Kenneth Warner, dean emeritus at the University of Michigan School of Public Health and Avedis Donabedian Distinguished University Professor Emeritus, said there is sufficient evidence to support the use of e-cigarettes as a first-line aid in smoking cessation in adults.

"Too many adults who want to quit smoking are unable to do so," Warner said in a statement. "E-cigarettes are the first new tool in decades to help them. Yet relatively few smokers and healthcare professionals are aware of their potential value."

In a study published in the journal Nature Medicine, Warner and colleagues looked at vaping from a global perspective, looking at countries that promote vaping as a way to quit smoking and those that don't.

According to the authors, while agencies in the United States and Canada acknowledge the potential benefits of e-cigarette use, they believe there is insufficient evidence to recommend e-cigarette use for smoking cessation.

However, in the UK and New Zealand, there is high-level support and promotion of e-cigarettes as a first-line smoking cessation treatment option.

"We believe that governments, medical professional groups, and individual healthcare professionals in countries such as the United States, Canada, and Australia should give greater consideration to the potential of e-cigarettes to promote smoking cessation," Warner said. E-cigarettes are not a panacea to end the damage caused by smoking, but they can contribute to this noble public health goal.

Warner's previous research found substantial evidence that e-cigarettes are an effective smoking cessation tool for adults in the United States, where hundreds of thousands of people die each year from smoking-related diseases.

In addition to assessing differences in regulatory activity across countries, the researchers examined the evidence that e-cigarettes promote smoking cessation, the health effects of e-cigarettes, and the impact on clinical care.

They also cited the U.S. Food and Drug Administration's designation of some e-cigarette brands as suitable to protect public health -- a standard required to gain marketing approval. The action indirectly implies that the FDA believes e-cigarettes can help some people quit smoking who would not otherwise, the researchers said.

Warner and colleagues concluded that acceptance of the promotion of e-cigarettes as a smoking cessation tool may depend on continued efforts to reduce exposure to and use of vaping products among young people who have never smoked. These two goals can and should co-exist.

Study co-authors include Neal Benowitz of the UCSF Department of Medicine, Ann McNeill of the National Center for Addiction at King's College London, UK, and Nancy Rigotti of the Harvard Medical School Department of Medicine.

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