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Vaping may help some people quit cigarettes, but what about nicotine?

E-cigarettes have helped quit smoking more than traditional nicotine replacement therapy, and a new study says – but vapes are not a miracle cure for nicotine addiction. Most of the smokers who tried vaping were still smoking cigarettes by the end of the trial, and most of the vapers who did manage to quit smoking continued to grow a year later.

The new study, published Wednesday in the New England Journal of Medicine, reported that 18 percent of smokers who switched to e-cigarettes had given up cigarettes after a year. That's more than the 9.9 percent of people who stopped smoking using conventional quit aids such as patches, gums, lozenges, or inhalators. The results add weight to the claims that e-cigarettes could help some people quit cigarettes, but there is still a lot we do not know about the long-term health effects of e-cigarettes, or how to keep millions of teens from using them.

E-cigarette companies market themselves as a less risky alternative for people looking to stop smoking cigarettes. But being less risky than cigarettes is a low bar, according to the CDC: "Burned cigarettes are extremely dangerous, killing half of all people who smoke long-term." And the jury's been out about whether e-cigarettes can help people quit, Vox reports: few rigorous trials have compared vaping to other quitting aids, like the patch, or gum.

"This kind of study, a systematic, well-done randomized controlled trial, was what was severely lacking in the decade-long debate about the potential benefits and harm of e-cigarettes," Gideon St. Helen, and a tobacco researcher at the University of California, San Francisco who was not involved in the research, says in an email to The Verge. There are still major caveats: for example, the study participants knew whether they were using e-cigarettes or, say, patches – and that knowledge might have skewed the results if they thought one strategy was better than the other. Plus, the study does not evaluate more popular types of e-cigarettes, like Juul. Still, St. Helen says, "The findings are really important and maybe game-changing."

Researchers led by Peter Hajek, a professor of clinical psychology at the Wolfson Institute of Preventive Medicine, found 866 people who wanted to quit smoking and did not care how. For the first month, all of them received weekly one-on-one meetings with a clinician. Half also received their favorite nicotine replacement therapies, and half were given a starter kit for a refillable bottle, including a bottle of Tobacco Royale flavored wape juice. Participants could swap out the device or the liquid if they wanted to.

The researchers checked in with the study participants periodically, evaluating things like their sleep, whether they felt nauseated, if their throat or mouth hurt, and how much phlegm they coughed up. The big question was whether the participants could stay off cigarettes a year out. The researchers checked by measuring the carbon monoxide that the study participants exhaled – a marker for cigarette smoking. After a year, 18 percent of e-cigarette users had quit smoking cigarettes, and had 10 percent of the nicotine replacement group. The e-cigarette users liked their vapos more than the other group liked their nicotine replacement therapies, and they had less severe withdrawal symptoms.

Here's the catch: Of 80% of people in the vaping group were still using e-cigarettes after a year. That's a huge fraction compared to the only 9 percent of people who were still using traditional nicotine replacement therapies at that point. So while vaping made it somewhat easier to quit cigarettes, it didnt help much with quitting nicotine altogether. Plus, the study did not use the types of e-cigarettes like Juuls that dominate the market. The science is still out, but given the convenience, the high nicotine dose, and the nicotine salt formulations, it's possible that sub-based vapes could be even harder to quit than the refillable kind used in the study.

The long-term health effects of vaping will be especially important to figure out if switching to e-cigarettes signals the start of a long-term habit. We know that nasty chemicals can form in the e-liquids while they sit on the shelf, for example, and vases show signs of exposure to carcinogens and irritants. Plus, the science around the health effects of nicotine itself is still dark: some studies suggest that it might be risky for people with heart problems. And it's addictive – which can lead people to feel controlled by their cravings, or to unpleasant withdrawal symptoms.

The question, Helen says, is what now? Yes, the study adds weight to some vapers have been saying for awhile: that e-cigarettes might be useful tools to help a fraction of smokers quit. But it is impossible to look at the findings in a vacuum: there are 3.6 million high school and middle school students using e-cigarettes in what the US Surgeon General has declared an epidemic. "That risk remains, but will it be prioritized even as this well-done study shows e-cigarettes can help adult smokers quit smoking?" Helen says. The answer lies with the regulators and the e-cigarette industry: if they can stop young people from vaping in record numbers then maybe.

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