JAMA paper offers first national clinical guidance on using e‑cigarettes to help adults quit smoking

A new paper led by Eleanor Leavens, Ph.D., assistant professor of population health and a member of The University of Kansas Cancer Center’s Cancer Prevention and Control research program, provides the first clinical recommendations in the United States on how e‑cigarettes can be used to help adults quit smoking. Developed by the Harm Reduction Workgroup of the Society for Research on Nicotine and Tobacco and published in JAMA, the guidance is expected to influence national treatment standards and reshape how clinicians support people who smoke.

The recommendations address a long‑standing gap in tobacco treatment. Although research shows that nicotine e‑cigarettes are less harmful than cigarettes and more effective than traditional nicotine replacement therapies, clinicians have not had clear direction on their use in clinical care for smoking cessation. This lack of guidance has contributed to confusion among both patients and clinicians about the risks and benefits of e‑cigarettes.

“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. “Adding clear guidance on e‑cigarettes gives clinicians a practical tool that can help people move away from combustible tobacco and toward better health.”

The team, which included second author Kinsey Pebley, Ph.D., MPH, assistant professor of population health at KU and a member of the Cancer Prevention and Control research program, worked alongside colleagues from other institutions to develop the recommendations.

What the guidance tells clinicians to do

A key contribution of the paper is its practical guidance for how clinicians can talk with patients about e‑cigarettes and incorporate them into a quit plan. Leavens notes that e‑cigarettes are not risk‑free, but she explains that switching completely from smoking to vaping reduces exposure to harmful chemicals and improves tobacco-related health outcomes. Leavens and her co-authors recommend that clinicians include nicotine e‑cigarettes on the menu of options when discussing all evidence-based treatment strategies for smoking cessation. Leavens notes that it is critical for the clinician and the patient to engage in a shared decision-making conversation to decide which strategy fits best. Their guidance includes:

• Research summaries showing that e‑cigarettes help more adults quit smoking than traditional nicotine-replacement therapies
• Guidance for addressing common misunderstandings about nicotine, addiction and the relative risks of smoking and vaping
• Practical clinical advice, including questions to ask patients and ways to support shared decision-making
• An approach that encourages complete switching from cigarettes to e‑cigarettes for people who choose to use them

Guidance for adults who choose to use e‑cigarettes

The paper also outlines recommendations clinicians can share with adults who want to use e‑cigarettes as part of a quit attempt. The authors advise patients to choose authorized products by the U.S. Food and Drug Administration, use e‑cigarettes whenever they would normally smoke or feel an urge to smoke and work toward complete switching as quickly as possible. They encourage pairing e‑cigarette use with behavioral counseling, including free national quit line support through 1‑800‑QUIT‑NOW. Clinicians are encouraged to schedule follow‑up visits to assess progress and adjust treatment if needed.

“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,” Leavens said. “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, providers will ensure patients have a better chance of quitting for good and improving their overall health.”