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Michael C. Fiore, M.D., M.P.H., M.B.A., Steven A. Schroeder, M.D., and Timothy B. Baker, Ph.D.

N England  J Med 2014; 370:297-299 January 23, 2014       DOI: 10.1056/NEJMp1314942

One opportunity afforded by today’s changing landscape lies in the diverse alternative nicotine-delivery vehicles available to smokers. Evidence shows that all the noncombustible delivery vehicles are substantially less dangerous than combustible tobacco products, though that’s not to say that they are all totally safe. Noncombustible forms include multiple nicotine-replacement therapies (NRTs) as well as smokeless tobacco (e.g., snus) and the electronic cigarette (e-cigarette). Over the past few years, smokers have begun using e-cigarettes at a markedly increasing rate. More than 20% of smokers report having tried them, and some early evidence suggests that e-cigarette use may help smokers reduce or quit combustible tobacco use. There is currently too little evidence, however, to conclude with confidence that using e-cigarettes will aid smoking reduction or cessation, and there are important clinical concerns regarding their growing use. One such concern is that using e-cigarettes along with combustible cigarettes (“dual use”) could prolong the use of combustibles.  Read more