For years, health officials have been encouraging people to quit smoking and young people to not start. E-cigarettes have complicated their messages.

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The Great American Smokeout starts November 15. Getty Images

For more than 40 years, the American Cancer Society’s Great American Smokeout has been encouraging people to quit smoking and reduce their risk of lung and other cancers, heart attack, stroke, and other conditions.

This, coupled with messages aimed at discouraging young people from starting to smoke in the first place, has had a big effect on smoking rates.

Between 1978 and 2014, cigarette smoking rates among American adults dropped from 34.1 percent to 16.8 percent. Rates among teens also fell sharply since the late 1990s.

However, the recent rise in the popularity of e-cigarettes — a product sometimes billed as a “safer” alternative to conventional cigarettes — has complicated how public health experts tackle smoking.

One oncologist has even called for e-cigarettes to be included in the Great American Smokeout, which takes place on November 15, to prevent current users of nicotine-filled vapes from becoming the “cigarette patients of tomorrow.”

Vaping appears less harmful but not risk-free

In an op-ed on The Hill, Dr. Peter Shields, deputy director of The Ohio State University Comprehensive Cancer Center, writes that “little is known” about the safety of vaping.

He also points out that millions of youth have tried vaping, putting them at risk of nicotine addiction and conventional cigarette use.

Not everyone agrees. Daniel Giovenco, PhD, MPH, an assistant professor at Columbia University Mailman School of Public Health, cautions against lumping together vaping and cigarette smoking.

“Including vaping in the Great American Smokeout may perpetuate the common misconception that e-cigarettes are as harmful as cigarettes,” he said.

The vapor from e-cigarettes contains far fewer chemicals than tobacco smoke, which has thousands of chemicals, including at least 70 known to cause cancer.

E-cigarettes may be less harmful than conventional cigarettes, but they are not risk-free.

Aerosol from e-cigarettes can contain nicotine, lead, cancer-causing chemicals, as well as very fine particles that may affect lung or heart function when inhaled.

Some studies have also found a link between vaping and an increased risk of heart attacks and lung disease.

More research is needed, and is ongoing.

This includes a study at The Ohio State University Comprehensive Cancer Center that is using bronchoscopy to examine the impact of vaping on the lungs of e-cigarette users, smokeless tobacco users, and nonsmokers.

Vaping is not “all good” or “all bad”

Whether e-cigarettes are “good” or “bad” depends on the situation.

Giovenco said that for adult smokers, “completely switching to a vaping product reduces exposure to many of the deadly toxins present in combusted tobacco.”

This kind of harm reduction approach helps people switch from a harmful activity to a less-harmful one.

But if people continue to smoke conventional cigarettes — even alongside vaping — the health risks remain.

“With adult smokers, if e-cigarettes help them quit smoking, then that’s a win,” said Shields. “But if e-cigarettes distract smokers and they stay smoking, that’s not a win.”

Some research also suggests that e-cigarettes may be a gateway to cigarette smoking for youth. So there’s a concern that young people who vape will become addicted to nicotine.

“Youth should not be using any form of nicotine,” said Giovenco, “so messages of abstinence may be appropriate for that population.”

Giovenco said that the continued decline in smoking rates, even after the introduction of e-cigarettes to the marketplace, suggests that these devices aren’t impacting the fight against conventional cigarette smoking.

But the high use of e-cigarettes among youth is still concerning, he added.

“The challenge now is finding a balance between reducing e-cigarette appeal to youth, while encouraging adoption among smokers who are unable to quit cigarettes using other methods,” said Giovenco.

This may mean separate public health messages targeted at adult smokers and teen nonsmokers.

Doctors also need to be open to using e-cigarettes to help patients give up cigarettes.

“If a patient tells me that e-cigs are the only way they quit smoking, I’m not going to tell them to stop using them,” said Shields. “But if the e-cigs aren’t working, I ask the patient to call me so they can get on something that we know works.”

Proven smoking cessation tools include nicotine-replacement therapy and prescription medications.

The bottom line

In spite of the drastic decline in smoking rates, cigarette smoking remains the leading cause of death in the United States, accounting for more than 480,000 deaths every year, according to the Centers for Disease Control and Prevention.

The ongoing toll of tobacco on the country’s health may mean that health officials need to move beyond an “all good” or “all bad” view of e-cigarettes.

“Eliminating smoking should be our number one public health priority,” said Giovenco, “and that may require being more receptive to tobacco harm reduction when complete cessation is not possible.”