That distinction is particularly important in vaping. A product can have a substantially different risk profile from cigarettes, yet if smokers believe the two products are equally dangerous, they may have little incentive to switch.
Risk perception is becoming a public-health problem
This matters because perceptions of relative risk can influence behaviour. Someone who believes switching from cigarettes to vaping merely exchanges one form of serious harm for another may reasonably conclude that there is little reason to make the change. Yet the evidence base does not support treating smoking and vaping as equivalent.
When caution creates confusion
NHS guidance previously described vaping as “far less harmful than cigarettes”, before changing the wording in July 2026 to “likely to be far less harmful”. Earlier NHS Better Health material similarly used the phrase “substantially less harmful” before later shortening it to “less harmful”.
Recent changes to NHS wording, caught by the sharp eye of tobacco policy researcher Clive Bates, have nevertheless raised questions about whether increasingly qualified language could unintentionally reinforce public uncertainty. Bates highlighted that NHS guidance previously described vaping as “far less harmful than cigarettes”, before changing the wording in July 2026 to “likely to be far less harmful”. Earlier NHS Better Health material similarly used the phrase “substantially less harmful” before later shortening it to “less harmful”.
Acknowledging scientific uncertainty is not inherently wrong. Vaping has not existed in its current form for several decades, and continued research into long-term effects is entirely appropriate. The problem arises when caution obscures the magnitude of the difference between vaping and smoking.
Simply saying that one product is “less harmful” than another provides almost no information about the size of the difference. A product could theoretically be 5%, 50% or 95% less harmful and still satisfy that description. For smokers deciding whether to switch, that distinction is not semantic—it could be life-changing.
The cessation evidence is becoming harder to ignore
Cochrane also found that nicotine e-cigarettes probably outperform non-nicotine vapes. Importantly, the review found no evidence of serious harm from nicotine e-cigarettes, although the authors emphasised that larger, longer studies are still needed to assess long-term safety. This evidence is consistent with earlier Cochrane network meta-analysis findings, which placed nicotine e-cigarettes alongside varenicline and cytisine among the most effective pharmacological approaches to smoking cessation.
The details behind the numbers
For example, ASH’s 2026 data show that 60% of current adult vapers in Great Britain are former smokers, representing approximately 3.3 million people. Another 1.7 million current vapers continue to smoke. Those figures demonstrate both the potential and the complexity of vaping as a harm-reduction intervention. Switching completely away from combustible tobacco is the key objective, but consumers’ experiences with nicotine delivery, flavours, convenience and cravings can influence whether that transition succeeds.
Clear communication is essential for harm reduction
That message does not require claiming that vaping is harmless. It requires communicating relative risk accurately and proportionately. For tobacco harm reduction to work, smokers need to understand not simply that vaping is “different” from smoking, but why the difference matters. CROMs can help researchers understand whether public-health messaging is achieving that goal.
The challenge for policymakers and health authorities is therefore not to eliminate every expression of uncertainty. It is to ensure that caution does not become confusion—and that confusion does not keep smokers smoking.
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