Peach Ice. Bubblegum. Cherry Cola. They might sound like sweets, but these artificial flavours are part of a chemical cocktail inhaled deep into the lungs by people who vape.
Britons are now vaping in unprecedented numbers – around one in ten adults (9.8 per cent) in 2023, rising to 15.8 per cent among 16 to 24-year-olds, according to the Office for National Statistics.
And while vapes are generally considered safer than cigarettes, and seen as a useful tool for quitting smoking, experts are warning the effects of the chemicals, solvents, sweeteners and flavourings found in e-cigarettes can have significant health risks, including lung damage – and these are still emerging as it’s a relatively new area of research.
The potential dangers were spelt out in a 2023 study which found people who vaped had DNA damage in mouth cells at similar levels to cigarette smokers, reported the journal Nicotine & Tobacco Research – the highest levels were seen in people using the pod-style devices now standard in Britain (different from a disposable vape, this has a battery and heating coil, and a replaceable pod containing the liquid).
Another study last year found that people who smoke and vape are four times more likely to develop lung cancer than those who just smoke, the Journal of Oncology Research and Therapy reported. The researchers, from Ohio State University, speculated this was due to the amount of chemicals in vapes that may be carcinogenic (cancer-causing) in their own right.
It’s not just the lungs that could be affected: chronic vaping was linked to impaired blood vessel function, which is an early warning sign for heart disease, according to 2024 study in the journal Tobacco Induced Disease.
Vapes contain nicotine, which is a vasoconstrictor, meaning it narrows blood vessels, so it could contribute to cardiovascular problems in people who already have underlying heart disease, explains Lion Shahab, a professor of health psychology at University College London.
Britons are now vaping in unprecedented numbers – around one in ten adults (9.8 per cent) in 2023
He adds nicotine may also impair the body’s ability to regulate blood sugar, which could increase the risk of developing type 2 diabetes, though evidence for this remains inconclusive.
As Cancer Research UK points out, vaping is much less harmful than smoking. But it is not risk-free, and experts stress children, teenagers and non-smokers should not vape at all.
Experts fear exposure during adolescence, when lungs are still developing, could increase the risk of lasting respiratory problems.
Indeed, the journal BMC Medicine reported in May last year teenagers in England and North America were more likely to suffer breathing problems.
Concerned, in February 2025, the UK Government launched a ten-year study that will follow 100,000 children and teenagers aged eight to 18 to track how vaping affects their health over time.
‘We are exposing children to an experimental risk,’ Andrew Grigg, a professor of paediatric respiratory medicine at Queen Mary University of London, told Good Health.‘We now have a generation of young people hooked on nicotine and they are inhaling not just nicotine, but a mixture of flavourings and chemicals into developing lungs, substances we know very little about when inhaled’.
Professor Grigg explains in lab studies these chemicals reduce key cell functions in the airway and may increase the risk of bacterial infections such as bronchitis.
‘We’re already seeing more bronchitis symptoms in children who vape,’ he adds, referring to persistent cough, wheezing and airway inflammation.
Vaping isn’t the only potential cause, however front line doctors are seeing more under-18s hooked on nicotine vapes turning up with chest tightness, wheeze, persistent cough, palpitations, nausea, headaches and anxiety, it was reported in earlier this year by researchers from Alder Hey Children’s Hospital, and other institutes, who called for dedicated NHS services for children addicted to vaping.
‘This is not a harmless habit,’ says Professor Grigg, ‘and the long-term risks are unknown’.
Andrew Grigg, a professor of paediatric respiratory medicine at Queen Mary University of London
So what exactly is in vapes that makes them potentially so dangerous? Good Health spoke to leading scientists and clinicians…
WHY YOU CAN’T STOP PUFFING
The main ingredient in vapes is nicotine, the same addictive substance found in cigarettes. It is added to satisfy cravings and help smokers switch.
Both legal and illegal vapes usually contain it, although some liquids are nicotine-free. The difference is illegal versions often carry far higher levels than laws allow – tests have found some packed with up to triple the legal limit.
The nicotine is usually delivered in one of two forms: ‘freebase’ nicotine, a purer chemical version that produces a harsher throat hit, or nicotine salts, which are smoother and easier to inhale at higher concentrations (legal vapes tend to contain the salts).
