A major international review has found nicotine vaping is more effective than traditional nicotine replacement products such as patches and gum for helping people stop smoking, findings with particular significance for Māori as Aotearoa continues to grapple with stubbornly high smoking rates and rapidly rising vaping.
The latest Cochrane review examined 80 randomised controlled trials involving almost 30,000 participants and found high-certainty evidence that nicotine e-cigarettes produce higher smoking quit rates than nicotine replacement therapy.
For every 100 people attempting to quit, researchers found around eight to ten people using nicotine vapes successfully stopped smoking for at least six months, compared with about six people using nicotine replacement therapy. The updated analysis estimates vaping produces around four additional quitters for every 100 people compared with patches and gum.
The findings add significant new weight to the debate over whether vaping should be viewed not simply as another public health problem, but also as a potential harm-reduction and smoking cessation tool for existing smokers.
A particularly important question for Māori
That debate matters for Māori because despite dramatic progress over the past decade, smoking inequities remain substantial.
The latest 2024/25 New Zealand Health Survey shows 15 percent of Māori adults smoke daily, compared with 6.8 percent across the total adult population.
Māori daily smoking has fallen significantly over the longer term, but the latest figures show the remaining gap is considerable. The Ministry of Health also cautions that smoking rates have flattened nationally over the past three years after years of decline.
The challenge is therefore no longer simply demonstrating that Māori smoking can be reduced. It is finding ways to maintain that momentum and reach those whānau who continue to smoke.
But vaping creates its own public health challenge
The same data that strengthens the argument for vaping as a smoking cessation tool also illustrates why the issue is complicated.
Daily vaping among Māori adults has reached 27.5 percent, the highest rate of any major ethnic group measured by the New Zealand Health Survey.
Across the entire adult population, 11.7 percent vape daily.
The Ministry of Health says increases in vaping have mirrored decreases in smoking among some groups, but cautions that survey data alone cannot prove that vaping caused the reduction in smoking.
That creates an important distinction for policymakers.
The potential benefits of a smoker switching completely from combustible cigarettes to a regulated nicotine vape are very different from a young person who has never smoked becoming dependent on nicotine through vaping.
Effective public health policy therefore needs to deal with both realities at the same time.
What does the international evidence actually show?
The Cochrane researchers found strong evidence that regulated nicotine e-cigarettes outperform nicotine replacement therapy for smoking cessation.
They also found vaping may outperform behavioural support or attempting to quit without support, although the evidence for those comparisons is less certain.
Serious adverse events were uncommon across the studies, and researchers did not detect evidence of serious short-term harm from nicotine e-cigarettes. However, they emphasise that larger and longer studies are still required to fully understand long-term safety. The trials also involved regulated nicotine vaping products, meaning the findings should not automatically be applied to illicit products or vapes containing other substances.
That distinction is critical.
The research does not conclude that vaping is harmless.
It asks a different question: for somebody who already smokes cigarettes and wants to stop, does nicotine vaping help them quit?
On that question, the evidence is becoming increasingly strong.
Harm reduction versus prevention
For Aotearoa, the challenge may now be developing policy sophisticated enough to separate smoking cessation from recreational uptake.
Measures designed to stop rangatahi and non-smokers becoming addicted to nicotine need to coexist with effective cessation options for adults who are already smoking.
For Māori health providers, that could mean ensuring whānau receive clear information about the relative risks of smoking and vaping while maintaining access to evidence-based cessation support.
New Zealand’s overall daily smoking rate has fallen from 16.4 percent in 2011/12 to 6.8 percent in 2024/25, while the estimated number of daily smokers has nearly halved. But Māori remain well above the country’s smokefree target.
The latest international evidence therefore adds another layer to an increasingly complex public health conversation.
The objective should not be to create another generation dependent on nicotine. But for people already smoking, the evidence increasingly suggests vaping may provide another pathway away from something considerably more deadly.
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