Nicotine E-Cigarettes May Be the Most Effective Way to Quit Smoking

Nicotine e-cigarettes and quitting smoking

A new review indicates that nicotine e-cigarettes may be the most effective choice for people seeking to stop smoking, outperforming nicotine gum, patches and behavioural support such as counselling.

These findings come with many important qualifications, discussed below. Still, the available evidence indicates that regular smokers who switch to vaping may achieve higher quit rates than with other approaches.

It remains unclear whether that improved quit rate outweighs the potential long-term harmful effects of vaping.

Tobacco use is known to kill more than 7 million people annually, including over 1.6 million non-smokers exposed to second-hand smoke.

If clinicians can give people dependable ways to give up smoking, these figures could fall – although doing so is plainly far from simple.

"Quitting smoking is hard and a lot of people who smoke will have tried many times to quit smoking and been unsuccessful," says Nicola Lindson, the study’s lead author and a smoking-cessation specialist at the University of Oxford.

"For that reason, it is important that there are a number of different options available to help somebody quit, which could encourage them to keep trying.

"Although nicotine vapes are unlikely to be completely risk-free, they are less harmful than smoking and that is the most important comparison to make for people who are still smoking tobacco."

Vapes, e-cigarettes and Juuls all refer to the same type of device: an electronic product that turns liquid into an aerosol, with or without nicotine, for the user to inhale.

Clinicians and health researchers generally call these products e-cigarettes, and that is the terminology used in this review.

Crucially, the review’s conclusions concern only regulated nicotine e-cigarettes. They do not apply to questionable disposable devices sold unofficially by vape shops, or to vapes containing other substances such as THC.

"Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals," says Jamie Hartmann-Boyce, a health-policy expert at the University of Massachusetts Amherst.

"Anyone looking to use e-cigarettes to quit smoking should only purchase devices that have been tested and approved by their country's regulatory body. Lists of regulated devices are available from the FDA in the US and MHRA in the UK."

What the Cochrane review of e-cigarettes found

The international research team combined and reanalysed data from 80 ‘gold-standard’ randomised controlled trials of smoking-cessation methods.

As a result, the findings draw on data from almost 30,000 smokers worldwide.

The study is particularly notable because it is a living systematic review published in the Cochrane Database.

Such reviews are recognised for bringing together the continuing body of evidence and judging the degree of confidence warranted by study findings, helping to guide the practical use of evidence-based medicine.

(AleksandrYu/Getty Images)

The researchers found high-certainty evidence that, compared with nicotine-replacement options such as patches and gum – which doctors have recommended as the principal quitting tools for decades – nicotine-containing e-cigarettes help about 4 additional people in every 100 smokers to quit.

Nicotine e-cigarettes also produced better quitting rates than non-nicotine e-cigarettes, leading to around 2 additional quitters per 100.

"We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking," says Hartmann-Boyce.

"Based on the consistency of the findings here, it's clear that they are a proven and viable option for people wishing to quit traditional cigarettes."

What e-cigarette evidence does not yet answer

Although the review points to vapes as an effective method of stopping smoking, it does not examine whether people later stop vaping or overcome their underlying nicotine dependence.

"We did not investigate the issues around use of e-cigarettes in people who don't smoke, nor of the issues related to becoming dependent on e-cigarettes and how best to quit using them," says Chris Bullen, a study author and population-health expert at the University of Auckland in New Zealand.

"These are genuine concerns that require separate evidence reviews."

The research also cannot determine how the benefits and risks of vaping compare when it is used as a tool to quit smoking.

Decades of evidence document the long-term effects of cigarette smoking, but comparable evidence does not yet exist for vaping.

The trials identified no serious short-term harms, yet their authors stress that larger studies lasting longer are needed to properly assess vape safety.

Related: Concerning Levels of Uranium And Lead Found in The Urine of Teens Who Frequently Vape

A substantial and growing body of evidence suggests that vapes may be harmful, and they even appear likely to cause cancer. For vaping as a way to stop smoking, the key long-term question is whether these risks exceed its benefits.

Only time, alongside ongoing rigorous scientific research, can provide the answer.

Funding for the systematic review was provided by Cancer Research UK, the National Cancer Institute of the National Institutes of Health, and the FDA Center for Tobacco Products.

The research appeared in the Cochrane Database of Systematic Reviews.

This article was fact-checked and edited by Michael Irving. Although we take pride in our process, we are only human. If you notice an error, please let us know.