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LINDA MONTGOMERY, MD, AND SARAH BEAVERSON, MD

Am Fam Physician. 2025;112(4):450-451

Author disclosure: No relevant financial relationships.

CLINICAL QUESTION

Is use of nicotine e-cigarettes an effective strategy for tobacco smoking cessation?

EVIDENCE-BASED ANSWER

Use of nicotine e-cigarettes increases tobacco smoking cessation rates compared with use of nicotine replacement therapy (NRT), non-nicotine e-cigarettes, behavioral support only, and no support. (Strength of Recommendation [SOR]: A, Cochrane review, systematic review, meta-analysis of five randomized controlled trials [RCTs], and a large RCT.) Nicotine e-cigarettes are as effective as varenicline (Chantix) for tobacco smoking cessation at 26 weeks, but the effect may wane over time. (SOR: B, single-site RCT.)

EVIDENCE SUMMARY

A 2024 Cochrane review analyzed 88 studies, including 47 RCTs, eight randomized crossover trials, and 33 uncontrolled cohort studies (N = 27,235). The review evaluated the effectiveness of nicotine e-cigarettes for tobacco smoking cessation vs conventional NRT (eg, nicotine gums, nicotine transdermal patches), varenicline, non-nicotine e-cigarettes, heated tobacco products, behavioral support only, and no support. The adults involved in the review smoked cigarettes and had varying levels of motivation to quit smoking.1

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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.

Copyright © Family Physicians Inquiries Network. Used with permission.

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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