A substantial body of research shows that vaping can help people stop smoking and exposes users to far fewer harmful chemicals than cigarettes.
But that is not how the story is widely understood.
Across Europe and beyond, public perceptions of vaping remain confused – and in many cases increasingly negative. Surveys suggest many people now believe vaping is as harmful as smoking, or even more so.
That disconnect is not just a matter of misunderstanding. It may be shaping whether smokers try to quit, how healthcare professionals advise patients, and how governments regulate alternatives to cigarettes.
At the centre of the issue is a widening gap between what the evidence shows and what people believe.
What the evidence actually shows
Over the past decade, research into vaping and smoking cessation has expanded rapidly, with findings that broadly align.
One of the most comprehensive assessments comes from the Cochrane review on electronic cigarettes for smoking cessation, which is widely regarded as a gold standard in evidence synthesis. Its latest update concluded that nicotine vapes “increase quit rates compared to nicotine replacement therapy” and also compared to behavioural support alone.
Real-world data points in a similar direction. The Smoking Toolkit Study in England, which tracks smoking behaviour over time, has linked the rise in vaping to increases in quit success rates at a population level.
Public health bodies in the UK have also remained consistent. The Office for Health Improvement and Disparities states that vaping poses “a small fraction of the risks of smoking”, while emphasising that it is not risk-free.
Taken together, these findings form a relatively clear picture: vaping is not harmless, but for people who smoke, switching completely is likely to reduce exposure to harmful chemicals and improve the chances of quitting.
A growing disconnect
Despite this, public understanding appears to be moving in the opposite direction.
Data from Action on Smoking and Health in England shows that perceptions of relative harm have worsened over time. In 2013, the majority of adults correctly believed vaping was less harmful than smoking. In recent years, that proportion has fallen sharply, with a growing share believing vaping is equally or more harmful.
This is not limited to the UK. Eurobarometer surveys across EU member states show widespread uncertainty about the relative risks of vaping, with many respondents either unsure or believing the risks are comparable to smoking.
Earlier European analyses suggest perceptions of harm have shifted significantly over time. One study found that the proportion of people who viewed vaping as harmful rose from 27.1 per cent to 51.6 per cent across EU countries between 2012 and 2014.
International Tobacco Control (ITC)-linked research and other multi-country studies have reported similar patterns, with increasing numbers of people believing vaping is as harmful as smoking despite a growing evidence base to the contrary.
In other words, the gap is not narrowing as evidence accumulates – it is widening.
Misunderstanding among healthcare professionals
The gap is not limited to the general public. A 2026 study by Martelle et al, published in Internal and Emergency Medicine, surveyed 700 healthcare providers to assess their understanding of the relative risks of tobacco and nicotine products.
It found that while most recognised that different products carry different levels of risk, their perceptions did not align with the evidence base.
Healthcare providers rated cigarettes as the most harmful product, but still assigned high risk scores to vaping, with a mean rating of 79.5 out of 100 compared with 95.9 for cigarettes.
More strikingly, the study found that around half did not believe that switching completely from cigarettes to vapes could reduce health risks.
The researchers concluded that “many healthcare professionals do not have accurate information about the relative risks of non-combustible tobacco and nicotine products” and warned that this could affect patient advice and smoking cessation efforts.
The study also highlighted confusion about the source of harm in smoking. On average, respondents attributed only around 38 per cent of lung cancer risk to smoke from burned tobacco, despite combustion being widely recognised as the primary driver of smoking-related disease.
That matters. If clinicians misunderstand relative risk, the advice given to patients may reinforce, rather than correct, public confusion.
EVALI and the power of early narratives
One explanation for this disconnect lies in the lasting impact of high-profile health scares.
In 2019, an outbreak of lung injuries in the US known as EVALI (e-cigarette or vaping-associated lung injury) triggered widespread alarm. At the height of the outbreak, hundreds of cases were reported, and headlines frequently linked severe lung damage to vaping more broadly.
However, subsequent investigations by the US Centers for Disease Control and Prevention found that the outbreak was strongly associated with illicit THC products contaminated with vitamin E acetate, rather than standard nicotine vaping products.
By the time that distinction became clear, the initial narrative had already spread globally.
Follow-up research found that perceptions of vaping harm increased significantly after the outbreak, including among people who did not use vaping products and in countries unaffected by the cases.
It is a clear example of how early, incomplete information can shape long-term beliefs.
The persistence of “popcorn lung”
A similar pattern can be seen in earlier coverage of “popcorn lung”, a rare condition known as bronchiolitis obliterans.
The condition was originally identified in workers exposed to diacetyl in microwave popcorn factories. Early media reports linked it to vaping, creating a lasting association in public discourse.
While trace levels of diacetyl have been detected in some e-liquids, the chemical is also present in cigarette smoke at much higher concentrations. To date, there have been no confirmed cases of popcorn lung linked to vaping.
Public health reviews have consistently concluded that the risk is extremely low and significantly lower than from smoking.
And yet the association persists – a reminder that once a risk narrative takes hold, it can be difficult to dislodge.
Awareness, behaviour and missed opportunities
More recent research suggests that even when public health initiatives promote vaping as a tool to quit smoking, awareness may be limited.
A 2026 study by Brose et al examined awareness of England’s “Swap to Stop” scheme, which offers free vapes and behavioural support to smokers.
It found that only 24.1 per cent of people who smoked or had recently stopped were aware of the scheme.
Awareness was not just informational, it was linked to behaviour. Those who knew about the programme were more likely to report using vapes in a quit attempt.
This suggests that communication plays a critical role. Evidence alone may not be enough if it does not reach the people it is intended to help.
The role of research and headlines
The research landscape itself may also play a role. Studies linking vaping to potential health risks often receive significant attention, particularly when they involve conditions such as cancer, cardiovascular disease or organ damage.
Some of these studies raise legitimate questions, particularly about long-term effects. Others are more limited – for example, relying on cross-sectional data or failing to fully account for smoking history.
These issues matter in a field where most people who vape are current or former smokers. Without careful adjustment, studies can end up attributing smoking-related disease to vaping.
At the same time, findings showing benefits, such as increased quit success or reduced exposure to harmful substances, tend to receive less prominent coverage.
This imbalance can shape perception. Over time, a steady flow of risk-focused headlines may create the impression of a stronger or more certain evidence base than actually exists.
Mixed messaging across Europe
Policy framing adds another layer. In the UK, public health authorities have generally taken a harm reduction approach, positioning vaping as a tool to help smokers quit.
In other European countries, messaging has often been more negative and precautionary, with greater emphasis on potential risks and restrictions.
Eurobarometer data suggests this divergence may influence public understanding, with countries taking more cautious approaches often showing higher levels of uncertainty or misperception about relative risk.
For consumers, the result is a fragmented information environment, where different interpretations of the same evidence coexist, and often conflict.
Real-world consequences
The consequences of this gap matter. Smoking remains one of the leading causes of preventable death in Europe, responsible for hundreds of thousands of deaths each year.
If people who smoke believe vaping is as harmful as cigarettes, they may be less likely to switch, even if doing so could reduce their risk.
There is also evidence from survey data that some people who have switched to vaping report returning to smoking after becoming concerned about safety.
At the same time, policymakers are making decisions about how to regulate vaping products, often in a context where public concern is high and understanding is uneven.
