• A new study states that cigarettes, e-cigarettes, and water pipes are all bad for your health.
• Researchers say all three methods stiffen arteries, damage DNA, and cause inflammation.
• They say smoking and vaping increase a person’s risk for lung cancer, COPD, and other conditions.
• They add that people who smoke or vape are also more susceptible to more serious cases of COVID-19.

Smoking and vaping are bad for people’s health.

That’s the blunt assessment from a new study led by Dr. Thomas Munzel, chief of cardiology at the University Medical Center at Johannes Gutenberg University in Mainz, Germany.

The study says smoking and vaping both stiffen arteries, cause inflammation, and damage DNA.

In addition, researchers say smoking and vaping increase the risk of serious COVID-19 complications.

Scientists say this is the first major study comparing the three forms of smoking and vaping: tobacco, e-cigarettes, and water pipes.

“This study, along with many others, has found that smoking and vaping causes significant harm to the cardiovascular system and damages pulmonary physiology impairing the respiratory system,” said Dr. Osita Onugha, the director of the surgical innovation lab at the John Wayne Cancer Institute in Santa Monica, California.

“They are all harmful,” Onugha told Healthline. “Cigarettes are better studied, so there is more data to demonstrate all the damaging effects on the body. Vaping is relatively new and has not been studied as extensively.”

Breaking down the health dangers

The scientists found multiple studies showing tobacco cigarettes are more harmful than e-cigarettes, but few large studies tackled the effects of water pipes, also referred to as hookahs, shishas, and narghiles.

Although more investigation is needed, the study concluded “water pipe smoking is not less harmful than tobacco smoking and thus cannot be considered a healthy alternative.”

“Inhaling water vapor has its risks as well, as you are still inhaling chemicals heated to higher temperatures,” Dr. Alvin Singh, a pediatric pulmonologist at Children’s Mercy Hospital in Kansas City, Missouri, told Healthline.

“I think it’s kind of like asking, ‘Would you rather be robbed at gunpoint, by someone with a knife, or by someone with a baseball bat?’ You may end up with a less severe form of injury, but in the end, you’re still going to be robbed,” he said.

Singh broke down some of the differences between the three.

“Cigarettes have more chemicals, which are heated at higher temperatures, increasing the risk of more severe harm over time. E-cigarettes are heated at lower temperatures — 400 degrees compared to 700 to 800 degrees in cigarettes — but can still cause some injuries, which are starting to be understood. Long-term outlooks are still not known, but do not look great,” he said.

Part of any public confusion over the potential harm comes from those profiting from smoking and vaping, says Dr. Brian Tiep, director of pulmonary rehabilitation and smoking cessation programs at City of Hope in Duarte, California.

“The seeds of doubt are sewn by the vaping/tobacco industry as well as some countries that believe smoking or vaping to be a binary choice,” Tiep told Healthline.

“The logic goes, ‘People addicted to nicotine will not stop smoking, thus vaping, being 95 percent safer, is a less harmful choice.’ They admit that some harm may be associated with vaping. However, they contend that turning to vaping saves lives,” he explained.

The study by the numbers

Researchers looked at a range of studies that they graded as providing strong, good, or medium levels of evidence on the three types of smoking and vaping.

Compared with nonsmokers, tobacco cigarettes increased the risk of chronic obstructive pulmonary disease (COPD) by 704 percent (good level of evidence). Water pipes increased COPD by 218 percent (strong) and e-cigarettes increased it by 194 percent (good).

Tobacco cigarettes increased lung cancer risk by 1,210 percent (strong), and water pipes increased it by 122 percent (strong). The level of evidence for e-cigarettes wasn’t sufficient to draw reliable conclusions.

“There has never been any evidence suggesting that vaping does not cause harm to the respiratory system,” Onugha said.

“People try to use vaping as a way to help patients quit smoking because of the presumption that vaping is not as bad as smoking cigarettes. This study is very important because it demonstrated that there is not only significant risk of COPD and lung cancer from cigarette smoking, but also from vaping,” he said.

The effects with COVID-19

The effects of smoking and vaping also make the effects of COVID-19 even more serious for those who already have lung damage.

“The COVID-19 pandemic has required us to focus on learning new things quickly,” Dr. Loren Wold, an assistant dean for biological health research at The Ohio State University, told Healthline.

“Many groups have shown that patients with compromised immune systems suffer greatly from COVID-19 infection. Smoking causes altered immune function, and smokers seem to have worse outcomes than nonsmokers if infected with COVID-19. This is likely due to changes in the body’s ability to fight off an infection due to changes in immune cells,” he said.

Doctors agree that more research is needed, and not using any of the three smoking and vaping methods is the best way to optimize one’s health down the line.

“The difference in harm is difficult to assess, as research into the effects of e-cigarettes and water pipe smoking are on their infancy compared to traditional smoking,” Wold said.

“At the core of all three, however, is exposure to particulate matter from the combustion of the devices, which we know can have dramatic short- and long-term effects on the lungs and heart,” he said.

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