A typical cigarette gives a smoker around 1 to 2mg of nicotine. By law, UK-approved vapes are capped at 20mg per millilitre of liquid; roughly 2 per cent strength.
In practice modern devices are designed to hit like a cigarette, often delivering a similar nicotine hit in a single session pf 10 to 15 puffs, though the exact dose depends on the gadget and how it is used. Nicotine salts allow delivery that is closer to that from cigarettes and so they are likely to be better at helping smokers quit,’ says Peter Hajek, a professor of clinical psychology and Director of the Tobacco Dependence Research Unit at Queen Mary University of London.
Once inhaled, the nicotine in the e-liquid rapidly enters your bloodstream, causing the body to release adrenaline, which in turn raises your blood pressure, pulse and breathing rates.
CONCERNS ABOUT OTHER INGREDIENTS
Vapes heat e-liquid, turning it into an aerosol that can be inhaled – as a result ultra-fine particles and dissolved chemicals can reach deep into the lungs.
They can stick and slip into cells. The liquid is propylene glycol (PG) and vegetable glycerin (VG), which hold the nicotine and flavourings. Both compounds are used in foods and medicine, but their safety when inhaled is less certain.
As Professor Shahab, a leading expert on vaping, explains: ‘PG and VG are considered safe in drink or food form. However, some lab and animal research suggests that VG in particular may affect cell health when inhaled.’
Lion Shahab, a professor of health psychology at University College London
For instance, a 2018 lab-based study in Frontiers in Physiology found vegetable glycerin, especially when combined with certain flavourings, can weaken the protective cells that line the lungs and reduce their ability to repair themselves or fight infection.
Vapers inhale an aerosol, but if the heating coil gets too hot – which can happen particularly in ‘dry puff’ conditions, i.e. when there isn’t enough liquid left to heat – PG and VG can break down into chemicals such as formaldehyde (a known carcinogen) and acrolein (a potent irritant).
Both can irritate the airways, according to the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment, an official UK expert advisory group.
AND THE ENTICING FLAVOURS…
The different flavours in vapes come from a wide range of chemicals, many also used in food products, including vanilla, ethyl maltol (sweet) and menthol (mint). But inhaling them is different from swallowing them.
‘In lab and animal studies some flavours, such as vanilla, menthol and cherry-type flavourings, may affect cell viability,’ says Professor Shahab. In other words, cells may work less effectively – for instance in the lungs that can translate into irritation, inflammation and weaker defences against infection. Cinnamon flavour, which contains cinnamaldehyde, and cherry-type flavourings that use benzaldehyde have been repeatedly highlighted in lab studies as among the most irritating and potentially toxic to airway cells.
For example, a 2018 study in Scientific Reports found both chemicals damaged lung cells exposed to e-cigarette vapour.
Laboratory work has shown cinnamon-flavoured liquids containing cinnamaldehyde suppress the tiny hair-like cilia that clear the airways and also blunt immune cell function.
Reviews in journals such as Tobacco Control in 2020 have warned a wide range of flavourings can be toxic to airway cells.
Vape packs must include an ingredients list, but flavouring chemicals are usually grouped together simply as ‘flavourings’.
The full list is provided to the UK regulator, the MHRA, but not always shown to consumers. The UK bans additives known to be risky such as diacetyl, a buttery-tasting chemical linked with a rare lung condition, bronchiolitis obliterans, or ‘popcorn lung’, named this because it was first seen in staff working in a microwave popcorn factory.
‘None of the flavourings allowed in UK-regulated vapes is linked with actual disease’ adds Professor Shahab.
But studies show diacetyl and other additives still appear in vapes sold in other countries outside of Europe, often without restrictions. It’s also been found in illegal vapes.
THE METAL IN THE DEVICE ITSELF
Red flags for illegal and unsafe vapes are super-strength devices with oversized tanks. They can feature cartoon-style branding, and are sold via social media or market stalls
Scientists have found that metals from the heating coil, including nickel, chromium and lead, can leach into the vapour.
A 2018 study in Environmental Health Perspectives detected these metals in e-cigarette aerosols from popular brands. A 2020 review in Environmental Research confirmed while levels are generally lower than in cigarette smoke, they still raise health concerns over time, adds Professor Shahab.
HOW CAN I TELL IF A VAPE IS ILLEGAL?
