FPIN's Clinical Inquiries

Electronic Cigarettes for Smoking Cessation


Am Fam Physician. 2021 Jan 1;103(1):53-54.

Clinical Question

Are electronic cigarettes (e-cigarettes) effective for tobacco cessation in adults?

Evidence-Based Answer

e-Cigarettes with nicotine can be used to encourage smoking cessation, but continued use after cessation may be a risk factor for relapse. (Strength of Recommendation [SOR]: B, based on a meta-analysis of two low-quality randomized controlled trials [RCTs].) e-Cigarettes with nicotine used for smoking cessation are more effective than e-cigarettes without nicotine (9% vs. 4% off cigarettes at six months). Nicotine e-cigarettes are more effective at one year than other forms of nicotine replacement (18% vs. 9.9% off cigarettes at one year), although 80% of abstinent patients will continue e-cigarette use. (SOR: B, based on a large RCT.)

Evidence Summary

A 2016 systematic review and meta-analysis evaluated the effect of using e-cigarettes to help patients who smoke achieve long-term smoking cessation.1 The study included two RCTs with 662 adults from New Zealand and Italy interested in smoking cessation and compared e-cigarettes with nicotine to e-cigarettes without nicotine (placebo). Patients using e-cigarettes abstained from smoking for at least six months at a higher rate than those using placebo e-cigarettes (9% vs. 4%, respectively; relative risk [RR] = 2.29; 95% CI, 1.05 to 4.96).1 There were no serious adverse effects related to e-cigarette use.1 The authors rated the overall quality of the evidence as low, with high risk of selection bias.

A 2019 pragmatic RCT with 886 patients from the United Kingdom who smoked cigarettes and were interested in quitting evaluated the one-year effectiveness of e-cigarettes with nicotine compared with other forms of nicotine replacement for smoking cessation. Patients had a median age of 41 years, and they smoked a median of 15 cigarettes per day. During randomization, researchers provided patients with an e-cigarette device and one 30-mL bottle of nicotine vaporizing fluid or three months of the nicotine replacement

Address correspondence to Jon Neher at jon_neher@valleymed.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

Copyright © Family Physicians Inquiries Network. Used with permission.


show all references

1. Hartmann-Boyce J, McRobbie H, Bullen C, et al. Electronic cigarettes for smoking cessation. Cochrane Database Syst Rev. 2016;(9):CD010216....

2. Hajek P, Phillips-Waller A, Przulj D, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019;380(7):629–637.

3. Gomajee R, El-Khoury F, Goldberg M, et al. Association between electronic cigarette use and smoking reduction in France. JAMA Intern Med. 2019;179(9):1193–1200.

4. American Cancer Society position statement on electronic cigarettes. Accessed December 4, 2020. https://www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (https://www.cebm.net).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to https://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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