Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them

6. Only consider e‑cigarettes if you’ve already tried quitting; non‑smokers should avoid them

Cost: The device plus cartridges cost anywhere from a few dozen to several hundred yuan per month. In China, only tobacco‑flavored e‑cigarettes are legally sold, and only at stores holding a tobacco retail license.

In plain terms: Switching to nicotine‑containing e‑cigarettes helps roughly 60% more people quit smoking than nicotine patches — this finding is quite reliable. However, e‑cigarettes are not harmless; long‑term safety data remain limited. For people who have never smoked, there is absolutely no benefit to using them.

Benefit: This up‑to‑date review includes 80 randomized trials involving 29,861 participants. Compared with nicotine replacement therapy, e‑cigarettes raise the quit rate by about 61% (RR 1.61, 95% CI 1.23–2.12; high‑certainty evidence based on 11 trials with 4,114 participants). In absolute terms, that translates to roughly 4 extra quitters per 100 users (range: 1–7). The rate of serious adverse events is similar between groups (risk difference 0.01, 95% CI −0.01–0.02; moderate‑certainty evidence). Compared with behavioral support alone or no support at all, e‑cigarettes improve quit rates by about 75% (RR 1.75, 95% CI 1.39–2.20; low‑certainty evidence).

Evidence grade: A

Sources: Lindson N, Livingstone-Banks J, Butler AR, et al. (2026). Electronic cigarettes for smoking cessation. Cochrane Database of Systematic Reviews, 8, CD010216. <https://doi.org/10.1002/14651858.CD010216.pub11>; State Tobacco Monopoly Administration (2022). E-cigarette management measures (Announcement from the State Tobacco Monopoly Administration 2022 year 1 Number,2022 Year 5 moon 1 Implemented on the day) Article 18: To engage in e-cigarette retail business, you must apply for a tobacco monopoly retail license from the tobacco monopoly administrative department. Article 22: "The sale of e-cigarette products to minors is prohibited."Article 23 Paragraph 2: "any individual, Legal persons or other organizations may not sell e-cigarette products through information networks other than the e-cigarette transaction management platform stipulated in these Measures., Nicotine for aerosols and e-cigarettes, etc."Article 26: "The sale of flavored e-cigarettes other than tobacco flavors and e-cigarettes that can be added with atomizers is prohibited.". <http://www.gov.cn/gongbao/content/2022/content_5697988.htm>

Notes: This topic is controversial. WHO does not recommend e‑cigarettes as a smoking‑cessation tool, citing insufficient long‑term safety data and concerns that they may attract youth to nicotine. The UK, however, includes them in its quit‑smoking services. In China, e‑cigarette sales are not completely banned but are tightly regulated under the “Administrative Measures for E‑Cigarettes.” Only tobacco‑flavored products may be sold, and only at physical stores holding a tobacco retail license; fruit‑flavored e‑cigarettes and refillable devices are prohibited. Sales through any website, online shop, or social‑media platform other than the state‑run e‑cigarette trading platform are illegal, and sales to minors are forbidden. Consequently, fruit‑flavored e‑cigarettes that are still available are sold through illicit channels outside regulatory oversight. This is also how synthetic‑cannabinoid‑laced “high‑effect” e‑cigarettes enter the market; see Section 22, Item 4 (“Do not accept unknown cartridges”). The review examined only legally regulated nicotine‑containing products; unverified e‑liquid mixtures were not included. As a first step, it is advisable to try the medication described in Item 3 of this section, which offers stronger evidence and lower cost.