Illegal vapes are flooding into the UK: trading standards officers say they are seizing millions of devices each year from corner shops, market stalls and even high street chains.
In 2023/24 they confiscated 1.19million illicit vapes, a 59 per cent rise on the year before.
Border Force reported an even sharper rise at entry points, with seizures soaring from less than a million in 2022 to around 4.5million between January and October 2023. A further 1.14million were seized in 2024.
Disposables, which fuelled much of the vaping craze, are now banned in Britain as of June 1, 2025. With refillable devices, cost is one clue to whether it’s an illegal product or not.
Legal vapes also follow strict rules. A legitimate UK product will always be reusable or refillable, with a tank or pod capacity no greater than 2ml. E-liquids must be sold in 10ml bottles, with nicotine content capped at 20mg/ml (2 per cent).
Packaging should be child-resistant and tamper-evident, with a batch number and UK contact details on the box.
Every product must carry a prominent nicotine warning covering 30 per cent of the front and back. Branding should never be cartoonish or designed to appeal to children.
The exact product will also appear on the MHRA’s public list of notified products, check on gov.uk.
This is not a stamp of approval in the way a medicine is licensed, but it does mean the device meets strict standards on nicotine strength, tank size, packaging and labelling.
Red flags for illegal and unsafe vapes are super-strength devices with oversized tanks, with claims of ‘3,000 to 10,000 puffs’, extra-strong liquid such as ‘5 per cent or 50mg’; they might have no warnings, or the warnings are in a foreign language; they can feature cartoon-style branding, and are sold via social media or market stalls.
Any vape advertised as containing THC, ‘spice’ or other psychoactive substances should be avoided outright.
Products may sometimes be sold as containing the black-market drug THC (the psychoactive ingredient in cannabis), but in fact can contain spice, a cheaper synthetic chemical that’s far more unpredictable and harmful than cannabis – and highly addictive.
A recent University of Bath study revealed around one in six vapes confiscated in secondary schools in England tested positive for spice.
HOW THEY COMPARE TO CIGARETTES
‘Cigarette smoke contains more than 7,000 chemicals, including over 70 known carcinogens, and is uniquely harmful and kills more than one out of every two lifelong smokers,’ says Professor Shahab. ‘By comparison, e-cigarette vapour is far simpler, mainly consisting of relatively harmless ingredients.
‘So it is likely the impact of vapes on health is magnitudes of order lower than smoking cigarettes.’
A study published in the journal Annals of Internal Medicine in 2017, led by Professor Shahab, found that people who vaped exclusively for at least six months had dramatically lower levels of toxic and carcinogenic markers than those who smoked cigarettes or used both.
In some cases, the reduction was as high as 97 per cent.
Professor Shabab uses the analogy of smoking as base-jumping and vaping as running: ‘Base-jumping is known to be quite risky, and marathon running can also carry risks but at a much lower rate.’ Vaping should not be a new habit for non-smokers but a stepping stone to quitting for those already addicted to cigarettes, he emphasises.
THE WAYS YOU CAN VAPE SAFELY
If you’re going to vape, choose a refillable product from a reputable UK retailer.
Nicotine should be used at the lowest strength that still controls cravings, with the aim of tapering down over time.
Do not use devices to chase a ‘buzz’, suggest experts.
Avoid unpleasant and possibly harmful ‘dry puffs’ by keeping the tank topped up, and don’t run devices at excessive power.
Never mix your own liquids, and never use products that may contain THC.
If you experience chest pain, tightness, breathlessness or a persistent cough, stop vaping and seek medical advice immediately.
Battery safety is also key: only use the supplied charger, avoid charging overnight, and never carry loose batteries in a pocket with coins or keys.
AND IF YOU’RE STRUGGLING TO QUIT VAPES…
The vast majority of the UK’s 5.5 million vapers are ex-smokers or current smokers.
But while experts generally agree vapes are less harmful than cigarettes, vaping is by no means risk free – potential harms include a risk of collapsed lungs, heart damage and possibly memory loss and leaky gut, while the e-liquids in vapes can contain toxic chemicals, including arsenic, lead and formaldehyde.
So ultimately, experts would prefer it we didn’t smoke or vape at all.
Yet quitting vapes can be difficult, as the Centers for Disease Control in the US says: ‘Quitting vaping is likely similar to quitting smoking because both involve nicotine addiction and quitting may lead to withdrawal symptoms.’
