Vaping cessation interventions: a systematic review and meta-analysis

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1. ANALYTICAL SUMMARY

Context and issues: a massive addiction without a validated response

Vaping has exploded in a decade: around 15% of those aged 15 and over worldwide have experimented with these products, with the highest rates among 15–24 year olds (p. 382). However, there is no approved vaping cessation aid, nor any recognised standard of care (p. 383). The target audiences are exclusive e-cigarette users and mixed users (vape + tobacco), with particular attention to adolescents and young adults who quickly develop nicotine addiction (p. 382-383). Practitioners use, for lack of better options, smoking cessation strategies "off-label", with uncertain effects.

Operational contributions: quantified evidence to guide action

The review aggregates 7 randomised controlled trials (5,763 participants) testing digital, pharmacological, and educational interventions (p. 384). It demonstrates a significant increase in point abstinence at 7 days (OR 1.52) and continuous abstinence (OR 2.71), with the effect being driven by pharmacological and educational approaches (p. 386). It therefore prioritises avenues for the field and identifies blind spots (unmeasured relapse to tobacco, lack of data on minors, limited geographical availability of tools).

2. KEY POINTS OF THE DOCUMENT

1. A modest but real overall effectiveness in the short term. Interventions increase the chances of abstinence at 7 days by 52% (OR 1.52; 95% CI 1.15–2.01; n = 3,244; moderate certainty) and multiply the chances of continuous abstinence by 2.7 (OR 2.71; 95% CI 1.31–5.61; n = 164; low certainty). At 30 days, the trend is positive but not significant (OR 1.32; 95% CI 0.72–2.42) (p. 382, 386).
2. The educational and pharmacological stand out, while the digital lags behind. In sub-group, pharmacological interventions (nicotine substitutes, varenicline: OR 2.42; 1.17–5.02) and educational interventions (brochures: OR 1.55; 1.07–2.25) are significantly effective, while digital interventions (apps, SMS) show a non-significant trend (OR 1.95; 0.73–5.22) (p. 386).
3. The effect erodes over time but persists. The chances of quitting are highest at 1–3 months (OR 3.29; 1.16–9.35) and then decrease, while remaining statistically significant up to 10–12 months (OR 1.55; 1.07–2.25) (p. 386).
4. A still fragile evidence base. The 7 RCTs were published after 2021, conducted in the United States (6) and Italy (1), with very unequal sample sizes (30 to 2,896). 4 out of 7 trials are at low risk of bias, 3 raise concerns; only one (Caponnetto) verified abstinence through cotinine testing, the other six relying on self-reporting (p. 384, 387).
5. Critical blind spots for practice. No study measures the risk of relapse to smoked tobacco after quitting vaping — a major risk reduction issue; almost all participants are adults, while the epidemiological priority concerns young people; follow-up often stops at the end of treatment, when relapse is most likely (p. 388).

3. ACTION POINTS FOR LOCAL ACTORS

1. Prioritise educational and pharmacological support in vaping cessation aid protocols, these are the only two families of intervention with demonstrated significant effects (p. 386). Digital alone is not enough: offer it as a complement, not as a substitute.
2. Target the 1 to 3 month window, where the effect is strongest, to concentrate the intensity of support (close monitoring, follow-ups), then plan follow-ups to counter the observed erosion beyond (p. 386).
3. Check the actual availability of tools in your context : the evaluated digital interventions are only available in the United States, and substitutes/varenicline are used off-label for vaping in most countries (p. 388). Adapt the offer to the resources accessible locally and the national regulatory framework.
4. Systematically integrate the issue of smoking relapse in the follow-up of individuals who stop vaping: this is an unmet need in the literature, but central to avoid turning a vaping cessation into a return to smoked tobacco (p. 388).
5. Document youth pathways : the epidemiological priority (15–24 years) is underrepresented in trials. Any local action targeting an adolescent audience constitutes a useful field data point; prioritise reproducible and low-cost interventions (SMS, brief counselling) recommended by the authors for future studies (p. 388).

4. ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Health Practices" on the topic of addictions ➡️🔗https://pratiquesensante.odoo.com/4-5-les-addictions

1. Butler AR, Lindson N, Livingstone-Banks J, et al. "Interventions for quitting vaping". Cochrane Database of Systematic Reviews, 2025 (living review, update pub3, Nov. 2025). Cochrane review reference on exactly the same question, with a higher level of evidence and comprehensiveness — a direct and essential complement. Verified URL: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD016058.pub3/full
2. Dean E, Marshall H, et al. « TSANZ Guidance for the Management of Electronic Cigarette Use (Vaping) in Adolescents and Adults ». Respirology, 2025;30(7):605–622. Operational clinical recommendations from the Thoracic Society of Australia and New Zealand on the management and cessation of vaping, useful for translating evidence into practice. Verified URL: https://onlinelibrary.wiley.com/doi/10.1111/resp.70066
3. Evoy KE, Lodise N, et al. « Evidence Regarding E-Cigarettes as a Harm Reduction Strategy and Treatment for E-Cigarette Cessation: An Overview and Guide for Clinicians ». JACCP, 2025;8(9):895–905. A recent and concise clinical guide, designed for practitioners, covering both risk reduction and cessation. Verified URL: https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/jac5.70092

5. FREQUENTLY ASKED QUESTIONS (FAQ)

1. Is there an officially approved vaping cessation aid?
   No. No validated aid or recognised standard of care exists to date; some practitioners use smoking cessation strategies off-label, with uncertain effects (p. 382-383).
2. Which approaches work best?
   Pharmacological (OR 2.42) and educational (OR 1.55) interventions have a significant effect on 7-day abstinence; digital interventions alone do not reach significance (p. 386).
3. How long does the effect last?
   The effect is maximal at 1–3 months and then decreases, while remaining significant up to 10–12 months (OR 1.55) (p. 386).
4. What is the strength of evidence for this result?
   The certainty (GRADE) is moderate for 7-day abstinence, low for continuous abstinence, and very low for 30-day abstinence; 4 out of 7 trials are at low risk of bias (p. 386-387).
5. Do the results apply to adolescents?
   Caution: almost all participants are adults, which prevents an age analysis while young people are the most affected population. The authors call for recruiting younger audiences (p. 388).
6. What happens to tobacco when you stop vaping?
   Unknown: no included study measures relapse to smoked tobacco after quitting vaping, while this is a central issue in harm reduction (p. 388).
7. Are these interventions transferable everywhere?
   Not directly: the digital tools evaluated are only available in the United States, and nicotine substitutes/varenicline remain unapproved for vaping in most jurisdictions (p. 388).

6. REWRITING IN PLAIN LANGUAGE

What this document says

E-cigarettes are widely used. Many young people use them. They can lead to nicotine addiction.

Today, there is no recognised medication to stop vaping. There is no official method.

Researchers looked at 7 serious studies. These studies followed 5,763 people. They tested aids to stop vaping.

The main results

• These aids work a little. They help people stop for 7 days.

• Two types of aid work best:

  • medications (like nicotine patches);
  • written information (brochures).
• Apps and SMS alone work less well.
• The effect is stronger at first. Then it decreases over time. But it remains useful for up to a year.

What we do not yet know

• We do not know if people start smoking tobacco again afterwards.
• Almost all the studied individuals are adults. We lack data on young people.
• Some aids exist only in the United States.

What to remember for fieldwork

• First, offer the medications and brochures.
• Help the person a lot during the first 3 months.
• Check that the person does not start smoking again.

7. CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES

• Literacy : an included trial relies on information brochures, but the document does not analyse the adaptation of materials to different levels of understanding.
• Empowerment : not addressed; beneficiaries are not described as involved in the design of interventions.
• Participation : no co-construction mechanism with users is reported; these are classic clinical trials.
• Community health : absent; the approach is strictly individual (interventions targeting the individual, systemic interventions being excluded, p. 383).
• Ethics : methodological biases are rigorously assessed (RoB 2.0, GRADE), but cultural or social biases are not explicitly addressed.
• Human rights / equity : not developed; the under-representation of young people and the unequal availability of tools across countries are reported as limitations (p. 388).
• Intersectorality : not addressed; the document remains within a clinical and research framework.
• Partnership: no formalised model of collaboration between stakeholders; the text calls for research partnerships for future RCTs (p. 388).
• Combating discrimination: not mentioned; no reference to non-judgment or the diversity of audiences beyond the described demographic variables.

8. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance: high. Rigorous and transparent methodology (pre-registered protocol on PROSPERO, PRISMA 2020 compliance, double reading, RoB 2.0, GRADE), updated literature review as of January 2024 including grey literature, and status as the first meta-analysis on the subject. Reservations to note: limited number of trials (7), high heterogeneity, predominance of self-reporting, and an internal inconsistency regarding the level of certainty of abstinence at 7 days — the abstract and discussion indicate a certainty of "moderate", while the "Quality review" section (p. 387) speaks of a certainty of "low". To be noted in case of precise citation.

Operational relevance: moderate to good. The document clearly ranks intervention families and provides usable orders of magnitude to guide support. However, it does not offer a ready-to-use protocol, and the transposability to the Francophone context is limited (American digital tools, off-label use of medications). To be used as a basis of evidence, to be supplemented by national clinical guidelines and the Cochrane review (ref. 1).