Nicotine e-cigarettes as a tool for smoking cessation.

Introduction:
This text provides an analysis of the role of e-cigarettes in smoking cessation, highlighting the evidence supporting their effectiveness in helping some individuals quit smoking, the health consequences of e-cigarettes, and the international variations in e-cigarette regulations. The authors also discuss the implications of the evidence for clinical care, taking into account the guidance from medical and governmental authorities in various countries.

Key Points:

* a living systematic review in the Cochrane Database of Systematic Reviews found that nicotine e-cigarettes increased quit rates compared to nicotine replacement therapy, non-nicotine e-cigarettes, behavioral support, or no treatment.
* Population studies in the UK and US have associated increases in smoking cessation with the use of e-cigarettes.
* Sales of cigarettes and e-cigarettes show an inverse relationship, suggesting that e-cigarettes and cigarettes are substitutes for each other.
* E-cigarette use is likely to be much less harmful than smoking, according to the US National academies of Sciences, Engineering, and Medicine and an independent review commissioned by the Department of health and Social Care in England.
* There is substantial variation in e-cigarette regulations internationally, with examples including prohibition of sales, pre-marketing authorization, restrictions on flavors, and taxes on e-cigarettes.
* The US authorization process for e-cigarettes is more stringent than the notification system used in the UK and New Zealand, resulting in fewer e-cigarette products available on the US market.
* Medical organizations and government agencies in the US and Canada have not yet recommended e-cigarettes as first-line cessation aids, while those in England and New Zealand encourage healthcare professionals to consider e-cigarettes as a cessation option.

Main Message:
The text emphasizes the potential of e-cigarettes in promoting smoking cessation and calls for governments, medical professional groups, and individual healthcare professionals in countries such as the US, Canada, and australia to give greater consideration to their use as a tool for smoking cessation. The authors acknowledge the need to reduce access to and use of e-cigarettes by young people who have never smoked but argue that the two objectives can and should co-exist.

Warner KE, Benowitz NL, McNeill a, Rigotti Na. Nicotine e-cigarettes as a tool for smoking cessation. Nature medicine. 2023;29(3):520-524. doi:10.1038/s41591-022-02201-7