Some vapers may be unknowingly inhaling more nicotine daily than a cigarette smoker with a 20-a-day habit. The amount of nicotine in each draw depends on the vape make but as a general rule, manufacturers advise that ten puffs on your vape are about the same as ten puffs on a cigarette.
Vaping is by no means risk free – potential harms include a risk of collapsed lungs, heart damage and possibly memory loss and leaky gut
A standard 20mg/ml vape, which allows for 600-800 puffs, with 40mg of nicotine is equivalent to smoking one or two packs of 20 cigarettes.
And illegal vapes, which are cheaper and unregulated, may contain more nicotine, warns Dr Gareth Nye, a lecturer in biomedical sciences at the University of Salford. ‘Vaping generally is harder to quit simply due to the level of nicotine involved in most products. Most vapes will contain significantly higher levels than traditional cigarettes – as nicotine is the primary addictive agent, this is the problem in quitting.’
Exacerbating this ‘is the fact that users report higher number of puffs compared with cigarettes and the habits can be tricky to break’, he adds.
(Nicotine-free vapes are available, but these are a very small proportion of the total, according to the government’s Creating a Smokefree Generation consultation.)
There may also be psychological issues to overcome.
‘There is the illusion that vaping is safe to continue and therefore people are less likely to stop,’ says Dr Nye. ‘Although vaping is safer, it isn’t without its risks and vaping products are always intended to be stepping stone to being completely free of nicotine products.’
He adds NHS resources are focused on smoking cessation but ‘there are a few clinics opening that offer vaping cessation support’.
The charity Asthma + Lung UK has recently suggested all stop-smoking schemes should also cover e-cigarettes. So what tools are available now to help you quit?
TEXT MESSAGE SUPPORT
Regular texts to support your efforts is one approach that’s been proven to work – in teens, at least.
When 13 to 17-year-old vapers in the US were enrolled on a text message-based quit-vaping programme, after seven months they were 35 per cent more likely to succeed compared to teenagers who weren’t on the programme, reported the Journal of the American Medical Association last year. Those on the programme received daily ‘timely and compelling messages’, full of tips and advice from real people.
Similarly, a recent review by the authoritative Cochrane group found that text message programmes may be effective for those aged 13 to 24. ‘The text message interventions were only tested in younger people, but our findings don’t mean that they wouldn’t also be successful in older people,’ says Dr Nicola Lindson, an associate professor at the Nuffield Department of Primary Care Health Sciences, University of Oxford.
There are free programmes that offer motivational text messages (e.g. via stopsmokinglondon.com).
VARENICLINE
This drug (brand name Champix) works by blocking nicotine receptors in the brain, making smoking and vaping less rewarding and reducing cravings.
In the latest Cochrane review, varenicline appeared to double the chances of quitting vaping compared with people receiving no medication.
‘It’s not yet licensed in the UK for vaping, but can be prescribed on private prescription on an off-label basis for reducing nicotine cravings, whatever causes them,’ says pharmacist Sultan Dajani. ‘Common side-effects can include chest discomfort, constipation, dizziness, drowsiness, as well as headache and weight gain.’ The usual course is 12 weeks of a twice-daily pill.
NICOTINE REPLACEMENT THERAPY (NRT)
NRT has long been the go-to method for quitting smoking, but there’s growing evidence that it may help vapers quit, too. It’s available over-the-counter (and on NHS prescription for smoking).
Sultan Dajani suggests the mouth sprays are potentially most effective for vapers. ‘They’re easy to use, safe and fast acting – and mimick the habit of taking puffs.’
REDUCE THE STRENGTH
Cutting down on nicotine vaping gradually ‘can make stopping much easier…it allows the body time to adjust to lower nicotine levels’, according to the National Centre for Smoking Cessation and Training in the UK.
Its suggestions include increasing the time between vaping and lowering the strength of nicotine.
Sultan Dajani advises: ‘Check your e-liquid’s nicotine content and gradually reduce it over time. If you find yourself vaping more at this lower level, it may be a sign that you’ve reduced your nicotine intake too quickly.’
Spacing out puffs can also help. ‘If you vape every 20 minutes, try to extend that to once every 40 minutes instead. Over time, this will reduce your cravings’ he adds.
Additional reporting by Thea Jourdan
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