E-cigarettes rated most effective smoking cessation method by new evidence review
A new overview of the best available evidence worldwide for smoking cessation has found that nicotine‑containing e‑cigarettes appear to be more effective for smoking cessation than other interventions such as nicotine replacement therapy (nicotine patches, gum, lozenges, etc.) e-cigarettes with no nicotine, and behavioural support.
This ‘overview’ of systematic reviews summarises existing evidence from several systematic reviews and makes the findings more accessible. The overview pooled the evidence from fourteen systematic reviews of smoking cessation interventions from 2014 to 2023.
Findings from higher-quality reviews consistently showed greater smoking cessation with nicotine-containing e‑cigarettes than other interventions. Lower-quality reviews produced more variable and imprecise estimates. When restricted to higher-quality evidence, results consistently favoured nicotine e‑cigarettes over nicotine replacement therapy, non-nicotine e-cigarettes, and other comparators.
The overview also created an ‘Evidence and Gap Map’ (EGM) to identify gaps in the current evidence that urgently need to be filled. There are currently no high-quality systematic reviews directly comparing nicotine e-cigarettes with cytisine, bupropion, or nicotine pouches. Also, direct evidence comparing nicotine e-cigarettes with varenicline is extremely limited, with only a single small trial at high risk of bias.
The EGM also showed that current evidence of serious adverse events associated with e-cigarettes is inconclusive, and that most of the studies collected data from high-income countries. Future primary research on e-cigarettes for smoking cessation should continue to collect data on serious adverse events and expand its data collection to include low-and middle-income countries.
Lead author DrAngela Difeng Wu, Senior Researcher and Lecturer at the Nuffield Department of Primary Care Health Sciences, University of Oxford, says “We hope this overview and Evidence and Gap Map can lay to rest some claims that evidence is ‘mixed’ regarding the impacts of nicotine e-cigarettes on smoking abstinence. In fact, the evidence is clear and consistent across all of the meta-analyses we consulted: e-cigarettes are effective at helping people stop smoking.”
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For editors:
This Open Access paper is available on the Wiley Online Library from the embargo date (https://onlinelibrary.wiley.com/doi/10.1111/add.70388) or you may request an early copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.
To speak with lead author Dr Angela Difeng Wu, please contact her at the Nuffield Department of Primary Care Health Sciences, University of Oxford by email (angela.wu@phc.ox.ac.uk).
Full citation for article: Wu AD, Conde M, Butler AR, Knight E, Lindson N, Livingstone-Banks J, Hajek P, McRobbie H, Begh R, Theodoulou A, Notley C, Turner T, Zhitnik E, and Hartmann-Boyce J. Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map. Addiction. 2026. DOI: 10.1111/add.70388.
Primary funding: This research work was funded by Cancer Research UK, Grant Number PRCPJT‐Nov22/100012.
Declaration of interests: Dr Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. All other authors report no known conflicts of interest.
Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.
Journal
Addiction
Method of Research
Systematic review
Subject of Research
People
Article Title
Electronic Cigarettes for Smoking Cessation: An Overview of Systematic Reviews and Evidence and Gap Map
Article Publication Date
27-Mar-2026
COI Statement
Dr Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. All other authors report no known conflicts of interest.
Nicotine E-cigarettes more successful in helping smokers quit
Analysis of 14 systematic reviews co-led by UMass Amherst public health researcher finds higher long-term quit rates than patches or gum
A new analysis of existing studies co-led by a University of Massachusetts Amherst public health researcher finds that nicotine e-cigarettes consistently help adults quit smoking, a conclusion that emerges with striking agreement across nearly a decade of studies.
The “review of reviews,” published today in Addiction, examined 14 systematic reviews covering 109 primary studies conducted between 2014 and 2023. Across 21 separate meta-analyses, every pooled estimate pointed in the same direction: Smokers using nicotine e-cigarettes were more likely to quit than those using most other methods.
The review found that nicotine e-cigarettes are associated with quit rates approximately 20% to 40% higher than traditional nicotine replacement therapies, such as patches or gum, for smoking cessation lasting at least six months. Compared with non-nicotine e-cigarettes or placebo devices, nicotine e-cigarettes performed even better, with quit rates at least 46% higher.
“We set out to determine if scientists agree on whether nicotine e-cigarettes help people quit smoking,” says senior author Jamie Hartmann-Boyce, assistant professor of health policy and management in the School of Public Health and Health Sciences at UMass Amherst. “Based on the consistency of the findings here, it’s clear that they do.”
However, she cautions that this doesn’t necessarily mean e-cigarettes are the best option to quit smoking, or that they will work for everyone. Vaping also comes with health risks, but those risks pale in comparison to the dangers of smoking.
“It’s not just the person who smokes who is affected by their smoking,” Hartmann-Boyce notes. “It’s the people around them who are affected by secondhand smoke, and secondhand vaping is nowhere near as harmful as secondhand smoking either.”
The effectiveness of e-cigarettes may stem from more than just nicotine delivery.
“If you look at neuro-imaging studies, the addiction often isn’t just to the nicotine,” she explains. “There are the sensory cues around it that really feed into those addiction pathways. Vaping fulfills some of those cues in a way that a patch doesn’t”—including the throat hit, the hand-to-mouth motion and the visible exhale.
Many of those same features, Hartmann-Boyce points out, are why youth uptake remains a serious concern.
“The primary concern about e-cigarettes is their use among people who don’t smoke and wouldn’t have otherwise smoked,” she says. “That doesn’t mean these devices don’t help people quit smoking.”
While e-cigarettes with nicotine may prove more effective than traditional nicotine replacement therapies, it remains unclear if they are as effective a class of drugs known as nicotine receptor partial agonists, which are available only via prescription. Varenicline, marketed as Chantix in the U.S., can lessen smoking satisfaction and reduce withdrawal cravings.
“We don’t have enough studies to compare these drugs to nicotine e-cigarettes to say whether one is better than the other for helping people quit smoking,” Hartmann-Boyce says.
She hopes the new analysis will provide some clarity about vaping. While the evidence that nicotine e-cigarettes can help quit smoking has never been stronger, public perception of vaping has soured, amid lung injuries associated with a certain additive in some THC-vaping products and marketing campaigns targeting young people.
When half of all lifelong daily smokers die from the habit, Hartmann-Boyce insists that evidence matters.
“We know e-cigarettes are not risk free, but they are so much less harmful than smoking,” she says.
Journal
Addiction
Method of Research
Systematic review
Subject of Research
People
Article Title
Electronic cigarettes for smoking cessation: An overview of systematic reviews and evidence and gap map
Article Publication Date
27-Mar-2026
COI Statement
Dr. Hartmann-Boyce is paid for research consultancy from the Truth Initiative. Dr. Lindson is an associate editor for Addiction. Dr. Notley has received an honorarium from Vox Media for filming a 'nicotine explainer' on the role of nicotine in addiction. All other authors report no known conflicts of interest.
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