Smokers who want to quit are most likely to succeed when they use nicotine e-cigarettes, according to a new Cochrane review.
For someone trying to leave cigarettes behind, the method they choose can make a measurable difference. An updated Cochrane review finds that nicotine e-cigarettes help more people stop smoking than several widely used approaches, including nicotine gum and patches, behavioral support, or attempting to quit without support.
Smoking remains the leading cause of preventable disease and death worldwide, accounting for more than seven million deaths each year, including 1.6 million among non-smokers exposed to second-hand smoke, according to the World Health Organization (WHO).
Nicotine e-cigarettes raise quit rates
To determine which approaches were most effective, the researchers drew on an ongoing living systematic review, meaning the evidence is reassessed as new research becomes available. The latest analysis included 80 randomized controlled trials with 29,861 participants, including nine trials added in this update.
The strongest evidence favored nicotine e-cigarettes over nicotine replacement therapy (NRT), including patches and gum. The review found high-certainty evidence that nicotine e-cigarettes produced about four additional quitters for every 100 people compared with NRT. They also performed better than e-cigarettes without nicotine, with about two additional people per 100 successfully quitting.
People given e-cigarettes also had higher quit rates than those receiving no support or behavioral support (such as individual counseling and group programs). However, the researchers have less confidence in this comparison because the design of those studies carried a greater risk of bias.
Evidence favors regulated nicotine products
“We have very strong evidence that regulated nicotine e-cigarettes are substantially less harmful than smoking,” says Dr. Jamie Hartmann-Boyce, senior author of the review from the University of Massachusetts Amherst. “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. This update includes 9 new trials and our main conclusions haven’t changed.”
Researchers found no evidence that using e-cigarettes to quit smoking increased serious harm, although longer-term research is still needed. Importantly, the conclusions apply to regulated e-cigarettes containing nicotine. Illicit products and devices containing other substances, including THC, may present different risks.
“It’s worth highlighting that our review looks at regulated e-cigarettes containing nicotine, but many of those available on the market do not meet these standards,” says Dr. Hartmann-Boyce. “Unlicensed e-cigarettes are potentially dangerous, with issues including unstable batteries and harmful chemicals. 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.”
Vaping still carries health risks
That advantage over smoking does not make vaping harmless. Major health organizations and bodies, including the WHO, caution that e-cigarettes expose users to nicotine and other potentially harmful chemicals. Health experts have also raised concerns that vaping among children and young people can lead to nicotine addiction and tobacco smoking.
The authors emphasize that e-cigarettes may not be the right quitting tool for everyone and recommend that people seek advice from stop smoking support services or clinicians. Vaping has health risks of its own, but the authors maintain that those risks are far smaller than the dangers associated with smoking.
Dr. Nicola Lindson, lead author of the review based at the University of Oxford, reflects that: “Quitting smoking is hard, and a lot of people who smoke will have tried many times to quit smoking and been unsuccessful. 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.”
For Dr. Hartmann-Boyce, moving from cigarettes to vaping can represent an intermediate step rather than the final goal. “For somebody who is already addicted to nicotine through cigarettes, having a safer alternative like an e-cigarette is something worth considering, especially when other quit aids have proven unsuccessful. We are currently working on a review of interventions to help people quit vaping, which could be the next step along for people looking to transition to a lower-harm product before quitting nicotine altogether.”
Reference: “Electronic cigarettes for smoking cessation” by Nicola Lindson, Jonathan Livingstone-Banks, Ailsa R Butler, Hayden McRobbie, Christopher R Bullen, Peter Hajek, Angela Difeng Wu, Rachna Begh, Annika Theodoulou, Claire Ma, Caitlin Notley, Nancy A Rigotti, Tari Turner, Thomas Fanshawe and Jamie Hartmann-Boyce, 26 August 2026, Cochrane Database of Systematic Reviews.
DOI: 10.1002/14651858.CD010216.pub11
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