This study evaluated the efficacy and safety of providing electronic nicotine delivery systems (ENDS) in addition to standard-of-care (SOC) smoking cessation counseling for tobacco smokers. The randomized controlled trial involved 1246 adult smokers who were willing to quit within 3 months. Participants were randomized to receive either free ENDS and e-liquids plus SOC counseling or SOC counseling alone. The primary outcome was biochemically validated, continuous self-reported tobacco smoking abstinence at 6 months. Secondary outcomes included participant-reported abstinence from tobacco and nicotine, respiratory symptoms, and serious adverse events (SAEs). The results showed that the intervention group had a higher rate of continuous tobacco smoking abstinence (28.9% vs. 16.3%) compared to the control group. However, many participants in the intervention group continued using ENDS with nicotine. The intervention also increased the rate of adverse events but not SAEs. The study concluded that adding ENDS to SOC counseling increased tobacco smoking abstinence more effectively than SOC alone, but it may be less suitable for smokers aiming to abstain from both tobacco and nicotine.This study evaluated the efficacy and safety of providing electronic nicotine delivery systems (ENDS) in addition to standard-of-care (SOC) smoking cessation counseling for tobacco smokers. The randomized controlled trial involved 1246 adult smokers who were willing to quit within 3 months. Participants were randomized to receive either free ENDS and e-liquids plus SOC counseling or SOC counseling alone. The primary outcome was biochemically validated, continuous self-reported tobacco smoking abstinence at 6 months. Secondary outcomes included participant-reported abstinence from tobacco and nicotine, respiratory symptoms, and serious adverse events (SAEs). The results showed that the intervention group had a higher rate of continuous tobacco smoking abstinence (28.9% vs. 16.3%) compared to the control group. However, many participants in the intervention group continued using ENDS with nicotine. The intervention also increased the rate of adverse events but not SAEs. The study concluded that adding ENDS to SOC counseling increased tobacco smoking abstinence more effectively than SOC alone, but it may be less suitable for smokers aiming to abstain from both tobacco and nicotine.