18.11 Cessation interventions for e-cigarette users

Last updated: October 2021
Suggested citation:
Greenhalgh, EM. 18.11 Cessation interventions for e-cigarette users. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2023. Available from:  https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/18-11-cessation-interventions-for-e-cigarette-users


With the rapidly increasing use of e-cigarettes, particularly among young people, researchers are increasingly examining e-cigarette cessation behaviours. The addictive potential of nicotine e-cigarettes/vaping products—including popular products that can deliver the equivalent nicotine of a pack of cigarettes1 —has led to urgent calls for evidence-based strategies to help people who vape to quit.2,3 Prolonged exclusive use of e-cigarettes is becoming an increasingly common pattern of use;4 however, like smokers,5 most people who vape report wanting to quit. Research among established e-cigarette users in the US in 2016–2018 found that 15% had made a past-year quit attempt and 60% reported future plans to quit,6 while a 2019 survey of current e-cigarette users aged 15–36 found that more than half (54%) reported general intentions to quit vaping, 15% reported intention to quit within the next month, and one third (33%) reported having tried to quit in the past year.7 Among teenagers in the US who use e-cigarettes, in 2019 45% reported being seriously interested in quitting and 25% tried to quit in the past year.3 In 2020, among vapers aged 11–18, about two-thirds (67%) had tried to quit vaping and more than half (53%) reported intention to quit vaping.8

Some of the motivations for wanting to stop vaping are similar to those reported by smokers wanting to quit, including health, financial, social, and academic reasons,9-14 as well as disliking the taste of the products.13 Several surveys have also found that respondents cite concern about risks of COVID-19 as a reason to stop vaping.9,15 In the US, calls and texts to quitlines from e-cigarette users,16 as well as internet searches for how to quit,17 reportedly rose in the wake of the EVALI outbreak (a respiratory illness linked to vaping—see Section 18.6). Among young current e-cigarette users in the US, higher levels of harm perceptions, dependence, and more frequent use were associated with having tried to quit in the past year, while harm perceptions, dependence, and less frequent use were associated with general intentions to quit 7 Perceptions of harm were also associated with intentions to quit and quit attempts among teenagers in the US, and attempts were lower among girls, users of e-cigarettes with prefilled pods or cartridges (versus disposable e-cigarettes), and those with nicotine cravings.7 Among adult established e-cigarette users in the US, predictors of past year quit attempts included higher nicotine dependence, lower frequency use, and higher interest in quitting.18 Common methods of trying to quit include cutting down frequency of use or nicotine concentrations, going ‘cold turkey’, getting advice from a doctor, using nicotine replacement therapy (NRT),9 and among adolescents, limiting interactions with peer users.19

18.11.1 Interventions for adults

Despite the identified need for evidence-based interventions, and even though surveys consistently show that more than half of adults vapers want to quit,6, 18 to date there have been limited studies on the effectiveness of cessation aids for stopping vaping. A 2021 review identified no evidence-based guidelines regarding the use of pharmacological vaping cessation interventions.20 One case study reported that varenicline combined with behavioural counselling helped a man who had been vaping nicotine daily for four years to stop.21 Although some e-cigarette users report gradually reducing use or nicotine concentrations in an attempt to quit,9 the effectiveness and safety of this is unclear; as with tobacco cigarettes (see Section 3.36), vapers may be able to compensate by utilising more liquid,13 which may also increase their exposure to compounds/flavours with largely unknown toxicity.22 Combining a tapering approach with behavioural support may increase the effectiveness of this strategy.23 Workplace-based cessation programs may also be helpful for supporting employees to stop vaping,24 and vape-free policies in the home can help to facilitate e-cigarette cessation.25

18.11.2 Interventions for young people

Many young people who vape report wanting to stop.3,7,8 A particular challenge in the provision of e-cigarette cessation support is that while interventions are urgently needed for young people,2,3 smoking cessation interventions (which may have some utility for helping people to quit vaping) have largely been developed for adults; there is limited evidence that either behavioural support or pharmacotherapies increase smoking cessation among young people26 (see also Section 7.19.1). Research is needed to inform effective interventions for helping young people to quit vaping; very few cessation programs have been developed or evaluated, though some show potential.27 Further, recruiting adolescents for clinical trials of vaping cessation interventions can be difficult.28 One review notes the importance of considering the complexities of youth vaping (e.g., social influences, limited negative outcome expectancies, quit intentions), and potential co-use with cannabis.29 Knowledge of predictors of uptake and ongoing use among young people (see Section 18.9) may also help inform targeted interventions.30

