The health hazards from smoking cigarettes are well-known. The nicotine in tobacco is the addictive substance. Some smokers can stop smoking on their own. Others benefit from smoking-cessation aids.

These aids are mainly psychological methods, medications, and nicotine replacement therapy (NRT). Examples of psychological methods include psychological support, cognitive behavioral therapy (CBT), mindfulness, coping strategy training, and others.

Motivational interviewing is a beneficial approach to helping people struggling with a nicotine addiction. It is a collaborative approach that utilizes open-ended questions to help the smoker identify their motivation for quitting and develop a plan for success.

Medical providers can prescribe varenicline, a medication that affects nicotine receptors in the brain. It reduces the reward from using nicotine and decreases craving and withdrawal symptoms. Bupropion is another medication for smoking cessation, but it is less effective.

Nicotine replacement therapy (NRT) is another option for smoking cessation. It has been considered a first-line treatment. Nicotine is given by nicotine gum, skin patches, or by vaping nicotine (e-cigarettes). These methods provide the addictive substance without the harmful effects of burning tobacco and inhaling its smoke.

Vaping nicotine is a relatively new approach to providing NRT. A review of 90 research studies showed that, “There is high-certainty evidence that e-cigarettes with nicotine increase quit rates compared” to other forms of NRT (Lindson, 2025).

However, vaping itself carries health risks that must be balanced with the benefit of stopping cigarette smoking. We don’t know the long-term effects of vaping because it has only been available in the United States since 2006. Its use did not become widespread until 2015 with the introduction of JUUL devices.

These devices are “small, rechargeable, battery-powered e-cigarettes that aerosolize liquid solutions containing glycerol, propylene glycol, natural oils, extracts and flavors, nicotine, and benzoic acid” (Fadus, 2020).

There are several harms from vaping with nicotine that have been identified. One very worrisome one is the development of severe lung damage in adolescents, named e-cigarette or vaping use-associated lung injury (EVALD), which requires admission to an ICU and can cause lifelong lung damage and even death (Park, 2022). Fortunately, it is uncommon.

Another health risk is nicotine addiction, which can lead to alterations in adolescents’ and young adults’ brain development with impaired cognition, learning, and memory, and altered reward processing (Castro, 2023). Other risks include possible exposure to illicit substances (Grant, 2029), paradoxically starting to smoke cigarettes [adolescents are 4 times more likely to start smoking tobacco cigarettes (O’Brien, 2021)], increasing depression and anxiety (Van Frank, 2025) exposure to toxic metals and carcinogens (Lukaez, 2023), and inhaling cannabis added to the device by the person using it (Suber, 2024).

Cannabis (marijuana) carries its own health risks. Although cigarette smoking has decreased in frequency during pregnancy, cannabis use has been increasing among pregnant women. Cannabis during pregnancy can alter the thickness of the fetus’s brain cortex, which may cause neurodevelopmental problems (El Marroun, 2016). This remains apparent during adolescence, when impairments in cognition and visuospatial ability can be identified (Hiraoka, 2023).

Long-term use can result in addiction to cannabis. The potency of cannabis has increased over the past 40 years, so addiction is more common today. Frequent use of cannabis can adversely affect lung function, increase the risk of heart attack and stroke, impair memory and problem-solving, trigger anxiety and panic attacks, paranoia, and, rarely, acute psychosis.

Another problem from cannabis use is severe vomiting, named cannabinoid hyperemesis syndrome; it is a growing problem in emergency departments. It is “characterized by recurrent episodes of intractable nausea and vomiting, relief with hot showers, and association with chronic cannabis use (defined as using cannabis 4 times per week for 12 months or longer)” (Gotttlieb, 2025).

In addition to its obvious symptoms, this syndrome can result in dehydration, electrolyte abnormalities, and, rarely, a tear in the esophagus or aspiration into the lungs.

The bottom line is that vaping with nicotine can be an effective approach to stopping cigarette smoking. However, that benefit needs to be balanced with considering the adverse effects that may result from vaping. So far, it appears that most people who vape do not experience serious consequences, but the long-term effects are not known.