Nearly 30,000 people tested quit-smoking methods. One stood out
Nicotine e-cigarettes appear to help more smokers quit than patches, gum, and several other common approaches, according to a major review of 80 clinical trials. Researchers say regulated vaping products are not risk-free, but may be a significantly less harmful alternative for people who would otherwise continue smoking.
Key points
- An updated Cochrane review of 80 trials with 29,861 participants found high-certainty evidence that nicotine e-cigarettes help more people quit smoking than nicotine replacement therapy, non-nicotine e-cigarettes, or no support.
- Nicotine e-cigarettes led to about 4 additional quitters per 100 people compared with nicotine patches or gum, and about 2 additional quitters per 100 compared with non-nicotine e-cigarettes.
- The review found no evidence that using e-cigarettes to quit smoking increased the risk of serious harm, but longer-term research is still needed.
An updated Cochrane review has found that nicotine e-cigarettes may help more people stop smoking than several commonly used methods, including nicotine gum, patches, behavioral support, or quitting without help. The findings come from a living systematic review that included 80 randomized controlled trials with 29,861 participants, adding nine new trials in this update.
Smoking remains the world's leading cause of preventable disease and death. According to the World Health Organization, it causes more than seven million deaths each year, including 1.6 million deaths among non-smokers exposed to second-hand smoke.
How e-cigarettes compared
The researchers found high-certainty evidence that nicotine e-cigarettes produced higher quit rates than nicotine replacement therapy, such as patches and gum. For every 100 people, nicotine e-cigarettes resulted in about 4 additional people successfully quitting.
Nicotine e-cigarettes also performed better than non-nicotine cigarettes, leading to about 2 additional quitters per 100 people. People given e-cigarettes also had higher quit rates than those who received no support or behavioral support, though researchers had less confidence in that comparison due to potential bias in some study designs.
We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking
— Dr. Jamie Hartmann-Boyce
What experts said
Dr. Jamie Hartmann-Boyce, senior author from the University of Massachusetts Amherst, said there is very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking. She added that they are a proven and viable option for people wishing to quit traditional cigarettes.
The review found no evidence that using e-cigarettes to quit smoking increased the risk of serious harm, but longer-term research is still needed. The conclusions apply specifically to regulated, nicotine-containing e-cigarettes; illicit products and those containing other substances like THC may present different risks.
Dr. Hartmann-Boyce noted that many e-cigarettes on the market do not meet regulatory standards and that unlicensed devices can be dangerous. She advised people to only purchase devices tested and approved by their country's regulatory body, such as the FDA in the US or MHRA in the UK.
Dr. Nicola Lindson, lead author based at the University of Oxford, said quitting smoking is hard and many people try multiple times. She emphasized that having several different options available is important to encourage people to keep trying, and that while nicotine vapes are unlikely to be completely risk-free, they are less harmful than smoking.
