Nicotine e-cigarettes help four more people per 100 quit than patches or gum

A comprehensive study analyzing dozens of clinical trials reveals that regulated nicotine vapes increase the odds of a successful quit attempt by 61 percent compared to conventional alternatives. The findings place electronic nicotine delivery systems at the center of smoking cessation strategies, though researchers and health advocates continue to urge caution regarding unregulated market products and long-term habits.

Cochrane Review Finds Vapes Outperform Patches and Gum

The extensive analysis, carried out by researchers including a team based at the University of Oxford, examined 80 separate studies involving nearly 30,000 people. The results demonstrate that for every 100 people using nicotine e-cigarettes to stop smoking, roughly eight to 10 successfully quit, compared to just six out of 100 people relying on conventional nicotine-replacement therapies like gum or patches.

Vapes containing nicotine outperformed those without, helping more people to quit. The Cochrane Review analysed 80 separate studies involving almost 30,000 people. Researchers found that vape use increased quit rates compared to nicotine replacement therapy, such as gum or patches, with vaping leading to 61% increased odds in a quit attempt being successful after six months.

Meanwhile, researchers looked at behavioural support – offered through advice and counselling – and found that smokers who receive six to eight sessions of a group behaviour treatment were almost twice as likely to quit as those using self-help programmes. However this represents only about four extra successes in every 100 who try. The quit rates after individual advice or brief support were very similar, but adding nicotine replacement gum and patches to group therapy or individual therapy did provide further benefits.

Writing in the BMJ, John Britton, director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, said the results suggested e-cigarette use could contribute to falling smoking rates. Smoking rates fell by 1% from 2014 to 2015.

This significant year-on-year fall indicates that something in UK tobacco control policy is working, and successful quitting through substitution with e-cigarettes is one likely major contributor. Dr Britton

The British public have voted with their feet and are choosing to use e-cigarettes. This is a positive choice, and we should promote it. Prof

Public Health England says e-cigarettes are 95% less harmful to your health than normal cigarettes, and when supported by a smoking cessation service, help most smokers to quit tobacco altogether.

Duke University Researchers Spot a Major Gap in Dual Use

While quit rates show clear benefits, a separate paper published in Nicotine and Tobacco Research by researchers at Duke University School of Medicine highlights a critical blind spot in existing clinical trials: the phenomenon of dual use, where individuals smoke traditional cigarettes and vape concurrently.

In a paper published in Nicotine and Tobacco Research, researchers reviewed 71 clinical trials included in a major 2025 analysis of e-cigarettes for smoking cessation. More than 80% of the studies never reported rates of dual use,” or smoking and vaping at the same time. Only 12 reported it directly, and just one clearly defined the term.

“We found that dual use is very infrequently reported,” said senior study author Joseph McClernon, PhD, professor of psychiatry and behavioral sciences and associate director of the Duke Clinical & Translational Science Institute. “And even when it is reported, how dual use is defined is typically unclear. This impedes having a clear picture of the efficacy of e-cigarettes as an intervention to help people quit smoking.”

Joseph McClernon, PhD

That matters because people who both smoke and vape tend to have a harder time quitting smoking and often remain highly dependent on nicotine. Their exposure to harmful chemicals is also much closer to that of cigarette smokers than to those who fully switched to e-cigarettes.

Among studies that measured it, dual use averaged 42.6% four weeks after participants started using e-cigarettes. The paper’s two co-first authors are Makayla Stewart, an undergraduate at North Carolina Central University who worked on the project through a joint Duke-NCCU summer research program, and Abigail Hoyt, a recent Duke graduate who completed an independent study with McClernon.

Looking beyond quit rates, why focus on dual use rather than quit rates alone? Cessation treatments were traditionally studied only briefly or were not sold on the open market, McClernon said, so continued use was not a concern.

But e-cigarettes are different — they are available in the market, are relatively cheap, and don't require a prescription. And, unlike other treatments, e-cigarettes can be addictive in their own right, McClernon noted

Regulatory Standards and Public Health Guidance

Vapes offer a proven and viable option for people wishing to quit traditional cigarettes, experts have said. It follows a comprehensive review into e-cigarettes compared with alternative cessation aids.

While vaping is unlikely to be completely risk-free, it is less harmful than smoking, experts added as they urged stop smoking services to offer a broad range of products to assist smokers in their quit attempts.

Healthcare providers should continue to consider group behaviour therapy in combination with other interventions, such as nicotine replacement therapy, as an option for helping smokers to quit, especially in settings such as the workplace, where support to attend sessions can also be given.

Readers should consult qualified medical professionals regarding individual smoking cessation plans and appropriate product selection.