Longer-term use of electronic cigarettes when provided as a stop smoking aid: Systematic review with meta-analyses

Ailsa R. Butler, Nicola Lindson, Thomas R. Fanshawe, Annika Theodoulou, Rachna Begh, Peter Hajek, Hayden McRobbie, Chris Bullen, Caitlin Notley, Nancy A. Rigotti, Jamie Hartmann-Boyce

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Moderate certainty evidence supports use of nicotine electronic cigarettes to quit smoking combustible cigarettes. However, there is less certainty regarding how long people continue to use e-cigarettes after smoking cessation attempts. We set out to synthesise data on the proportion of people still using e-cigarettes or other study products at 6 months or longer in studies of e-cigarettes for smoking cessation.

We updated Cochrane searches (November 2021). For the first time, we meta-analysed prevalence of continued e-cigarette use among individuals allocated to e-cigarette conditions, and among those individuals who had successfully quit smoking. We updated meta-analyses comparing proportions continuing product use among individuals allocated to use nicotine e-cigarettes and other treatments.

We included 19 studies (n = 7787). The pooled prevalence of continued e-cigarette use at 6 months or longer was 54% (95% CI: 46% to 61%, I2 86%, N = 1482) in participants assigned to e-cigarette conditions. Of participants who had quit combustible cigarettes overall 70% were still using e-cigarettes at six months or longer (95% CI: 53% to 82%, I2 73%, N = 215). Heterogeneity in direction of effect precluded meta-analysis comparing long-term use of nicotine e-cigarettes with NRT. More people were using nicotine e-cigarettes at longest follow-up compared to non-nicotine e-cigarettes, but CIs included no difference (risk ratio 1.15, 95% CI: 0.94 to 1.41, n = 601). The levels of continued e-cigarette use observed may reflect the success of e-cigarettes as a quitting tool. Further research is needed to establish drivers of variation in and implications of continued use of e-cigarettes.
Original languageEnglish
Article number107182
JournalPreventive Medicine
Issue numberB
Early online date3 Aug 2022
Publication statusPublished - Dec 2022


  • E-cigarette
  • Electronic cigarette
  • Longer term use
  • Quitting smoking
  • Smoking cessation
  • Systematic review

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