A new paper in JAMA provides the first US recommendations for clinicians on integrating nicotine e-cigarettes into smoking cessation plans.


RT’s Three Key Takeaways:

  1. First US Guidance: A new position paper published in JAMA provides the first clinical recommendations in the United States for using nicotine e-cigarettes to assist adults with smoking cessation.
  2. Shared Decision-Making: The guidance encourages clinicians to include e-cigarettes as a treatment option alongside traditional pharmacotherapies and to engage in shared decision-making conversations with patients.
  3. FDA-Authorized Products: Clinicians should advise patients to use FDA-authorized products, switch completely from combustible tobacco as quickly as possible, and pair use with behavioral counseling.


New research provides the first clinical recommendations in the US on how e-cigarettes can be used to help adults quit smoking, according to a report published in JAMA.1 Developed by the Harm Reduction Workgroup of the Society for Research on Nicotine and Tobacco (SRNT), the guidance is expected to influence national treatment standards for people who smoke.1

The recommendations address a long-standing gap in tobacco treatment. While research indicates that nicotine e-cigarettes are less harmful than cigarettes and more effective than traditional nicotine replacement therapy (NRT), clinicians have lacked clear direction on their use in clinical care.1

“Cigarette smoking causes about 30% of all cancer deaths in the United States and most people want to quit but struggle to do so,” said Leavens, assistant professor of population health and a member of the University of Kansas Cancer Center’s cancer prevention and control research program, in a news release. “Adding clear guidance on e-cigarettes gives clinicians a practical tool that can help people move away from combustible tobacco and toward better health.”1

Clinical Integration and Shared Decision-Making

The paper provides practical guidance for how clinicians can discuss e-cigarettes with patients and incorporate them into a quit plan. While e-cigarettes are not risk-free, switching completely from smoking to vaping reduces exposure to harmful chemicals and improves tobacco-related healthcare outcomes.1

The authors recommend that clinicians include nicotine e-cigarettes on the menu of options when discussing evidence-based treatment for smoking cessation. The guidance suggests three primary recommendations for clinicians:1

  • Include e-cigarettes on the list of options alongside medications authorized by the Food and Drug Administration (FDA), such as NRT, varenicline, and bupropion.
  • Assess and correct misperceptions regarding the harm and safety of cigarettes versus e-cigarettes.
  • Ask key questions to guide the decision-making process, including the patient’s goals and previous methods tried.

“This work is about correcting misperceptions that act as barriers to evidence-based care for smokers and expanding the tools clinicians can use to support smoking cessation among their patients,” said Leavens, in a news release. “There is no single approach that will help all smokers quit but by providing patients with a menu of options and engaging in a risk-benefit conversation, they have a better chance of quitting for good and improving their overall health.”1

Guidance for Patient Use

The paper also outlines specific advice clinicians can share with adults who choose to use e-cigarettes as part of a quit attempt. Patients are advised to choose FDA-authorized products and use e-cigarettes whenever they would normally smoke or feel an urge to smoke.1

The authors encourage a rapid transition to complete switching, as a period of using both products is common but carries continued risks. Additionally, clinicians should encourage pairing e-cigarette use with behavioral counseling, such as the national quit line support at 1-800-QUIT-NOW.1

The guidance suggests that clinicians schedule follow-up visits within the first few weeks of treatment to assess progress, monitor adverse effects, and adjust the treatment plan if necessary. If a patient achieves cigarette abstinence but continues to use e-cigarettes, the clinician and patient should eventually discuss longer-term goals regarding complete nicotine abstinence, though maintaining abstinence from combustible cigarettes remains the primary objective.1


Reference

  1. Leavens ELS, Pebley K, Smith TT, et al. Nicotine E-Cigarettes for Cigarette Smoking Cessation: Recommendations to US-Based Clinicians. JAMA. Published online July 30, 2026. doi:10.1001/jama.2026.13087