Royal College of Physicians (RCP)

April 2024

A new report from the Royal College of Physicians endorses vaping as an effective smoking cessation tool and emphasises that vaping carries significantly lower risks compared to smoking.

Containing over 50 recommendations, many aimed at reducing appeal to youth, the report concludes that 'e-cigarettes remain an important tool to alleviate the burden of tobacco use'.

Recommendations on the effectiveness of e-cigarettes for smoking cessation include:

• E-cigarettes should be promoted as an effective means of helping people who smoke to quit smoking tobacco.

• Campaigns recommending e-cigarettes for smoking cessation should include populations who are likely to experience the most benefit, including people with mental disorders, those who experience socio-economic disadvantage and people living in social housing.

• E-cigarettes should be offered as an effective treatment for smoking cessation across all NHS settings alongside established pharmacotherapy.

Link to the evidence review here.

Nancy A. Rigotti

14 February 2024

The author highlights that the evidence 'indicates that switching completely from smoking combustible cigarettes to vaping nicotine e-cigarettes substantially reduces a person’s exposure to tobacco toxins, reduces respiratory symptoms, and reverses smoking-related physiological changes' with these results likely to 'translate into future declines in the risk of tobacco-related diseases'.

Rigotti points out that the policy debate around vaping has tended to overshadow the evidence that it has been used as a smoking-cessation tool that could help the millions who still smoke. Randomized clinical trials such as the recent Swiss study (Reto Auer et al.) and a 2024 Cochrane systematic review 'show the growth in evidence regarding the efficacy and safety of e-cigarettes for smoking cessation' and 'the evidence now supports a strong conclusion that e-cigarettes are tools that clinicians can use to help adults stop smoking, especially those who are unable to quit with current evidence-based treatments'.

Rigotti believes it 'is now time for the medical community to acknowledge this progress and add e-cigarettes the smoking-cessation toolkit' and 'the evidence has brought e-cigarettes to a tipping point. The burden of tobacco-related disease is too big for potential solutions such as e-cigarettes to be ignored.'

Read the full article here.

Reto Auer, Anna Schoeni, Jean-Paul Humair, Isabelle Jacot-Sadowski, Ivan Berlin, Mirah J. Stuber, Moa Lina Haller, Aurélie Berthet

14 February 2024

Researchers found that the addition of e-cigarettes to standard smoking-cessation counseling resulted in greater abstinence from tobacco use among smokers than smoking-cessation counseling alone.

This trial showed that adding e-cigarettes to standard-of-care counseling improved smoking cessation rates without worsening health risks over 6 months. These findings are consistent with those in the 2024 update of the Cochrane systematic review of e-cigarettes for smoking cessation.

Read the full paper here.

Robert Beaglehole Ruth Bonita

1 February 2024

Read Professor Beaglehole and Professor Bonita’s comment in The Lancet questioning the WHO’s scientific justification for their position that e-cigarettes and other novel nicotine products should be treated in the same way as tobacco products.

The authors believe this position overlooks a risk-proportionate approach.

They believe the WHO needs to provide positive leadership and technical support to countries as they consider the use of e-cigarettes and other nicotine delivery devices, including snus, pouches, and heated and smokeless tobacco.

WHO’s current approach to these lower risk products is to reward countries, such as India, for banning e-cigarettes; countries, primarily low-income and middle-income countries, now ban e-cigarettes.

Abigail Friedman, Alex C. Liber, Alyssa Crippen, Michael Pesko

29 January 2024

Over 375 US localities and 7 states have adopted permanent restrictions on sales of flavored electronic nicotine delivery systems (“ENDS”). These policies’ effects on combustible cigarette use, a more harmful habit, remain unclear. Matching new flavor policy data to retail sales data, we find a tradeoff of 12 additional cigarettes for every 1 less 0.7 mL ENDS pod sold due to ENDS flavor restrictions. Further, cigarette sales increase even among brands disproportionately used by underage youth. Thus, any public health benefits of reducing ENDS sales via flavor restrictions may be offset by public health costs from increased cigarette sales.

Read full study detail here.

Nicola Lindson, Annika Theodoulou, José M Ordóñez-Mena, Thomas R Fanshawe, Alex J Sutton, Jonathan Livingstone-Banks, Anisa Hajizadeh, Sufen Zhu. Paul Aveyard, Suzanne C Freeman. Sanjay Agrawal, Jamie Hartmann-Boyce

22 September 2023

New Cochrane analysis comparing the results of 319 smoking cessation clinical trials involving 157,179 people, found that nicotine e-cigarettes are the most effective tool for helping people quit smoking.

