurses agreed that nicotine causes most cardiovascular disease caused by smoking, compared with 38 per cent of physicians and advanced practice providers, 32 per cent of students and 42 per cent of respiratory therapists.
Students were more likely than other groups to recognise that vapes are less harmful than cigarettes. The study found 32 per cent of students identified vapes as less harmful, compared with 22 per cent of physicians and advanced practice providers, 18 per cent of respiratory therapists and just 10 per cent of registered nurses.
The authors suggested the findings may point to gaps in professional training, particularly as understanding of nicotine and tobacco-related harms has changed over time.
They wrote that the results highlight “an opportunity to enhance nursing training and awareness in this area to ensure accurate understanding of nicotine-caused risks”.
Training did not appear to fix the problem
One striking finding was that previous smoking cessation training was not associated with whether participants understood the relative harms of vapes.
Only 27.4 per cent of participants said they had received prior smoking cessation training. But the study found that receiving formal training, age and having ever used tobacco were not associated with beliefs about vape harms.
That raises questions about what healthcare providers are being taught.
The issue is not whether vapes are risk-free. The study notes that vapes contain substances including propylene glycol, vegetable glycerine, flavourings, solvents and tobacco-related toxicants, some of which may carry potential health concerns.
But for adult smokers, the central point is relative risk. Cigarettes kill because they burn tobacco and expose users to thousands of harmful chemicals, while vapes do not involve combustion.
The authors wrote: “While e-cigarettes may offer a less harmful alternative to combustible tobacco, reluctance to recommend these products is influenced by insufficient data on long-term effects coupled with these persistent misconceptions.”
Risks for smokers
The study warns that discouraging smokers from using vapes when other quit methods have failed could have unintended consequences.
The authors noted that evidence suggests smokers attempting to quit are more likely to use vapes than other methods, and may have greater success doing so.
They wrote: “Thus, discouraging e-cigarette use by smokers who may not have succeeded at quitting with other cessation methods may have unintended consequences.”
Researchers call for better education
The authors said healthcare providers need clearer training on the different risks of nicotine, tobacco smoke and non-combustible nicotine products.
They concluded that the findings show the need for “targeted educational initiatives” to address misconceptions about nicotine’s role in addiction versus disease.
They also said better education could help providers give more accurate advice on smoking cessation and harm reduction.
The study concluded: “By clarifying the distinct harms associated with nicotine, tobacco combustion products, and e-cigarettes, these interventions can equip healthcare providers to deliver evidence-based counseling on smoking cessation and harm reduction strategies.”
The study does have limitations. It was based on a single academic medical centre in the US, used convenience sampling and relied on self-reported answers. That means the findings may not apply to all healthcare providers.
Even so, the results add to a growing concern. If the people advising smokers do not understand the difference between nicotine addiction and smoke-related disease, many smokers may never hear the message clearly enough to act on it.
