E-cigarettes help smokers quit even without specialist support, randomized trial finds
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A new study by Queen Mary University of London has found that e-cigarettes can help people quit smoking even without ongoing behavioral support.
The randomized controlled trial, published in NEJM Evidence and involving 1,170 adults given e-cigarettes, found that 11.3% of participants given e-cigarettes alone successfully quit smoking for six months, compared with 6.4% of those who received automated NHS stop-smoking messages—making them 76% more likely to quit.
Adding telephone-based behavioral support nearly doubled quit rates. Among participants receiving e-cigarettes alongside counseling, 21.1% successfully stopped smoking for six months, compared with 11.3% receiving e-cigarettes alone.
Testing e-cigarettes without specialist counseling
Previous research has established that e-cigarettes can help smokers quit, but most clinical trials have provided them alongside ongoing behavioral support. This study addresses an important unanswered question: whether e-cigarettes remain effective when specialist counseling is unavailable or unwanted, and how much additional benefit counseling provides.
Participants were randomly assigned to receive automated NHS stop-smoking emails, an e-cigarette starter pack alone, or an e-cigarette starter pack alongside telephone counseling. Those receiving additional support were offered five telephone sessions over four weeks. Quitting was verified using carbon monoxide breath tests.
The researchers also found that more than two-thirds of participants who successfully quit in the NHS supportive messages group were using e-cigarettes at six months. When participants who used treatments outside their allocated group were excluded, the quit rate in the supportive messages group fell to 2.7%.
Dr. Katie Myers-Smith, lead author and senior lecturer in health psychology at Queen Mary, said, "One of the most important findings is that smokers don't necessarily need specialist counseling to benefit from e-cigarettes, but when counseling is available, it can make a difference. In our trial, adding telephone support almost doubled the proportion of people who successfully quit.
"This suggests we shouldn't make counseling a condition of receiving help to stop smoking, but we should make it as easy as possible for people to access that extra support."
Quit rates remain higher after a year
The benefits were also evident at 12 months, with sustained quit rates of 16.8% among those receiving e-cigarettes and counseling, 9% among those receiving e-cigarettes alone, and 5.4% among those receiving supportive messages.
Most participants who successfully quit smoking with e-cigarettes were still vaping a year later. Vaping is not completely risk-free, but it poses only a small fraction of the risks of smoking, and it can protect ex-smokers from post-cessation weight gain and mood changes, and from relapse back to smoking.
Support for free vaping starter packs
The findings strongly support Swap and Stop, a government initiative that provides free vaping starter packs to help smokers quit. The initiative encourages smokers to enlist with the U.K. stop-smoking services for behavioral support but does not make it mandatory. E-cigarettes help smokers quit even without ongoing counseling, but behavioral support increases their efficacy further.
Hayden McRobbie, a collaborator on the study and professor of population health at Queen Mary, said, "These findings matter for stop-smoking services. Not everyone who wants to quit smoking is able or willing to attend regular counseling sessions, and our results show that they can still benefit from simply being offered an e-cigarette.
"At the same time, the extra benefit we saw from telephone support still matters. Stop-smoking services are still needed to make both effective quitting aids and the additional support available as widely as possible."
Peter Hajek, senior author and professor of clinical psychology at Queen Mary, said, "This trial adds to the strong evidence that e-cigarettes help people stop smoking, and clinicians can recommend them with confidence. Clinicians should also take the opportunity to explain that vaping is far less harmful than smoking, and that ex-smokers can keep using an e-cigarette for as long as they need to feel sure they won't go back to smoking."
Publication details
E-Cigarettes with and without Behavioral Support for Smoking Cessation, NEJM Evidence (2026). DOI: 10.1056/EVIDoa2600065
Journal information: NEJM Evidence
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