The Leading Peer-Reviewed Journal for the Primary Care Nursing Team
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May 2018

Should e-cigarettes be recommended to help smokers quit?

Emerging evidence suggests that e-cigarettes may not help smokers to quit and are a gateway to smoking for young people, according to the BMJ.

Nevertheless, e-cigarettes are recommended in the latest NICE guidance on smoking cessation (See Guidelines in a Nutshell – Stop smoking interventions and services. NICE NG92, at

In a BMJ debate, Paul Aveyard, Professor of Behavioural Medicine at University of Oxford, and Deborah Arnott, Chief Executive of Action on Smoking & Health argue that smokers are asking for advice on e-cigarette use, they want to vape, and e-cigarettes can help them quit.

They claim that e-cigarettes are as effective as nicotine replacement therapy (NRT), and are popular quit smoking aids, which leads to increases in quit attempts and quitting as a whole in England, they explain.

Although some young people do experiment with e-cigarettes, only one in several hundred young people who have never smoked use them more than once a week. While e-cigarettes have become more common, smoking among young people has fallen to record lows, so the risk of picking up smoking must be low, if it exists at all, Aveyard and Arnott claim.

‘In the UK, e-cigarettes are part of a comprehensive anti-smoking strategy. [UK health policy] promotes vaping as an alternative to smoking and has consensus among the public health community with the endorsement of Cancer Research UK and other charities, medical royal colleges, and the BMA,’ they conclude.

But Kenneth Johnson, Adjunct Professor at the University of Ottawa, says recommending e-cigarettes for quitting smoking is irresponsible.

The overall evidence is that e-cigarettes as actually used depress, not assist cigarette smoking cessation, he said. New research is replacing optimistic speculation with evidence that indicate the limits and hazards of e-cigarettes as a smoking aid, he says.

E-cigarettes have a serious public health risk of addicting new generations of young smokers, he adds. In a 2016 study among English youth (11-18 years of age), e-cigarette users were 12 times as likely to initiate smoking (52%) as never e-cigarette users.

Johnson says: ‘The net effect of e-cigarettes on smoking cessation is negative, high levels of dual use undermine harm reduction, and gateway risks for youth smoking initiation are a demonstrated danger,’ he concludes.

BMJ 2018;361:k1759 doi: 10.1136/bmj.k1759

May 2018