A growing body of scientific evidence is prompting healthcare professionals to reconsider how they discuss smoking cessation with adult patients. A new
Special Communication published in
JAMA by an expert panel convened by the Society for Research on Nicotine and Tobacco (SRNT) argues that nicotine-containing e-cigarettes should be included in conversations about quitting smoking alongside established cessation therapies, particularly for smokers who have struggled to quit using conventional methods.
The guidance reflects a broader shift towards tobacco harm reduction, recognising that while nicotine products may not be entirely risk-free, the overwhelming burden of disease comes from inhaling the toxic chemicals created by burning tobacco rather than from nicotine itself. In the United States alone, cigarette smoking is responsible for more than 480,000 deaths each year, while globally tobacco use claims more than eight million lives annually, according to World Health Organization data.
Although smoking prevalence has declined substantially over the past few decades, progress has slowed among some population groups. Middle-aged and older smokers, many of whom have smoked for decades, often experience greater difficulty quitting because of long-term nicotine dependence and deeply ingrained behavioural habits. For these smokers, finding an effective cessation strategy can be the difference between continuing to inhale thousands of combustion-related toxicants every day or moving to a substantially lower-risk alternative.
Clinicians need practical guidance
Rather than promoting a single approach, the expert panel recommends patient-centred discussions that take into account individual preferences, previous quit attempts and treatment goals.
The new recommendations were developed after clinicians increasingly sought clear, evidence-based advice about how to respond when patients ask whether vaping could help them stop smoking. Rather than promoting a single approach, the expert panel recommends patient-centred discussions that take into account individual preferences, previous quit attempts and treatment goals.
Healthcare providers are rightly encouraged to discuss the full range of evidence-based options, including nicotine replacement therapies such as patches, gum, lozenges and inhalers, prescription medications including varenicline and bupropion, behavioural counselling and, where appropriate, nicotine-containing e-cigarettes. Importantly, the guidance stresses that these recommendations apply specifically to adults who currently smoke cigarettes and are not intended to encourage nicotine use among people who have never smoked or among young people.
One of the strongest arguments supporting the recommendations comes from the expanding evidence base evaluating vaping as a smoking cessation aid. The latest
Cochrane living systematic review—widely regarded as one of the highest standards in evidence-based medicine—concluded that nicotine vapes help more adults quit smoking than traditional nicotine replacement therapy while outperforming their nicotine-free counterparts. The review included dozens of randomised controlled trials involving tens of thousands of participants.
A separate Cochrane network meta-analysis comparing multiple cessation interventions also found nicotine e-cigarettes, varenicline and cytisine among the most effective treatments currently available for helping smokers achieve long-term abstinence. These findings reinforce growing international evidence that vaping can provide an effective alternative for smokers who have repeatedly failed with other cessation methods.
Why do smokers find vaping effective?
Traditional cessation medications primarily address nicotine withdrawal, while vapes also replicate many of the behavioural aspects of smoking. For long-term smokers, the familiar hand-to-mouth movement, inhalation, visible aerosol and rapid nicotine delivery help satisfy both the physical dependence and the behavioural rituals associated with cigarette use. This combination may explain why many smokers who have been unable to quit using patches or gum successfully transition away from combustible cigarettes after switching to vaping.
A central theme of the recommendations is correcting widespread misconceptions about nicotine. While nicotine is addictive, decades of research indicate that it is not the primary cause of smoking-related cancers, cardiovascular disease or chronic obstructive pulmonary disease (COPD). Those diseases arise largely from exposure to thousands of toxic chemicals produced when tobacco burns.
Understanding this distinction is essential when discussing harm reduction. Public Health England’s landmark evidence reviews, subsequently supported by the UK’s Office for Health Improvement and Disparities, have consistently concluded that regulated nicotine vaping products expose users to substantially fewer harmful chemicals than combustible cigarettes. Although researchers continue studying their long-term effects, toxicant exposure is significantly lower than with smoking.
Yet not all medical organisations share the same position. Some US health organisations continue recommending only FDA-approved cessation medications, citing concerns about the long-term effects of vaping and the presence of residual toxic compounds in aerosol.
However, the countries which have incorporated harm reduction into tobacco control policy, such as the United Kingdom, New Zealand and Sweden, have all found that lower-risk nicotine alternatives are playing an essential role in reducing smoking-related disease when used by adults who smoke.
Helping smokers make informed choices
Ultimately, the new recommendations do not position vaping as a universal solution or a replacement for established cessation therapies. Rather, they acknowledge that smokers differ, and that successful quitting often requires multiple approaches.
For clinicians, the message is straightforward: provide patients with accurate, balanced information about the benefits and risks of every evidence-based option.
For smokers, the message is even clearer. Continuing to smoke remains by far the most dangerous choice. While nicotine-containing e-cigarettes are not without risk, the evidence increasingly suggests they can help many adult smokers move away from combustible tobacco, offering an important opportunity to reduce the enormous health burden caused by cigarette smoking.
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