Researchers concluded nicotine e-cigarettes, varenicline and cytisine are the most effective options currently available for helping smokers quit long-term (more than six months) after data showed that for every 100 people, 10 to 19 are likely to quit using an e-cigarette; 12 to 16 using varenicline; and 10 to 18 using cytisine.

Dr Nicola Lindson, the lead author stressed the importance of pulling together such a large data set involving over 150,000 people. The results clearly show e-cigarettes increase the likelihood of people quitting smoking.

Read the full review here.

Colin Paul Mendelsohn, Wayne Hall

July 2023

An increase in youth vaping has raised concerns, particularly for young people who have never smoked. However, most vaping by never-smokers is occasional and transient and frequent vaping by never-smokers is rare. Vaping is not risk-free but there is limited evidence of significant harm so far to young people who vape.

There is weak evidence that vaping is a gateway to smoking. In fact, the evidence suggests that vaping is diverting young people away from smoking overall and is displacing smoking at a population level.

The risk of nicotine dependence is very low in never-smokers who vape. Vaping is likely to be beneficial to young smokers who switch to vaping.

Policy measures to reduce vaping are discussed. A tightly regulated, risk-proportionate consumer model is recommended to restrict vaping by young people while allowing easy access for adult smokers, for whom it is an effective and popular quitting aid.

Read the full paper here.

Jeremy Y. Levett, Kristian B. Filion, Pauline Reynier, CelinePrell, Mark J. Eisenberg,

4 May 2023

A total of 5 RCTs (n = 3253) were included. Compared with conventional smoking cessation therapies, the use of nicotine e-cigarettes was associated with an increase in abstinence, defined by the most rigorous criterion of abstinence reported.

The authors found that among individuals attempting to quit smoking, nicotine e-cigarettes are more efficacious than conventional nicotine replacement or behavioral smoking cessation therapies, and may prove beneficial in reducing smoking-related health risks.

Read the full review here.

Lindson N, Butler AR, McRobbie H, Bullen C, Hajek P, Begh R, Theodoulou A, Notley C, Rigotti NA, Turner T, Livingstone-Banks J, Morris T, Hartmann-Boyce J

17 November 2022

The authors included 78 completed studies, representing 22,052 participants, of which 40 were RCTs. Seventeen of the 78 included studies were new to this review update.

Results found there was high‐certainty evidence that ECs with nicotine increase quit rates compared to NRT and moderate‐certainty evidence that they increase quit rates compared to ECs without nicotine. Evidence comparing nicotine EC with usual care/no treatment also suggests benefit, but is less certain.

Read the full review here.

Riccardo Polosa, Thomas B. Casale,Donald P. Tashkin

November 2022

Vaping by adolescents and young adults is a legitimate concern. This commentary provides updated information on vaping patterns among adolescents and young adults in the United States, as well as the impact of eletronic cigarettes (EC) usage on respiratory health.

The authors conclude that concerns that ECs may provide a risk are valid, but this risk might be reduced by a mix of technological innovation and vaping product regulation that prioritizes quality and safety checks.

They also state that although EC use by young nonsmokers is a legitimate concern, known risks from vaping are often greatly exaggerated.

Commentary dispels a number of commonly held misconceptions by providing evidence that:

• ECs have a positive role in helping smokers quit,

• Harm is 95% less than than tobacco,

• Nicotine does not cause cancer or heart disease,

• Vaping does not cause cancer, heart disease or lung disease,

• ECs do not cause EVALI,

• No evidence of a teen nicotine vaping epidemic in the US,

• Youth vaping is not a gateway to smoking,

• ECs are not more addictive that cigarettes,

• Duals user rates are falling.

Read full commentary here.

Sharon Cox, Lynne Dawkins, Jay Doshi, and James Cameron

December 2019

The study found that smokers opting for an EC alone or an EC + NRT were more likely to report complete abstinence from smoking at 4–6 weeks (62.2% and 61.5% respectively) compared to NRT alone (34.8%). An EC intervention was significantly more effective for smoking cessation than NRT in this community pharmacy.

Read the full paper here.

Karin Modig Wennerstad, Karri Silventoinen, Per Tynelius, Lars Bergman, Jaakko Kaprio, Finn Rasmussen

20 November 2009

Researchers concluded that their study did not support a causal relation between IQ and smoking.

Additionally, the fact that the IQ–smoking association disappeared after adjustments for shared environment and genetics suggests that the IQ–smoking association found in the analyses of single subjects was confounded by unmeasured social and psychosocial factors or by genetic factors, and that smoking appears to be associated with, but not the result of, IQ.

Read the full research paper here.