Since electronic cigarettes (e-cigarettes) first appeared in the tobacco product marketplace over a decade ago, they have been evaluated as another tool for promoting successful smoking cessation. The randomised controlled trial by Pope et al reported in this issue of the Emergency Medicine Journal, adds to a growing literature on the use of e-cigarettes as a smoking cessation intervention, providing evidence in a novel, pragmatic setting—emergency departments (EDs).1 A 2024 Cochrane review reported high-certainty evidence for their effectiveness, primarily from randomised controlled trials, showing that nicotine e-cigarettes are more effective in helping smokers to quit than nicotine replacement therapy (NRT), a cessation modality approved by the US Food and Drug Administration.2 Although the evidence is increasingly compelling, its generalisability to other healthcare settings is uncertain.

This study is a step toward addressing that uncertainty about how e-cigarettes could be used to promote smoking cessation among patients visiting EDs.1 In this comparative effectiveness study, the high rate …