E-cigarettes as addictive as traditional cigarettes, study finds

They entered the market as a promising alternative to traditional cigarettes — a tool to help smokers quit. But in practice, e-cigarettes have taken a different turn: They have become especially popular among young people and are often used recreationally rather than as a smoking cessation aid. Now, a new study reveals troubling findings about their addictive potential — levels of addiction that, in some cases, rival those of regular cigarettes.

A new meta-analysis (a study that analyzes data from previously published research) suggests that e-cigarettes can cause real dependence — not only among former smokers but also among new users.

The researchers, from the School of Public Health Sciences at the University of Waterloo in Canada, reviewed 107 studies published between 2017 and 2023, most of them from the United States, to examine how addictive e-cigarette use is and how users’ previous smoking habits influence it. The study is expected to be published in the April 2025 issue of the international scientific journal Addictive Behaviors.

According to the findings, "dual users" — those who continue to smoke both traditional and electronic cigarettes — reported similar levels of dependence to users who had switched exclusively to e-cigarettes. In contrast, individuals who never smoked traditional cigarettes but currently use e-cigarettes reported lower levels of dependence — although some level of addiction was still evident, particularly when using products containing nicotine.

The study also found that the higher the nicotine concentration in an e-cigarette, the greater the level of addiction. Frequency of use and the duration of consistent use also directly affected the degree of dependence. However, researchers did not find a significant link between different device types and addiction levels, nor were there notable differences based on age, gender, or socioeconomic background.

The researchers stressed, however, that due to significant variability between the studies analyzed — both in population composition and in the methods used to measure addiction — further, broader, and more precise studies are needed to fully understand the scope of the problem.

Moshe Bar-Haim, CEO of the Israel Cancer Association, said the findings expose a dangerous manipulation by the tobacco industry: "Tobacco and nicotine companies convince long-time smokers to switch to e-cigarettes under the pretense of smoking cessation, but the new study proves this is a deception — because using them leads to dependence similar to that of regular cigarettes," he said. "Those who are tempted to switch end up perpetuating their addiction instead of quitting altogether."

Bar-Haim added that manufacturers are also targeting teenagers, obscuring the risks of use. "Tobacco companies market flavored and scented vaping products to children and teenagers, masking the fact that these are addictive products that serve as a gateway to smoking — including traditional cigarettes," he emphasized. "We call for immediate legislation to ban the sale of flavored e-cigarettes and to reduce the permissible nicotine levels in smoking products in Israel."

The Israel Cancer Association further noted that e-cigarettes are associated with a range of symptoms and health issues, including coughing, vomiting, high blood pressure, heart attacks, and an increased risk of asthma. Among adolescents, use of e-cigarettes can also cause developmental damage to the brain, potentially leading to attention disorders, learning difficulties, depression, anxiety, and emotional instability. Prolonged use has been shown to harm the physical fitness of healthy young people and may even increase the risk of cancerous tumors — in the lungs, bladder, and oral cavity.

"To date, dozens of deaths and thousands of cases of vaping-related illness (EVALI) have been documented worldwide. This condition causes severe lung damage due to the inhalation of harmful substances and can result in lung collapse," the association noted.

Dr. Daniel Starobin, a pulmonary disease specialist and director of the Pulmonary Institute at Assuta Ashdod Public Hospital, also addressed the misconception of e-cigarettes as a cessation tool. "Very few people actually use them to quit smoking — most continue to smoke," he said. According to Starobin, the difference in addiction levels between regular and electronic cigarettes is minimal. "E-cigarettes come at a cost," he warned. "Like traditional cigarettes, they contain substances that reach the lungs, cause combustion, and lead to severe secondary damage. It may seem less harmful — but in reality, the harm is cumulative."

However, Dr. Starobin emphasized that e-cigarettes are still a relatively new product, and therefore, their long-term effects are not yet fully known. "It will take many more years of research and medical monitoring to fully understand their impact on the human body," he said.

For now, regulation of the product in Israel is still evolving — but remains insufficient. Two years ago, the Ministerial Committee on Legislation approved a bill proposed by Knesset member Boaz Bismuth to ban the production and marketing of flavored e-cigarettes. However, the Israel Cancer Association warned that "the road to final approval is still long" and that a "broad mobilization of Knesset members and government ministries is needed to advance the legislation."