A SUMMARY OF SMOKING CESSATION: A REPORT OF THE SURGEON GENERAL – 2020

Adult Smoking Cessation – 

The Use of E-Cigarettes

Cigarette Smoking and 

E-Cigarette Use in the U.S.

Since the first Surgeon General’s report on smoking and health was 

released in 1964, cigarette smoking among U.S. adults declined from 

nearly 43% to a low of nearly 14% in 2018, the most recent year for 

which data about adult use are available. 

Some people who smoke have turned to e-cigarettes for help 

quitting smoking, raising questions about the benefits and risks of 

using these products.

E-cigarettes entered the U.S. market around 2007 and were used 

by nearly 4% of adults by 2014. However, current use of e-cigarettes 

among U.S. adults has declined in recent years. In 2018, 3.2% of U.S. 

adults were current e-cigarette users. About half of adults who use 

e-cigarettes also smoke regular cigarettes, a behavior known as 

“dual use.” 

E-Cigarette Basics

E-cigarettes are sometimes called “e-cigs,” “vapes,” “e-hookahs,” 

“vape pens,” “electronic nicotine delivery systems” or “ENDS.” Using 

an e-cigarette is sometimes called “vaping.” Some e-cigarettes 

look like regular cigarettes, cigars, or pipes, while others look like 

everyday items, such as USB flash drives, highlighters, or pens. 

Most e-cigarettes have a battery, a heating element, and a place to 

hold a liquid. E-cigarettes produce an aerosol by heating a liquid that 

usually contains nicotine, flavorings, and other chemicals that help 

make the aerosol. This aerosol is inhaled into the lungs during use. 

Health Effects of E-Cigarette Use

E-cigarettes are fairly new, and scientists are still learning about 

their long-term health effects. Here is what we currently know 

about the health effects of e-cigarettes:

` E-cigarette aerosol generally contains fewer harmful chemicals 

than the smoke from burned tobacco products. However, 

e-cigarette aerosol can contain cancer-causing chemicals and 

tiny particles that reach deep into the lungs.

` Most e-cigarettes contain nicotine, the highly addictive drug 

found in tobacco. 

` In youth and young adults, nicotine can harm brain development, 

which continues until about age 25.

` Nicotine is dangerous for pregnant women and their 

developing babies. 

Key Findings from the 2020 

Surgeon General’s Report

` E-cigarettes, a continually changing and heterogeneous 

group of products, are used in a variety of ways. 

Consequently, it is difficult to make generalizations 

about efficacy for cessation based on clinical trials 

involving a particular e-cigarette, and there is 

presently inadequate evidence to conclude that 

e-cigarettes, in general, increase smoking cessation. 

` However, the evidence is suggestive but not sufficient 

to infer that the use of e-cigarettes containing 

nicotine is associated with increased smoking 

cessation compared with the use of e-cigarettes not 

containing nicotine, and the evidence is suggestive 

but not sufficient to infer that more frequent use of 

e-cigarettes is associated with increased smoking 

cessation compared with less frequent use of 

e-cigarettes. 

` Smoking cessation medications approved by the 

U.S. Food and Drug Administration (FDA) and behavioral 

counseling are effective treatments for quitting 

smoking, particularly when used in combination.

Many newer types of e-cigarettes use nicotine salts (also called 

nic salts). Nicotine salts allow particularly high levels of nicotine 

to be inhaled more easily and with less throat irritation than 

the typical freebase nicotine found in most tobacco products, 

including the types of e-cigarettes that have been on the market 

for a longer period of time. This feature allows for more efficient 

nicotine delivery than previous generations of e-cigarettes, 

which has the potential to help adults using these products in 

an attempt to quit smoking. However, it could also increase the 

potential for initiation and dependence, particularly among 

youth and young adults.
Proven Strategies to Quit 

Smoking Cigarettes

Several evidence-based methods have been scientifically proven safe 

and effective for quitting smoking. These include: 

` Counseling – Behavioral counseling increases the chances of 

quitting successfully. Counseling can be delivered in a variety 

of ways, including in-person (either one-on-one or in a group) 

and over the telephone (through the nationwide quitline 

1-800-QUIT-NOW). Text messaging and web-based cessation 

interventions can also help people successfully quit smoking. 

` Medications – The FDA has approved seven medications 

shown to be effective for helping people quit smoking. These 

medications include five forms of nicotine replacement therapy 

and two non-nicotine medications (bupropion and varenicline). 

` Combination of counseling and medication – Although 

counseling and medication are each proven treatments alone, 

using them in combination can more than double the chances of 

quitting smoking. 

For Adults Who Are Ready to 

Quit Smoking Cigarettes

` Adults who smoke should talk to their doctor about 

proven methods to quit, such as counseling and 

FDA-approved medications. 

` Adult smokers who are not pregnant and who want to try 

quitting by using e-cigarettes should completely switch to 

e-cigarettes and eliminate all use of cigarettes, cigars, and other 

burned tobacco products. Completely switching is the only way 

to fully reduce smoking-related health risks. Smoking even a 

few cigarettes per day is still harmful to health. The use of both 

cigarettes and e-cigarettes (dual use) can lead to the same, or in 

some cases higher, exposures to harmful chemicals as cigarette 

smoking alone. Adults who switch to e-cigarettes should also 

establish a goal for quitting them, to fully eliminate health risks 

from any tobacco product use.

` Pregnant women who smoke should talk to their doctor 

about counseling programs and the risks and benefits of using 

FDA-approved cessation medications to help them quit. Although 

e-cigarette aerosol generally has fewer harmful substances than 

cigarette smoke, e-cigarettes containing nicotine are not safe to 

use during pregnancy.

The Bottom Line About 

Adult Use of E-Cigarettes to 

Quit Smoking 

` Research is uncertain on whether e-cigarettes, in 

general, increase smoking cessation. 

` Some research suggests that using e-cigarettes 

containing nicotine is associated with greater smoking 

cessation than using e-cigarettes that don’t contain 

nicotine, and more frequent use of e-cigarettes is 

associated with greater smoking cessation than less 

frequent use. 

` The FDA has not approved e-cigarettes as a quit 

smoking aid, and more research is needed on whether 

e-cigarettes are effective for quitting smoking and to 

better understand the health effects of e-cigarettes. 

` E-cigarettes are not safe for youth, young adults, 

pregnant women, and adults who do not currently use 

tobacco products. 

` In order for adult smokers to achieve any meaningful 

health benefits from e-cigarettes, they would need 

to fully switch to e-cigarettes and stop smoking 

cigarettes and other tobacco products completely.

` Among those who have switched completely, 

the ultimate goal should be to also stop using 

e-cigarettes completely to achieve the maximum 

health benefit. 

` People who smoke should talk to their doctor about 

proven methods to quit.

For information about:

quitting smoking, visit www.CDC.gov/quit

the Surgeon General’s report, visit www.CDC.gov/CessationSGR

For E-Cigarette Resources, visit: 

` www.CDC.gov/e-cigarettes