Background: Smoking remains a significant public health concern in the UAE, with efforts to reduce its prevalence facing various challenges. Vaping has emerged as a potential harm reduction strategy, yet little is known about its perceptions, usage patterns, and health outcomes among smokers and ex-smokers in the country. This study aims to assess the perceptions of vaping, its usage patterns, and self-reported health outcomes among current and former smokers in the UAE. Methods: A cross-sectional survey was conducted among adults and ex-smokers across the UAE. A structured questionnaire will collect data on demographics, smoking and vaping history, perceived harm reduction, usage patterns, and self-reported health effects. Descriptive statistics, chi-square tests, and logistic regression models were analyzed for the data. Results: In the research, 290 participants identified as male (93.1%), with their mean age at 34.7 years (±9.2). Most individuals who started vaping were between 19 and 25 years of age (52.8%). Current smokers evaluated vaping more favorably than former smokers on all key dimensions, although harm reduction, harm reduction support, and social approval ratings proved particularly significant (p < 0.01). Former smokers provided evidence showing they consider vaping to be a substance with addictive properties (p < 0.001) aimed at youth (p < 0.01) and dangerous to use occasionally (p < 0.01). A significant number of 41.4% of participants showed better respiratory symptom improvement following vaping, yet this response was more prominent among former smokers at 58.3% than current smokers at 39.0% (p < 0.005). Commitment to conventional smoking increased the risk of adverse effects between 21.65% for active smokers and 16.7% for previous users (p < 0.001). Multivariate logistic regression identified former smoking status (AOR = 2.8, p < 0.001), strong belief in vaping as a cessation aid (AOR = 1.9, p < 0.001), and higher education (AOR = 1.6, p = 0.04) as significant predictors of exclusive e-cigarette use. Conclusion: Ex-smokers gain greater advantages from vaping, but existing cigarette users mostly suffer additional negative consequences and reduced positive outcomes. Vaping behavior strongly depends on how much individuals believe vaping harms them, works as a substitute, or fits into their social environment based on their smoking status. The promotion of exclusive e-cigarette usage for cessation requires complete educational programs, together with strict regulation measures and persistent assessment of health results.