by EBSCO Medical Review Board

Cigarette smoking can be addictive. Just ask the many people who try to quit smoking each year. Smoking causes changes in the body that lead to physical symptoms when you stop. These symptoms will fade but can make it hard to quit. There are several products that may help some quit. This includes nicotine gum, lozenges, sprays, patches, or inhalers. They replace one of chemicals in cigarettes that cause withdrawal symptoms. Many people have also turned to electronic cigarettes (e-cigarettes) as a solution. It not only uses a nicotine vapor but also feels like smoking a real cigarette. Since e-cigarettes are still fairly new, it is not clear if it is truly helpful as a quitting tool.

Researchers wanted to compare e-cigarettes to standard nicotine therapy to determine which is most helpful in getting people to quit. The study, published in The New England Journal of Medicine, found that e-cigarettes were more effective for smoking cessation than nicotine-replacement therapy.

About the Study

Therandomized controlled trial compared nicotine replacement therapy products to e-cigarettes in 886 adults attending UK National Health Service stop-smoking services. Participants in the nicotine replacement therapy group were able to use a product of their choice, including combinations of products. The participants in the e-cigarette group were given a e-cigarette starter pack that contained a refillable e-cigarette with one bottle of nicotine e-liquid. They were told to purchase future e-liquids of the flavor and strength of their choice. Both groups received weekly behavioral support for four weeks.

Participants were followed up at one year to find out if they had stopped smoking. The percent of participants who were not smoking at one year was 18% in the e-cigarette group and 9.9% in the nicotine replacement group.

How Does This Affect You?

A randomized trial is considered the most reliable form of research, but how the research is done will affect its reliability. For example, the participants in the e-cigarette group all used the same brand of e-cigarette. It is not known whether other brands would be as effective in helping people quit smoking. There are many brands on the market that differ in design. There are also many types of e-liquid refills that deliver different amounts of nicotine, additives, flavoring, and chemicals. More trials will also be needed to see if these results hold true.

Current guidelines state that there is not enough evidence to recommend e-cigarettes to patients who want to stop smoking. The health impact of e-cigarettes is also still not clear. If you are considering e-cigarettes, discuss the pros and cons with your doctor. It may also make a difference if you are using this as a tool to quit, or as an alternative to smoking that you plan to continue indefinitely. Making an informed decision is an important step in taking control of your health.


Family Doctor—American Academy of Family Physicians—US Department of Health and Human Services 


Hajek P, Phillips-Waller A, et al. A randomized trial of e-cigarettes versus nicotine-replacement therapy. N Engl J Med. 2019 Jan 30. doi: 10.1056/NEJMoa1808779. [Epub ahead of print].

Treatment for tobacco use. EBSCO DynaMed Plus website. Available at: . Updated October 17, 2018. Updated February 1, 2019.

Revision Information

  • Reviewer: EBSCO Medical Review Board
  • Review Date: 02/2019