E-Cigarettes Alone Aid Smoking Cessation; Behavioral Support Adds Further Benefit

E-cigarettes provided without additional support were more effective than automated supportive messages in helping people achieve sustained, validated smoking abstinence at 6 months, and e-cigarettes plus multisession telephone-based behavioral support were more effective than e-cigarettes alone, according to a randomized trial published in NEJM Evidence.

The investigators noted that trials showing e-cigarettes to be effective for smoking cessation typically provided behavioral support in addition to e-cigarettes. Behavioral support is not always available or wanted, and it was not known whether e-cigarettes are effective without it.

Participants who smoked and were motivated to quit were randomly assigned to National Health Service (NHS) SmokeFree automated email messages, an e-cigarette starter pack alone, or an e-cigarette starter pack plus multisession telephone-based behavioral support. The primary outcome was biochemically validated sustained abstinence at 6 months. Abstinence rates were 6.4% with supportive messages, 11.3% with e-cigarettes alone, and 21.1% with e-cigarettes plus behavioral support. The relative risk was 1.76 for e-cigarettes alone vs supportive messages (97.5% CI, 1.03 to 3.01) and 1.87 for e-cigarettes plus support vs e-cigarettes alone (97.5% CI, 1.27 to 2.75). For the first comparison, the lower bound of the confidence interval was close to no difference.

Participants who were lost to follow-up or did not provide biochemical validation were assumed to continue smoking. Serious adverse events were reported by 8.1% of participants in the supportive messages group, 10.8% in the e-cigarette–only group, and 10.7% in the e-cigarette-plus-support group. Four participants died, 2 in each e-cigarette group.

The investigators concluded that e-cigarettes without further support were more effective than supportive messaging and that e-cigarettes with multisession telephone-based support were more effective than e-cigarettes alone.

Source: Myers Smith K, Przulj D, Pesola F, et al. E-cigarettes with and without behavioral support for smoking cessation. NEJM Evid. 2026;5(11):EVIDoa2600065. doi 10.1056/EVIDoa2600065