Key Takeaway:
- Nicotine e-cigarettes help more smokers quit than nicotine patches, gum, and other nicotine replacement therapies.
- Vaping is not risk-free: The review does not establish its long-term safety or whether users eventually quit vaping.
- Use regulated products only: Findings apply to regulated nicotine e-cigarettes, not illicit or unapproved devices.
A Cochrane review finds regulated Nicotine Vapes and nicotine e-cigarettes help more adults quit smoking than nicotine replacement therapy, such as patches or gum, although long-term vaping risks remain uncertain.
Review Finds Higher Quit Rates With Nicotine Vapes
The living systematic review, updated in November 2025, analyzes 104 completed studies involving 30,366 adults who smoke, including 61 randomized controlled trials. Researchers found high-certainty evidence that nicotine e-cigarettes increase quit rates compared with nicotine replacement therapy.
The review found the difference translates to about four additional people quitting for every 100 smokers who use nicotine e-cigarettes rather than nicotine replacement therapy. The evidence also suggests nicotine e-cigarettes are more effective than non-nicotine e-cigarettes, although that comparison carries less certainty.
Nicola Lindson, a smoking cessation researcher at the University of Oxford and lead author, said quitting can be difficult and people may need several options to find an approach that works.
“Quitting smoking is hard, and a lot of people who smoke will have tried many times,” Lindson said.
The review assesses Nicotine Vapes and other products used by adults who already smoke. It does not establish that people who do not smoke should begin using e-cigarettes.
Researchers Stress Limits Of Vaping Evidence
The findings do not show that vaping is harmless or that smokers should continue using Nicotine Vapes indefinitely after quitting cigarettes. The review says evidence on serious adverse effects remains limited, and longer, larger studies are needed to assess safety.
The researchers also did not determine how many people who quit smoking with e-cigarettes later stop vaping or overcome nicotine dependence. Chris Bullen, a population health expert at the University of Auckland and review author, said those questions require separate research.
“We did not investigate the issues around use of e-cigarettes in people who don’t smoke,” Bullen said, adding that dependence on e-cigarettes also needs further evidence.
The review is part of a living evidence project, meaning researchers continue to search for new studies and update the evidence when relevant findings emerge. The latest published review searched research databases through March 2025.
Regulated Products Remain Critical To Findings
The evidence applies to regulated nicotine e-cigarettes studied in clinical research, including regulated Nicotine Vapes, not illicit products or devices containing other active substances. Cochrane specifically warns that unregulated products and products containing substances such as THC may have different risk profiles.
Jamie Hartmann-Boyce, a University of Massachusetts Amherst health policy researcher and review author, said regulated e-cigarettes are less harmful than smoking, but users should still consider their risks.
“Regulated nicotine e-cigarettes are substantially less harmful than smoking,” Hartmann-Boyce said.
The review does not settle whether the long-term health risks of vaping outweigh its benefits as a smoking cessation tool. Smoking has established long-term health consequences, while comparable decades-long evidence for vaping is unavailable.
For smokers who have struggled to quit, the findings add regulated Nicotine Vapes and other nicotine e-cigarettes to the evidence-based options available for cessation. But researchers say continued monitoring and longer-term studies are needed to clarify the health effects of vaping after smoking stops.
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