New study: Vaping three times more effective than NRT for disadvantaged smokers
Posted on July 16, 2025 By Colin
OUR STUDY PUBLISHED TODAY in the prestigious Annals of Internal Medicine found that vaping was three times more effective than nicotine replacement therapy (NRT) in helping people from disadvantaged backgrounds quit smoking.
The randomised controlled trial* —one of the largest of its kind—involved 1,045 daily smokers in Australia on government pensions or allowances. These participants represent a population with some of the highest smoking rates, greatest nicotine dependence, and lowest quit success.
The design of the study aimed to mimic the real world by giving participants a choice of vaping device and flavour. All those in the vaping group were given a tank device (Innokin Endura T18 with 18mg/mL nicotine e-liquid) and a pod device (Alt. with 40mg/mL nicotine e-liquid). All liquids were provided in 3 flavours (tobacco, menthol and fruit). Subjects could use one or both devices.
The NRT group had a choice of 4mg nicotine gum or lozenges (mint flavour). All subjects were given minimal behavioural support.
The results were striking: after six months, 28.4% of those in the vaping group had quit smoking, compared to just 9.6% in the NRT group
The primary endpoint was continuous abstinence, with quitting verified using carbon monoxide breath tests.
Not only was vaping more effective, it was also better tolerated—participants using vapes experienced significantly fewer side effects than those using gum or lozenges.
These findings carry powerful implications for public health and social justice. Smoking remains the leading cause of preventable death and illness in Australia, but its harms fall hardest on our most vulnerable communities
People in low-income groups smoke at much higher rates and suffer more smoking-related illness and death. Yet, ironically, they also face the greatest barriers to accessing safer alternatives like vaping.
This is not just a health issue—it’s a matter of equity. Every Australian deserves access to the most effective tools to quit smoking, regardless of income or postcode.
Real-world impact in New Zealand
This latest trial echoes findings from our research published in Addiction last year, which compared smoking trends in Australia and New Zealand. In New Zealand—where vaping products are widely available to adult smokers—the smoking rate among the lowest socioeconomic group dropped three times faster than in Australia, where access to vaping is heavily restricted and requires a prescription.
The message is clear: when adult smokers are given access to regulated vaping products, especially those in disadvantaged groups, they are more likely to quit successfully. Denying access maintains the status quo—and the deadly toll of smoking.
Time for action
Australia’s current approach to vaping is out of step with both the evidence and the rest of the world. While countries like New Zealand and the UK support vaping as a harm-reduction tool, Australian policy continues to restrict access through complex prescription-only schemes that discourage quit attempts.
We now have robust, local evidence that vaping works—and works best for those who need it most.
We call on Australian policymakers to urgently rethink our outdated and punitive approach. Here’s what we need:
- Make regulated vaping products available over the counter to adult smokers, just like NRT products
- Provide clear, evidence-based public messaging about the relative risks of vaping versus smoking
- Prioritise disadvantaged communities in national smoking cessation programs, ensuring they have access to the most effective tools
- Stop criminalising smokers who are trying to quit
It is no longer scientifically or morally defensible to block access to a tool that can save lives—especially when smoking continues to devastate low-income communities
This is a pivotal moment for public health in Australia. Let’s act on the evidence, reduce health inequality, and finally give all smokers a fair chance to quit.
* Trial conducted at the National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney. Project Grant 1127390 from the Australian National Health and Medical Research Council. All study medications were purchased by the research team.
References
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