Electronic cigarettes (e-cigarettes) may be an effective tool for smoking cessation. In a randomized trial, researchers found that 18% of those assigned to use e-cigarettes were smoke-free after a year, compared with 9.9% of those assigned to nicotine replacement therapies such as patches and gum. However, those in the e-cigarette group were more likely to continue using the products, maintaining their addiction to nicotine.

Electronic cigarettes (e-cigarettes) have been marketed as a tool for smoking cessation, and now a British study in The New England Journal of Medicine indicates that they may indeed be effective for this purpose. In a randomized trial, the devices were more effective than nicotine replacement therapies (NRT), such as patches or gum, for smoking cessation. However, e-cigarette users were more likely to continue using the products, maintaining their addiction to nicotine.

E-cigarettes—electronic devices that vaporize a nicotine-containing liquid that is then inhaled via “vaping”—provide an alternative to combustible cigarettes. They are considered less toxic than their combustible counterparts, says Peter Hajek, PhD, of the Wolfson Institute of Preventive Medicine at Queen Mary University in London, UK, the study's lead author. Previous epidemiologic studies suggest that e-cigarettes can help smokers quit, but supporting data from a randomized, controlled trial has been lacking.

Hajek and his team randomly assigned 886 people motivated to quit smoking to use NRTs of their choice (including combinations), or e-cigarettes. They found that 18% of e-cigarette users successfully stopped smoking for a year, compared with 9.9% of NRT users; 12.8% of e-cigarette users who were not smoke-free for a year reduced their smoking by at least 50%, compared with 7.4% of NRT users. However, 80% of those in the e-cigarette group who were smoke-free for a year continued using the products, compared with 9% of those in the NRT group.

“I think there's space for all treatments, e-cigarettes and nicotine replacement therapies—the more methods you have in your arsenal, the more likely that something will work,” says Hajek. However, based on the findings, “if somebody asks which of these two is better [for smoking cessation], then I think the answer is e-cigarettes.”

“It's difficult to ignore a head-to-head comparison,” says Benjamin Toll, PhD, of the Medical University of South Carolina in Charleston. He notes that the study is one of the first to compare second-generation e-cigarettes to combination NRTs, which increases the relevance of the findings.

However, Toll is concerned that people were more likely to continue using e-cigarettes. “I have no problem with people using NRTs for a very long time,” Toll says. “That's not true at all for e-cigarettes—I don't want people using them long term. They're probably safer than smoking, but they're not entirely safe.” He says he'll likely continue recommending e-cigarettes only as a last resort.

For Dorothy Hatsukami, PhD, of the University of Minnesota in Minneapolis, the trial provides compelling evidence that e-cigarettes are effective for smoking cessation. She would like to see a similar trial conducted in the United States, where many people use higher nicotine delivery devices such as JUUL that are not available in the UK.

Hatsukami also questions whether the numerous flavored e-cigarette cartridges on the market are essential for smoking-cessation success. Both JUUL devices and flavored cartridges have been criticized for contributing to widespread e-cigarette use among U.S. youth.

Furthermore, “I think it's really important to conduct further research to see how we can optimize smoking cessation success,” she says. “We need to think about new ways to help smokers quit.” –Catherine Caruso