Nancy Rigotti, MD

Nancy Rigotti, MD, associate chief of the Division of General Internal Medicine and director of the Tobacco Research and Treatment Center at Mass General, is the co-author of a new commentary in Nature Medicine, Nicotine E-Cigarettes as a Tool for Smoking Cessation.

What was the question you set out to answer with this study?

As a diverse group of internationally known experts in tobacco cessation and the risks/benefits of electronic cigarettes, we were asked to discuss the evidence regarding the use of e-cigarettes as tools to help smokers quit using tobacco.

We were asked specifically to address the current knowledge for the clinical care of smokers and not to discuss issues about e-cigarette use by youths or never smokers.

The paper reviews evidence that vaping increases smoking cessation and evidence about the health consequences of e-cigarette use. It concludes by summarizing what this evidence implies for clinical care.

What Did You Find?

Considerable evidence indicates that e-cigarettes help some adults quit smoking.

  • A recent review of randomized control trials found that smoking quit rates were higher in people randomized to electronic cigarettes than to those randomized to nicotine replacement therapy.
  • Other studies have consistently found that smokers who switch to e-cigarettes and vape regularly are significantly more likely to quit smoking than smokers who do not vape.
  • Market data find an inverse relationship between sales of cigarettes and e-cigarettes (the more people buy e-cigarettes, the less they buy traditional cigarettes)

While e-cigarette use is not harmless, both the US National Academies of Science, Engineering and Medicine and a review written for the UK Department of Health and Social Care concluded that e-cigarette use is likely to be much less harmful than smoking.

  • While nicotine is the addictive agent common to both products, chemicals other than nicotine cause nearly all of cigarette smoking’s health risks
  • The number of chemicals in e-cigarette aerosol is magnitudes lower, and toxicants in both cigarettes and e-cigarettes are in found at much lower concentrations in e-cigarette aerosol.

Given the relative novelty of vaping, its long-term health risks cannot directly be assessed. But existing evidence suggests that potential long-term harms are likely to be substantially less.

What are the Implications?

In the US and Canada, government agencies acknowledge a potential benefit of e-cigarette use but conclude the evidence to recommend e-cigarettes for smoking cessation is currently insufficient.

Reflecting this, neither government agencies nor major medical organizations in the US, Canada or Australia recommend e-cigarettes as first line cessation aids, instead prioritizing government licensed pharmacotherapies.

In contrast, in England and New Zealand. government health agencies and professional societies interpret the risk/benefit balance of e-cigarettes more favorably and encourage health care professionals to consider them on par with drugs and behavioral support.

What's next?

The authors favor the approach adopted by England’s and New Zealand’s governments and recommend that health care organizations in the US, Canada, and Australia should give greater consideration to e-cigarettes as smoking cessation tools.

“E-cigarettes are not the magic bullet that will end the devastation wrought by cigarette smoking, but they can contribute to that lofty public health goal, ”they write.

However, acceptance of promoting them for smoking cessation will likely depend on continuing efforts to reduce youth from accessing and using e-cigarettes. The two objectives can and should co-exist.

Paper cited:

Warner, K. E., Benowitz, N. L., McNeill, A., & Rigotti, N. A. (2023). Nicotine e-cigarettes as a tool for smoking cessation. Nature medicine, 10.1038/s41591-022-02201-7. Advance online publication.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.