A comprehensive new analysis provides the strongest evidence yet that nicotine e-cigarettes are a more effective tool for quitting smoking than traditional nicotine replacement therapies (NRT) such as patches, gum, and sprays. The Cochrane review, which pooled data from 80 studies involving nearly 30,000 adults, found that people using nicotine vapes were significantly more likely to remain smoke-free for at least six months compared to those relying on conventional NRT.
“There is clear evidence that nicotine e-cigarettes increase smoking cessation rates at six months or longer compared to nicotine replacement therapy,” said Jamie Hartmann-Boyce, senior author of the review at the University of Massachusetts Amherst, during a press briefing. She added that nicotine vapes boost cessation rates by about 60%, and that the certainty of this evidence is high, meaning future studies are unlikely to change the conclusion.
The review’s findings translate into a meaningful real-world difference: in a typical group of 100 smokers, about six would quit with NRT, but that number rises to around ten when nicotine e-cigarettes are used. This places vaping ahead of patches, gum, and sprays as a smoking cessation aid, though the researchers stress that not all vaping products are equal.
Not all vapes are the same
Hartmann-Boyce cautioned that the harms frequently associated with vaping come largely from unregulated devices that may contain harmful ingredients or psychoactive substances other than nicotine, such as THC. The products evaluated in the review were part of controlled trials and regulated for sale, which may differ from what consumers encounter in everyday settings. The researchers also noted that more evidence is needed on newer types of vaping devices.
The review also found that nicotine vapes may outperform non-nicotine alternatives and behavioural support alone. However, the authors emphasise that tobacco dependence is not purely a chemical addiction; it also involves social and behavioural rituals. This explains why many smokers struggle to quit even with support: nearly half of those who try without assistance fail to last a week, and fewer than 5% remain smoke-free after a year.
Given these challenges, the researchers call for continued innovation in cessation products that not only relieve withdrawal symptoms but also replicate the sensory and behavioural aspects of smoking without the health risks of inhaling tobacco smoke. The findings come as the EU considers new regulations on vaping products, including tax plans targeting vapes and nicotine pouches, which could affect their availability and affordability across member states.
While the review offers hope for smokers seeking to quit, it also underscores the need for careful regulation. The line between regulated therapeutic vapes and unregulated consumer products remains a key concern for public health officials. As European countries grapple with smoking rates and vaping trends, this evidence could inform both clinical guidelines and policy decisions.
For those considering vaping as a quitting aid, the message is clear: regulated nicotine e-cigarettes are a viable option, but they are not risk-free. The long-term health effects of vaping are still being studied, and the harms of nicotine in all forms are well documented. Nonetheless, for smokers unable to quit with conventional methods, the new evidence suggests that switching to a regulated nicotine vape could be a step in the right direction.
