In this review, we examined what changes people’s perceptions of the risks of vaping and how these perceptions affect smoking and vaping behaviours. Messages warning about the dangers of vaping were often effective, especially among young people—but some also led to the false belief that vaping is as harmful as smoking. We also found that what people believe really matters. For adults who smoke, misunderstanding relative risks can discourage them from quitting smoking and switching to vapes. Clear, evidence-based communication is needed to enhance public understanding. This is particularly important because, in England, over 7 in 10 adults who smoke inaccurately believe that vaping is as, or more, harmful than smoking.
Dr Katie East, Associate Professor in Public Health, Department of Primary Care and Public Health, Brighton and Sussex Medical School (BSMS)
25 July 2025
Systematic review explores the range and effectiveness of interventions aiming to change vaping harm perceptions
The review, published in Addiction, looked at what interventions have been effective in changing the perception of how harmful vaping is, and how that may affect vaping and smoking behaviours.
The systematic review looked at 85 articles around the harms of vaping or nicotine, specifically focusing on what communications and interventions have been effective in changing people’s perceptions of the harms of vaping. The review looked separately at interventions aimed at young people and those aimed at adults, finding that the messages in each varied. Interventions aimed at young people focused more on vaping being addictive and harmful. However, interventions aimed at adults typically communicated that, whilst vaping is not without risks, it is less harmful than smoking.
The review found that interventions communicating that vaping is harmful and addictive were effective in changing perceptions of their audience, with 12 out of 14 studies in young people showing an alteration in understanding, and 16 out of 23 studies in adults. However, this theme of communication did also increase the misperception that vaping is as harmful as smoking.
A quarter of people who smoke cigarettes have never tried vaping and they are the most likely to wrongly believe that vaping is as, or more, harmful than smoking. Our research shows that these misperceptions are likely discouraging people from using vapes to stop smoking which other evidence shows are more effective stop-smoking aids than licensed nicotine replacement therapies. Our research also shows that misperceptions can be corrected when people are given accurate information – this is urgently needed given smoking kills nearly two-thirds of those who smoke.
Professor Ann McNeill, Professor of Tobacco Addiction IoPPN
The researchers also found that perceptions of vaping harm predicted vaping and smoking behaviours. Specifically, perceiving vaping as harmful deterred vaping among both young people and adults, while misperceiving vaping as equally/more harmful than smoking prevented adults from quitting smoking. This highlights the importance of correcting vaping misperceptions because they can have a real impact on people’s behaviours and can help reduce the harms from smoking.
Public perceptions of the harmfulness of vaping versus smoking are more out of line with the evidence than ever before. Our comprehensive review demonstrates that these perceptions can be influenced and that they predict smoking and vaping behaviours. As England prepares to implement the Tobacco and Vapes Bill - designed to create a smokefree generation and tighten regulations on vaping - it is essential to ensure the public receives accurate information to maximise health benefits and avoid unintended consequences, such as individuals switching from vaping to the far more harmful smoking due to misperceptions.
Professor Leonie Brose, Professor of Addictions & Public Health, IoPPN
“Interventions to change vaping harm perceptions and associations between harm perceptions and vaping and smoking behaviours: A systematic review” was published in Addiction https://onlinelibrary.wiley.com/doi/10.1111/add.70129
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Professor of Tobacco Addiction
Professor of Addictions & Public Health
Senior Lecturer in Tobacco Harm Reduction