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Quitting smoking: Are e-cigarettes or nicotine replacements more effective?

Researchers compared the differences between e-cigarettes or nicotine replacement treatments in quitting smoking. They compared the one-year effectiveness of both products

E-cigarettes and nicotine replacement treatments have both been used to help individuals quit smoking.

In a study published by The New England Journal of Medicine, researchers investigated which method is more effective.

For the study, 886 participants took part in a randomized, controlled trial that lasted from May 2015 to February 2018. Participants were looking for help, specifically from support services, to quit smoking.

Participants chose a quit date, and shortly after, they were randomly assigned either refillable e-cigarettes (439 participants) or nicotine replacement treatments (447 participants). There were a variety of nicotine replacement treatments (sprays, gum, patches, etc.). All participants received one-on-one behavioural support meetings with professionals.

After four weeks, the researchers tested the participants’ expired carbon monoxide levels. Participants revealed the level of withdrawal symptoms they experienced and they evaluated the product(s) they were using. This included whether or not they were experiencing nausea, irregular sleep patterns, mouth or throat discomfort, and/or respiratory symptoms such as phlegm presence, coughing, wheezing, shortness of breath, etc.

E-cigarettes were more effective in helping individuals quit smoking

Findings revealed that e-cigarettes were more successful in quitting smoking. For the e-cigarette group, the rate of sustained one-year abstinence was 18%, while the nicotine replacement group was 9.9%. Researchers found that throughout the entire trial, the e-cigarette group’s abstinence rates were much higher than the nicotine replacement group’s.

Findings showed that e-cigarettes provided participants with more fulfillment than nicotine replacement products did. Participants rated e-cigarettes as more effective and helpful when quitting smoking. Researchers found that participants who used e-cigarettes revealed that their smoking desires were less than those who used nicotine replacement. The e-cigarette group experienced less irritability than those in the nicotine replacement group.

Furthermore, participants who used nicotine replacement experienced more nausea than the e-cigarette group. The e-cigarette group experienced more throat and mouth discomfort than the nicotine replacement group. Both groups saw an improvement in cough and phlegm presence; nonetheless, the e-cigarette group had fewer symptoms 52 weeks into the trial. Both groups revealed that their withdrawal symptoms were not too severe.

Trial had a higher success rate of e-cigarettes compared to other studies

A limitation to this study is that the expired carbon monoxide tests only measure smoking from the last 24 hours. The authors state that this could have resulted in some false negative outcomes.

This trial showed a higher success rate in e-cigarettes than in previous studies. The authors note that this could be due to the fact that the participants wanted to quit smoking and looked for help to do so. The one-on-one behavioural support was likely a huge contributor in the success rate of e-cigarettes in quitting smoking.


  1. E-cigarettes more effective than nicotine replacement therapies, finds major trial. 2019,, assessed 14 Mar. 2019.
  2. Hajek, Peter. “A Randomized Trial of E-Cigarettes Versus Nicotine-Replacement Therapy”. The New England Journal of Medicine. 2019. 1-9. Online.


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