More than 60 years after the U.S. Surgeon General released its landmark report on the dangers of smoking, a new breed of “cigfluencers” has emerged in popular culture of celebrities puffing cigarettes in paparazzi photos. While some speculate whether smoking is actually making a comeback, other public health experts are noticing a more worrisome trend in people’s relationship with cigarettes.
Emerging research shows that more individuals are switching from vaping back to combustible cigarettes, a reversal of a pattern of e-cigarettes being used as a tool to quit. An Action on Smoking and Health (ASH)-commissioned survey by Talbot Mills Research found that of 623 current smokers and 1,070 former smokers in New Zealand, 14% reported using smoking to quit vaping. In a separate ASH survey of 940 adults in the UK, 19% said they’ve tried to quit vaping using cigarettes as a quitting aid, the second most popular strategy to quit vaping.
To be sure, cigarette smoking rates have plummeted since public health advocates began publicizing its harms, with only 9.1% of American adults smoking cigarettes as of 2025 compared with 42.4% in 1965, according to Centers for Disease Control and Prevention (CDC) data. Meanwhile, about 7% of American adults vape. But these trends of a shift from vaping to smoking as a cessation tool are less about changes in smoking prevalence, and more about a public health messaging failure that could have lasting consequences, experts warn.
“This is not just a trivial misunderstanding,” ASH Director Ben Youdan said in the New Zealand report. “It’s misinformation to the point of significant harm. Public health needs to urgently get back on track with clear, honest communication.”
Anti-smoking’s overcorrection
Michael Siegel, a professor of public health and community medicine at the Tufts University School of Medicine, would agree. He sees the shift as the result of an overcorrection in messages around the dangers of vaping relative to smoking.
“This to me suggests that there’s a lot of youth who have been misled by the public statements and messages that have been sent by the public health community and especially anti-smoking groups,” he told Fortune, “because there’s really no comparison. Smoking is orders of magnitude higher-risk than vaping.”
Smoking causes one in five deaths in the U.S. annually, or about 480,000 deaths, per CDC data, primarily as a result of lung cancer, chronic obstructive pulmonary disease (COPD), heart disease, and stroke. While vaping is associated with increased COPD and asthma risk, related deaths are fewer. For example, in February 2020, vaping was linked with 2,807 cases of lung injury and 68 deaths attributed to that lung injury.
Messaging around vaping began to appear in 2006, following the introduction of the first e-cigarettes on the U.S. market, and quickly snowballed after the 2015 release of the Juul. The products were largely designed as a harm reduction tool to help smokers transition from combustible cigarettes to a nicotine product with fewer adverse health effects. As more youth got access to this new product, the Food and Drug Administration (FDA) expanded its “Real Cost” campaign for youth from combustible tobacco to e-cigarettes. According to the agency, the campaign prevented more than 444,000 American youth from starting to use e-cigarettes between 2023 and 2024.
While a growing number of campaigns were effective in focusing on the specific health harms associated with vaping, there was soon a disconnect: Researchers noticed more people erroneously viewing vaping as more dangerous than smoking. A study published by researchers at the UT Southwestern Medical Center in March 2026 found that, among 20,771 survey respondents, the portion of those who perceived e-cigarettes as more harmful than combustible cigarettes grew from 3% in 2012 to 30% in 2022. Those who viewed e-cigarettes as less harmful shrunk from 51% to 17% over the same time period.
Pop culture’s overstated impact
Despite popular media like Euphoria’s frequent depiction of smoking or Reddit users proclaiming smoking “cool again,” Siegel is quick to squash the idea that a misunderstanding of the harms of smoking relative to vaping means that smoking is becoming more popular, particularly among young people, who are the frequent targets of both pro- and anti-nicotine product advertising.
“The data doesn’t show it,” he said. “We’re not seeing any kind of uptake in youth smoking.”
Indeed, the FDA’s National Youth Tobacco Survey found current tobacco use in middle and high school students in the U.S. fell to 7.2%, down from 8.1% the previous year. E-cigarette use dropped from 5.9% to 5.2%.
Siegel’s real fear is not increased prevalence among nicotine users, but rather that if more people think vaping and smoking are equally harmful, smoking seems like less of a risk, leading to more cigarette smoking among those already addicted to nicotine—and thereby increasing their risk of health problems, rather than decreasing them. If people see smoking as less harmful because the risk is on par with vaping, they may be less likely to quit altogether.
While solutions to this problem can come in the form of clearing the pathway for e-cigarettes to apply for and attain FDA approval while continuing to crack down on cigarettes, Siegel argued, the messaging around vaping versus cigarettes needs to reflect the reality, and young people seeing ads for nicotine products can handle the nuance.
“From a messaging point of view, I think we need to stop lying to kids,” he said. “I think that youth are sophisticated enough to be able to handle the truth.”
