Smokers Wanting to Quit Need Guidelines on How Vaping Can Help
A new paper in the Journal of the American Medical Association (JAMA) asks U.S. clinicians to address whether nicotine e-cigarettes can help adults stop smoking. The research recommends including e-cigarettes when discussing the risks and benefits of evidence-based cessation options with adults who smoke. Written by a harm reduction working group of the Society for Research on Nicotine and Tobacco (SRNT), it is a position paper, not a new federal guideline. However, it is still a dramatic change in perspective from many in the public health conversation, a change that should not be ignored. This is great news, but it is not well known, and new guidelines—especially from the FDA and CDC—would help save lives.
Research Confirms E-Cigarettes Can Help Quitters Stop Smoking
An editorial that was published alongside the JAMA report does not call e-cigarettes harmless or recommend them for everyone. The paper rightfully argues that approved medicines should be prioritized when a patient has no preference for how they try to stop smoking. However, when someone prefers an e-cigarette, they should not be required to try and fail using an FDA-approved medicine first before e-cigarettes are offered as an option towards quitting.
The central evidence for seeing e-cigarettes as part of harm reduction comes from an ongoing Cochrane review which combines and evaluates medical research against high standards. Nine randomized trials involving 2,703 participants found nicotine e-cigarettes more effective than Food and Drug Administration (FDA)-approved nicotine-replacement therapy. In fact, for those looking to quit smoking, roughly 1 in 10 e-cigarette users were able to stay abstinent at six months.
As such, the paper recommends trying to quit by using an FDA-authorized product, selecting enough nicotine to control cravings, switching completely and quickly, adding counseling, and following up with a medical provider within a few weeks. After all, continued vaping may be reasonable when it prevents a relapse, and stopping all nicotine use can remain a later goal for patients.
Why E-Cigarettes Remain Controversial
The controversy persists despite those trials proving e-cigarettes can help reduce smoking harms. For example, important questions remain about long-term health effects and which devices to recommend. Larger controversies include important considerations about whether eliminating nicotine use or reducing smoking-related disease is more important. The traditional—and widely spread—view is that both are required. However, major health harms come from actual smoke, which makes switching to Electronic Nicotine Delivery Systems (ENDS), such as vapes, comparatively less harmful. Of course, there is also a debate over whether favorable official advice regarding ENDS might instead increase youth interest in those products and whether tobacco-company products can have a legitimate role in reducing the harms from cigarettes in the first place.
However, these outstanding questions do not change the reality that ENDS frequently outperform traditional medicinal alternatives in achieving tobacco abstinence. It is also not well known that several prominent studies claiming major harms from these products were retracted because of data problems. This is why the researchers who wrote the JAMA paper have suggested a “both/and” framing and “intellectual honesty” as the solution. Ideally, studies should present evidence and uncertainty, disclose industry complications, discuss patient and clinician values, and protect autonomy. E-cigarettes are not a “magic bullet,” but neither is any other cessation treatment.
The American Heart Association (AHA) and American Lung Association (ALA) have long raised concerns over these products. E-cigarette aerosols can contain nicotine, metals, and other harmful chemicals. Nicotine also sustains dependence and has short-term cardiovascular effects. Long-term heart and lung risks remain uncertain, products change rapidly, and dual use may preserve much of smoking’s danger. Both groups also worry about youth initiation. The ALA emphasizes FDA-approved treatments, while the AHA calls for more long-term research and youth protection. The 2021 U.S. Preventive Services Task Force found the cessation evidence insufficient, although that review predates later trials and Cochrane updates.
A Knowledge Gap: Different Products Have Different Risks
Those concerns should not erase the difference in risks for each product. For a young person who does not use nicotine, the comparison is vaping versus no tobacco use. For an adult who repeatedly returns to cigarettes, it may be vaping versus continued smoking. What is helpful in one case may be harmful in another. Burning tobacco creates the smoke responsible for most smoking-related cancer, lung disease, and cardiovascular harm. And although nicotine drives addiction and is not harmless, it is not the main cause of smoking-related cancer.
But many clinicians miss that distinction. In a national survey of 1,020 U.S. physicians, 80.5% strongly agreed that nicotine directly contributes to cancer; similar proportions linked it to chronic obstructive pulmonary disease and cardiovascular disease. A randomized follow-up found that wording the question as “nicotine, on its own” reduced some errors, but misconceptions remained common. A 2026 paper found lower but still troubling rates: 25.9% blamed nicotine for smoking-related cancer, and only 21.4% identified e-cigarettes as less harmful than cigarettes. The percentage varied by wording and sample, but the knowledge gap is clear.
The Medical Community Has a Vaping Knowledge Gap Problem
The JAMA papers can improve clinical conversations, but they cannot do what FDA approval through the Center for Drug Evaluation and Research (CDER) could do. A CDER-approved cessation product would signal e-cigarettes can help those who smoke finally quit. And CDER approval would have product-specific evidence of safety and effectiveness, consistent manufacturing, an approved dose and indication, standardized labeling, and continuing safety monitoring. A manufacturer could make claims that match that label. The JAMA recommendation approves no product, sets no dose, creates no medical label, and authorizes no treatment advertising. As of publication, the authors knew of no e-cigarette manufacturer that had even applied for CDER approval as a cessation treatment.
FDA tobacco authorization is different. The Center for Tobacco Products asks whether marketing a product is appropriate for protecting the population as a whole, including users and nonusers. That is not the medical-product standard of being safe and effective for a specific patient and use. FDA states that an authorized e-cigarette is not thereby “FDA approved” or safe, and no e-cigarette is approved as a cessation aid.
Why New FDA and CDC Vaping Guidelines Can Help Smokers Quit
In order to better communicate the message from the JAMA piece and to build on what is already published on the CDC’s evidence page, the CDC and FDA should issue a joint guidance document. The message should be direct: e-cigarettes are not harmless or for youth and nonsmokers, but switching completely reduces exposure to combustion toxicants and can help some adults quit. The U.S. quit lines (telephone help lines for those who are attempting to quit smoking) are only beginning to consider e-cigarettes as a frontline option. Because of this, the agencies should update clinician webpages, quit line scripts, professional education, and electronic health-record prompts. FDA should link to legally marketed products while clearly separating tobacco authorization from medical approval.
The SRNT workgroup has taken the first, much-needed step of building a public health message based on the current science, not dogma. This approach will save lives. Now, the message needs to be disseminated through physicians, nurses, pharmacists, public health departments, quit lines, and former smokers, not just manufacturers. A simple, short guide could help clinicians review past attempts, explain every option, correct nicotine and relative-risk errors, support complete switching, and arrange follow-up. The CDC and FDA should measure clinician knowledge, informed quit attempts, complete switching, and unintended youth uptake. The goal of reducing the disease and death associated with smoking can be achieved by following the science of tobacco harm reduction. The SRNT workgroup should be commended for accelerating that effort.