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Updated: Jan 11, 2026

Comparing the Effects of Electronic Cigarette Vapor and Cigarette Smoke in a Novel In Vivo Exposure System
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Electronic cigarettes for smoking cessation.

Nicola Lindson1, Jonathan Livingstone-Banks1, Ailsa R Butler1

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The Cochrane Database of Systematic Reviews
|November 10, 2025
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Summary
This summary is machine-generated.

Nicotine electronic cigarettes (EC) significantly increase smoking cessation rates compared to nicotine replacement therapy and non-nicotine EC. While generally safe, further research is needed to fully assess long-term safety outcomes.

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Area of Science:

  • Public Health
  • Addiction Medicine
  • Respiratory Medicine

Background:

  • Electronic cigarettes (EC) are vaping devices that heat liquids to produce an aerosol.
  • There is a need to understand the efficacy and safety of EC for smoking cessation.
  • This review is an update of a living systematic review on EC for smoking cessation.

Purpose of the Study:

  • To evaluate the effectiveness of EC in achieving long-term smoking abstinence.
  • To assess the safety and tolerability of EC compared to various control conditions.
  • Comparisons include non-nicotine EC, other smoking cessation treatments, and no treatment.

Main Methods:

  • A systematic review including randomized controlled trials (RCTs) and uncontrolled intervention studies.
  • Searches conducted across multiple databases (CENTRAL, MEDLINE, Embase, PsycINFO) up to March 2025.
  • Critical outcomes: smoking abstinence (≥6 months), adverse events (AEs), serious adverse events (SAEs).

Main Results:

  • Nicotine EC significantly increased quit rates compared to nicotine replacement therapy (NRT) (high-certainty evidence).
  • Nicotine EC likely increased quit rates compared to non-nicotine EC (moderate-certainty evidence).
  • Quit rates may be higher with nicotine EC compared to behavioral support or no support (low-certainty evidence).

Conclusions:

  • High-certainty evidence supports nicotine EC as more effective than NRT for smoking cessation.
  • Moderate-certainty evidence suggests nicotine EC are more effective than non-nicotine EC.
  • No evidence of serious harm was detected, but longer trials are needed for comprehensive safety evaluation.