Pop quiz: Which of the following statements is true?

A.    Smoking is no longer a major public health concern.
B.    E-cigarettes with nicotine are more harmful to your health than tobacco cigarettes.
C.    Nicotine is a carcinogen.
D.    None of the above.

If you chose answer D—congratulations! You are unusually well-informed about this crucial public health issue.

According to Jamie Hartmann-Boyce, assistant professor of health policy and management at UMass Amherst, there are still many common misconceptions about smoking, despite decades of public outreach and education. The introduction of electronic cigarettes (also known as e-cigarettes or “vapes”) to the market within the past couple of decades only confuses matters further. 

Though many gains have been made in smoking policy and research aimed at helping people quit, smoking remains the leading cause of preventable death and disease, both in the U.S. and worldwide, as well as one of the leading causes of health inequalities. Overall cigarette smoking rates have declined significantly but remain stubbornly high in specific groups, including people of lower socioeconomic status and those living in rural communities, people with mental health conditions, middle-aged to older adults, and certain racial minorities, notably Native Americans.

“We’ve known for a long time that smoking isn’t a choice most people make,” says Hartmann-Boyce. “Most people start smoking very young, before the age of 15, due to deliberate targeting by the tobacco industry and find it very hard to quit. The majority of adults who smoke do not want to smoke. Many have tried to quit several times and unfortunately have been unsuccessful.”

Yet, Hartmann-Boyce urges anyone who struggles to quit not to despair. 

“Many people think quitting just isn’t in the cards for them. They often try to go it alone, but there’s no need to do that. There are lots of options and supports that can help people quit,” she says.

A Commitment to Promoting Public Health

Hartmann-Boyce has dedicated her career to studying pressing public health issues, aiming to inform policy and help the public. Much of her research focuses on tobacco control and electronic cigarettes, but she also studies diet, physical activity, and management of long-term health conditions, including asthma and diabetes.

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Hartmann-Boyce’s interest in public health began early, when she was diagnosed with Type 1 diabetes at the age of 10. As an undergraduate at Tufts University, she double majored in community health and English literature, as well as worked as a research assistant to a professor who was studying the tobacco industry’s tactics. 

“One summer, I got involved in my professor's research examining previously confidential documents from the tobacco industry, which had been made public through a lawsuit,” she recalls. “I read about how the industry worked to get people addicted to smoking and fought back against tobacco control legislation. I learned that they knew just how addictive smoking is. It really captured my attention, and I realized I wanted to stick with this topic and find a way to give back.”

After undergrad, Hartmann-Boyce moved to England, where she ended up working at the University of Oxford and with Cochrane, a nonprofit that produces systematic reviews to help people make informed health decisions. She ultimately earned her PhD at Oxford and stayed on as a researcher. She returned to the U.S. in 2023 and joined the faculty of UMass Amherst—where her father previously taught before retiring—in the School of Public Health and Health Sciences. She continues to collaborate closely with colleagues at Oxford and Cochrane on research related to smoking cessation and e-cigarettes.
 

Evidence-Backed Ways to Quit

Hartmann-Boyce conducts her research using an applied evidence synthesis methodology, which involves applying a rigorous methodological process and conducting statistical analysis to combine data across all existing studies on a topic; it considers not only what the studies find but also how much their results can be trusted.

“This approach is an efficient and effective way to conduct research that is useful to policymakers, clinicians, and the public, who often don’t have time to review the results of hundreds of different studies,” she explains.

Hartmann-Boyce’s research offers an optimistic view for the millions of adults who smoke and want to quit. She has found evidence supporting several effective options to help make quitting easier, including nicotine replacement therapies (such as patches and gum) that are available over the counter and prescription medications like Varenicline (also known by the brand name Champix) that block some of the rewarding effects of nicotine.

“People should not be afraid to use nicotine to help them quit smoking; it’s safe and effective,” says Hartmann-Boyce.

“There’s a common misconception that nicotine causes cancer and is the reason that cigarettes are harmful to your health. While nicotine is addictive, it’s not the substance that directly causes disease and death. In reality, it’s all the other stuff you burn in cigarettes that’s bad for you.”

She adds, “We also know that you’re more likely to successfully quit if you combine one of these options with behavioral support, such as counseling or text message programs. There are many options out there, including free online programs and state quitlines you can call.”

Since 2014, much of Hartmann-Boyce’s research has considered nicotine e-cigarettes as a tool to help people quit smoking tobacco cigarettes. E-cigarettes are devices that heat a liquid that usually contains nicotine, flavoring, and other chemicals to produce an aerosol that users inhale. She emphasizes that e-cigarettes are not risk-free—their health effects vary widely depending on the brand, and people who don’t currently smoke should not start vaping—but there is clear and convincing evidence from randomized controlled trials that e-cigarettes can help people who smoke cigarettes to quit. And because nothing is burned in e-cigarettes—rather, the liquid is heated up—they are much less harmful to human health.

“In England, e-cigarettes have long been embraced as a tool to help people quit smoking. We have a living systematic review, which we continually update whenever new trials emerge, to study this topic,” says Hartmann-Boyce. “In the U.S., health policy and dialogue have been much more mixed when it comes to e-cigarettes because of concern over the addictive nature of nicotine.”

As her research on cigarettes and e-cigarettes continues, Hartmann-Boyce is also following new developments, such as the introduction of novel products like oral nicotine pouches, which are rapidly gaining popularity. She’s also closely watching a new standard being considered by the U.S. Food and Drug Administration (FDA), which would reduce the level of nicotine in cigarettes.

Hartmann-Boyce views communicating research findings to policymakers and the public in a clear and trustworthy manner as an essential part of her work. She regularly talks to policymakers and writes policy briefs, and has advised public health groups in the U.S., U.K., Canada, and France. In addition, she frequently writes about her research in The Conversation U.S. and co-hosts a podcast called Let’s Talk E-Cigarettes, which reviews the latest research on e-cigarettes. 

“I’m really interested in thinking about where tobacco and health policy might be heading and what research we can do to be useful, to inform policymaking, and to ensure the people making these important decisions have the best evidence available,” she says.

This story was originally published in May 2025.