Over the summer, we’re producing a short series of articles that summarise the core policy debates around safer nicotine products. We’ve taken a lot of inspiration from the most recent set of policy briefings produced by Clive Bates: the full briefings are available here.
The reason safer nicotine products exist is to reduce the number of people who smoke, and by extension the death and disease associated with smoking. And as they become more prevalent, evidence increasingly supports the argument that the use of safer nicotine products - like vapes, pouches and heated tobacco products - reduces smoking rates. They do so through five key mechanisms:
Helping smokers quit
Smokers who use safer alternatives are more likely to quit smoking, with success rates improving over time as smokers become more familiar with these products as a viable alternative and as the products themselves evolve and improve. This trend is supported by randomised controlled trials, observational studies, and population data. And the gold standard is the randomised control trial.
A January 2024 “Cochrane” review of the relevant randomized control trials - a systematic review of research considered one of the most authoritative in the healthcare field - examined 88 studies and, based on seven studies that met its strict inclusion criteria, concluded that vaping nicotine was 59% more effective for quitting than nicotine patches and gum. And a review of 363 studies by the UK National Institute for Health Research found that vaping was the most effective single quitting aid.
Making cessation more attractive
Safer alternatives offer significant health, welfare, and economic benefits without requiring complete nicotine abstinence, making them an attractive option for those reluctant to quit nicotine altogether. This broadens the demographic willing to attempt smoking cessation. Studies have shown that smoking cessation rates using (for example) vaping products increase over time as smokers adjust to exclusive e-cigarette use. In contrast, conventional quit approaches have declining quit rates over time as abstinence gives way to relapse back to smoking.
Economic data further supports the substitution effect of ENDS for cigarettes. The WHO has concluded that "ENDS/ENNDS [aka vaping products] and cigarettes are substitutes," a claim backed by economic evidence showing pronounced substitution effects between combustibles and smoke-free alternatives.
Accidental quitters
Safer nicotine products - and vaping in particular - has also been shown to lead to “accidental quitters” (of which the author of this piece is one). These former smokers had no intention to quit, but migrated away from smoking when they had discovered and experimented with vaping products. This phenomenon captures a crucial segment of smokers who might not otherwise engage with traditional cessation methods.
A “naturalistic” randomized control trial funded by the US National Cancer Institute has shown that even unguided use of vaping products leads to cessation; while survey data indicated that adults with no initial intention to quit smoking were eight times more likely to quit subsequently if they used vaping products.
User Testimony
Thousands of users have given eloquent testimonies of their success in quitting smoking using ENDS. These first-person accounts, often dismissed as anecdotes, are rich in detail and offer compelling evidence of tobacco harm reduction at an individual level. These testimonies align well with trial data, observational studies, trends, and economic analyses, forming a robust body of evidence supporting the efficacy of vaping. Many consumer organisations around the world collect these systematically, and in multiple languages. If you’d like to learn more about these, please visit:
CASAA (US consumer organisation) testimonies
ANESVAP (Spanish consumer organisation) testimonies
AIDUCE (French consumer organisation) testimonies
