Johner Images/Getty ImagesIf you’ve ever been a smoker, you’ll know how hard it is to quit. It can take as many as 30 attempts to finally break the habit. An updated Cochrane review assessed the evidence of which common tools are most effective to help people quit smoking for six months.It found e-cigarettes (or vapes) containing nicotine are more effective than other types of nicotine-replacement therapies (including patches and gums) and counselling support. Here’s what this means for people trying to quit smoking.What the reserchers examinedCochrane reviews draw together the most robust evidence to answer a research question, in this case, the most effective way to give up smoking.The reviewers compared the efficacy and safety of different categories of aids to quit smoking:vapes containing nicotine, which use a battery to create an aerosol that can be inhalednicotine-replacement therapies such as nicotine gum, patches and inhalersnon-nicotine vapescounselling support for quitting, or no support at all. The review was based on 80 randomised control trials which included 29,861 participants. These randomly allocate participants either to receive a treatment or to a control group, which receives a different intervention, standard care or no treatment.Twelve of these studies were rated as being at low risk of bias; 41 were rated at high risk of bias; and the remainder had an unclear risk. The reviewers assessed whether the findings changed when they excluded tobacco industry-funded studies and those judged to be at high risk of bias. There were no differences in their substantive conclusions.What they foundThe reviewers found high-certainty evidence that using vapes containing nicotine produced higher quit rates than nicotine-replacement therapy, such as patches and gums. For every 100 people using nicotine vapes to stop smoking, eight to ten might successfully stop, compared with only six of 100 people usingnicotine-replacement therapy.They were moderately certain that nicotine vapes outperformed non-nicotine cigarettes, resulting in about two more quitters per 100 people. And they were moderately certain that nicotine vapes were superior to behavioural support (counselling or advice), which resulted in five of 100 people quitting. They were less confident about these last two conclusions because there were fewer studies that compared nicotine vapes with non-nicotine vapes or counselling to aid quitting.The reviewers did not look at the outcomes of people who tried to quit without support.The reviewers were moderately certain that nicotine vapes didn’t cause more harms (serious adverse events) than those using nicotine-replacement therapies. This reflected the fact that severe adverse events were rare in people who used any of the quitting aids they compared.What were the limitations?The review had two major limitations.First, most studies only followed participants for six months, making it uncertain whether their attempt at quitting smoking lasted longer.Longer-term studies of other quitting aids suggest many people who quit smoking relapse. Among those who try to quit without support, less than 5% are still abstinent a year later.Second, many of these studies used older vapes that didn’t deliver nicotine as efficiently as newer devices. So the review may underestimate the effectiveness of newer vapes for quitting smoking.It’s also important to note what the review didn’t set out to do. It wasn’t designed to assess any health benefits of switching from cigarettes to vapes only. The review didn’t look at stopping vaping or nicotine-replacement therapies. However, the researchers are currently working on a review of interventions to help people quit vaping.What does this mean for smokers?The Cochrane review makes a good case for quitting services to offer vapes to people who have failed to quit smoking using nicotine-replacement therapies and drugs such as varenicline. Australia’s drug regulator, the Therapeutic Goods Administration (TGA), has not approved any nicotine-containing vapes but people who smoke cigarettes can buy unapproved devices through a TGA special access scheme. Since October 2024, this scheme has allowed pharmacists to dispense vapes with specified levels of nicotine without a prescription. Devices with higher nicotine levels can be dispensed if prescribed by a doctor. But very few people use this scheme. In the 2025 household survey, 93% of the 6.1% of Australians who reported using vapes containing nicotine in the past year still bought them illicitly.What does this mean for policy?New Zealand, unlike Australia, has encouraged people who smoke and fail to quit to switch to using vapes as a less harmful way of getting nicotine. Now, vaping daily rates in New Zealand are higher than smoking rates (about 12% vs about 7%).In Australia, where vapes are only legally accessible for quitting smoking, the percentage of people who vape daily is lower than those who smoke daily (3.6% vs 5.6%).Australia’s cautious policy to only allow vapes as an aid to quit smoking reflects concerns about the unknown long-term risks of vape use by young people who have never smoked cigarettes. But this policy may have persuaded some people who smoke cigarettes that they would be no better off switching to vapes than they would continuing to smoke. This is despite evidence that nicotine-containing vapes are less harmful than smoking cigarettes.Wayne Hall has in the past (2008-2011) received funding from the NHMRC for research on tobacco policy. He has been a paid advisor to the TGA on the effectiveness and safety of medical uses of cannabis (2017-2020).