Cigarette smoking remains one of the leading preventable causes of death in the United States, killing nearly half a million people each year. Although millions of smokers attempt to quit, most require multiple attempts before achieving long-term abstinence. Now, an interdisciplinary group of tobacco-treatment experts is urging clinicians to widen the range of cessation options they discuss with adult patients, including nicotine-containing electronic cigarettes.
The recommendations, published in JAMA, are designed to help clinicians have practical, evidence-based conversations about e-cigarettes rather than treating them as an automatic alternative to established medications. The authors stress that the objective is not to promote nicotine use. Instead, it is to move people away from combustible cigarettes, whose smoke contains thousands of chemicals generated when tobacco is burned. Many of those combustion products, rather than nicotine itself, drive the development of cancer, cardiovascular disease and chronic lung disease.
Developed by the Harm Reduction Work Group of the Society for Research on Nicotine and Tobacco’s Treatment Research Network, the guidance recommends a patient-centered “menu of options.” This approach asks clinicians to consider a smoker’s medical history, previous quit attempts, treatment preferences and likelihood of following a particular plan. When patients have no strong preference, FDA-approved medications such as nicotine-replacement therapy, varenicline or bupropion remain appropriate starting points. However, patients who prefer nicotine e-cigarettes should not necessarily be required to fail other treatments before trying them.
The recommendation reflects the principle of shared decision-making, in which clinicians explain potential benefits, limitations and uncertainties while patients participate actively in selecting treatment. Nicotine e-cigarettes deliver nicotine through an aerosol rather than tobacco smoke. Because the device does not burn tobacco, users generally encounter substantially lower levels of many toxic chemicals than they would from cigarettes. That difference is central to the concept of harm reduction: replacing a far more hazardous source of nicotine with a lower-risk, though not risk-free, product.
Evidence summarized in the recommendations includes high-certainty findings from Cochrane systematic reviews indicating that nicotine e-cigarettes can help some adults stop smoking and may outperform nicotine patches or gum in achieving cessation. Other reviews have reported effectiveness comparable to certain FDA-approved smoking-cessation medications. The researchers caution, however, that effectiveness varies among individuals. Some smokers do not quit with e-cigarettes, while others continue using both cigarettes and e-cigarettes for extended periods, a pattern known as dual use that may limit health benefits.
The guidance therefore emphasizes complete transition away from combustible cigarettes as quickly as possible. A smoker who continues to inhale cigarette smoke remains exposed to combustion-related toxins, even if e-cigarette use is added. Clinicians are encouraged to monitor progress, reinforce cigarette abstinence and provide follow-up care. They should also explain that e-cigarettes are intended in this context for adults who currently smoke, not for young people, nonsmokers or anyone who has never used tobacco.
Long-term safety remains an important uncertainty. Although e-cigarettes have been available for years, researchers do not yet have the decades of observational data needed to fully characterize risks that may emerge after prolonged exposure. E-cigarette aerosols can contain nicotine, ultrafine particles, flavoring chemicals, metals and other substances, depending on the device and liquid formulation. Nicotine itself is highly addictive and can affect heart rate and blood pressure, even though it is not the primary cause of smoking-related cancers. For that reason, the authors describe e-cigarettes as a cessation tool with trade-offs, not as harmless consumer products.
The recommendations also call for behavioral counseling alongside medication or nicotine e-cigarette use. Smoking is not solely a pharmacological dependence; it is also a learned behavioral pattern linked to routines, environments and emotional states. A smoker may associate nicotine with morning coffee, driving, alcohol or stress. Counseling can help patients identify these cues, establish a quit date or reduction plan, manage cravings and develop alternative behaviors. Combining behavioral support with pharmacological treatment has long been considered one of the most effective strategies for improving the chances of sustained cessation.
Researchers from the Medical University of South Carolina’s Hollings Cancer Center contributed to the guidance, including Alana Rojewski, Tracy Smith, Mariel Bello, Matthew Carpenter and Erin McClure. They say the recommendations answer a question clinicians have repeatedly raised: how to discuss e-cigarettes responsibly when patients ask whether they can help them quit. The authors’ central message is that clinicians should present accurate information without endorsing a single product, while keeping the immediate health priority clear—helping adult smokers stop using combustible cigarettes and reducing their risk of tobacco-related disease.
Subject of Research: People
Article Title: Nicotine E-Cigarettes for Cigarette Smoking Cessation: Recommendations to US-Based Clinicians
News Publication Date: 30-Jul-2026
Web References: JAMA article; Society for Research on Nicotine and Tobacco Treatment Research Network; Cochrane systematic review; MUSC Hollings Cancer Center
References: DOI: 10.1001/jama.2026.13087
Image Credits: Medical University of South Carolina
Keywords: smoking cessation, nicotine e-cigarettes, tobacco harm reduction, nicotine replacement therapy, combustible cigarettes, tobacco-related disease, behavioral counseling, public health, addiction science, electronic cigarettes
