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Updated: May 30, 2025

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Electronic cigarettes for smoking cessation.

Nicola Lindson1, Ailsa R Butler1, Hayden McRobbie2

  • 1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

The Cochrane Database of Systematic Reviews
|January 29, 2025
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Summary
This summary is machine-generated.

Electronic cigarettes (ECs) with nicotine significantly increase smoking cessation rates compared to nicotine replacement therapy (NRT) and non-nicotine ECs. While generally safe, more research is needed to fully assess long-term safety.

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Area of Science:

  • Public Health
  • Clinical Trials
  • Evidence-Based Medicine

Background:

  • Electronic cigarettes (ECs) are vaping devices used to deliver nicotine.
  • There is ongoing debate regarding their efficacy and safety for smoking cessation.
  • This review is an update of a living systematic review on ECs for smoking abstinence.

Purpose of the Study:

  • To evaluate the safety, tolerability, and effectiveness of nicotine ECs for long-term smoking abstinence.
  • Comparisons include non-nicotine ECs, other smoking cessation treatments, and no treatment.

Main Methods:

  • Systematic review including randomized controlled trials (RCTs) and uncontrolled intervention studies.
  • Searches conducted across major databases up to February 2024.
  • Risk of bias and GRADE assessments used; meta-analyses performed for pooled data.

Main Results:

  • High-certainty evidence shows nicotine ECs increase quit rates versus NRT (RR 1.59).
  • Moderate-certainty evidence shows nicotine ECs increase quit rates versus non-nicotine ECs (RR 1.46).
  • Adverse events (AEs) rates were similar between nicotine ECs and NRT/non-nicotine ECs; low-certainty evidence suggests higher AEs versus behavioral support.

Conclusions:

  • Nicotine ECs are effective for smoking cessation, with high-certainty evidence supporting their use over NRT.
  • No evidence of serious harm detected, but longer-term safety requires further investigation.
  • The review is ongoing, with monthly searches to incorporate new evidence.