Cochrane Review: Nicotine E-Cigarettes Boost Smoking Cessation Rates

A newly updated Cochrane review concludes that nicotine-containing e-cigarettes help more smokers quit than some conventional cessation methods. The analysis draws on evidence from 80 randomized controlled trials involving 29,861 participants, including nine newly added studies in this latest update. The review is part of an ongoing scientific project revised whenever new evidence emerges.

How nicotine e-cigarettes compare to other cessation aids

The review identifies high-certainty evidence showing nicotine e-cigarettes outperform nicotine replacement therapies—such as nicotine patches and gum—in helping people stop smoking. According to the findings, approximately four additional people per 100 succeed in quitting when using nicotine e-cigarettes instead of other nicotine-replacement options.

Nicotine e-cigarettes also demonstrated higher cessation rates than non-nicotine e-cigarettes, with around two extra quitters per 100 users. When compared to receiving no support or only behavioral support—including individual counseling and group programs—e-cigarettes again showed higher quit rates. However, researchers judged the evidence for these comparisons to be less certain due to potential bias in some of the underlying studies.

Regulatory oversight and product safety

Dr. Jamie Hartmann-Bois, lead author of the review and researcher at the University of Massachusetts Amherst, stated the results provide strong evidence that regulated nicotine e-cigarettes are substantially less harmful than traditional cigarettes. She noted the nine newly included trials did not alter the review’s core conclusions and affirmed e-cigarettes represent a proven, practical option for people attempting to quit smoking.

The review found no evidence of increased serious harms linked to using nicotine e-cigarettes specifically for smoking cessation. Still, researchers emphasized the need for further long-term studies tracking users over extended periods. They stressed that the findings apply exclusively to regulated nicotine e-cigarettes; risks may differ for unlicensed products or those containing substances such as tetrahydrocannabinol (THC).

Hartmann-Bois warned against using unregulated devices, citing possible hazards including battery instability and exposure to harmful chemicals. She advised individuals seeking to quit smoking with e-cigarettes to select only products that have undergone testing and received regulatory approval in their country.

Concerns about youth health and dual use

Major health organizations—including the World Health Organization—caution that e-cigarettes are not risk-free. They expose users to nicotine and potentially harmful chemicals. These bodies express particular concern regarding use by children and adolescents, citing risks of nicotine addiction and increased likelihood of transitioning to tobacco products.

Transitional tool, not end goal

Dr. Nicola Lindson, the review’s lead researcher from the University of Oxford, highlighted the difficulty many smokers face in quitting, noting that multiple attempts are often required before success. She acknowledged nicotine e-cigarettes carry some risk but affirmed they are less harmful than continued smoking—a critical distinction for current smokers.

Hartmann-Bois described switching from conventional cigarettes to nicotine e-cigarettes as a transitional step toward eliminating nicotine dependence—not an endpoint in itself. She explained that offering a less harmful alternative may benefit individuals for whom other cessation supports have failed.

The review authors recommend that people aiming to quit smoking consult cessation support services or speak with healthcare providers to identify the most appropriate method. They underscore that the ultimate objective remains complete cessation of both smoking and nicotine dependence.