Technology-based interventions show promise, with findings from a randomised clinical trial in the US showing that a tailored and interactive text message intervention promoted vaping cessation among young adults.31, 32 Social media campaigns have also been developed to encourage young people to quit vaping.33 One small study found encouraging evidence for the use of financial incentives to promote e-cigarette cessation among young people,34 and a case series reported that a combination of counselling and NRT increased e-cigarette cessation among youth and young adults.35 Training health professionals who have frequent contact with young people or parents in brief interventions may help to increase their knowledge, skills and the provision of cessation support for e-cigarette users.36-38 Resources have also been developed for parents wishing to have conversations with their teenagers about the risks of vaping.39

Broader policies and programs have been developed that aim to minimise e-cigarette use among young people and non-smokers, including restrictions on advertising and promotion, prohibiting use in smokefree areas, banning flavours that could appeal to youth, raising taxes, implementing health warnings, prohibiting sales to minors, public education campaigns, and school-based programs. An overview of these strategies is provided in Section 18.9.

18.11.3 Interventions for dual users of tobacco cigarettes and e-cigarettes

Although many smokers take up e-cigarettes as a means to quit tobacco cigarettes,40-42 evidence shows that many will continue to use both.43, 44 Targeted interventions have therefore begun to be developed for dual users, who may require more intensive support to achieve complete cessation of both products.25 One randomised trial found that a self-help intervention designed specifically for dual users45 improved smoking cessation, particularly during the 18 month intervention period and among dual users with higher tobacco dependence. However, there were no differences between intervention or control groups in vaping reduction or cessation.46 In the US, almost all of the vapers who contact the quitline are dual users, therefore quitline counsellors have an opportunity to provide cessation support for both tobacco and e-cigarettes. However, the authors note the challenges of providing evidence-based advice with the current uncertainty around e-cigarettes.47

For those who have successfully replaced tobacco cigarettes with e-cigarettes, cessation needs to be carefully managed to minimise the risk of relapse to smoking. Extended support from cessation services or NRT may be helpful for those making the transition to using neither product.13 In general, addressing the reasons why people start vaping will help to inform the most appropriate type of vaping cessation support, as e-cigarette users who have vaped to quit smoking may have different cessation needs to those who started vaping due to peer influences or curiosity.13  

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated March 2024)


1.  Prochaska JJ, Vogel EA, and Benowitz N. Nicotine delivery and cigarette equivalents from vaping a juulpod. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33762429

2. Adams ZW, Kwon E, Aalsma MC, Zapolski TCB, Dir A, et al. Treatment of adolescent e-cigarette use: Limitations of existing nicotine use disorder treatment and future directions for e-cigarette use cessation. J Am Acad Child Adolesc Psychiatry, 2021; 60(1):14–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33353661

3. Smith TT, Nahhas GJ, Carpenter MJ, Squeglia LM, Diaz VA, et al. Intention to quit vaping among United States adolescents. JAMA Pediatrics, 2021; 175(1):97–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32804194

4. Public Health England. Vaping in England: 2021 evidence update summary 2021. Available from: https://www.gov.uk/government/publications/vaping-in-england-evidence-update-february-2021/vaping-in-england-2021-evidence-update-summary.

5. U.S. Department of Health and Human Services. Smoking cessation. A report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, 2020. Available from: https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf.

6. Palmer AM, Smith TT, Nahhas GJ, Rojewski AM, Sanford BT, et al. Interest in quitting e-cigarettes among adult e-cigarette users with and without cigarette smoking history. JAMA Netw Open, 2021; 4(4):e214146. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33797554

7. Cuccia AF, Patel M, Amato MS, Stephens DK, Yoon SN, et al. Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults. Preventive Medicine Reports, 2021; 21:101287. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33489721

8. Dai H. Prevalence and factors associated with youth vaping cessation intention and quit attempts. Pediatrics, 2021; 148(3). Available from: https://www.ncbi.nlm.nih.gov/pubmed/34408090

9. Klemperer EM and Villanti AC. Why and how do dual users quit vaping? Survey findings from adults who use electronic and combustible cigarettes. Tobacco Induced Diseases, 2021; 19:12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33603595

10. Sanchez S, Kaufman P, Pelletier H, Baskerville B, Feng P, et al. Is vaping cessation like smoking cessation? A qualitative study exploring the responses of youth and young adults who vape e-cigarettes. Addictive Behaviors, 2021; 113:106687. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33045643

11. Garey L, Scott-Sheldon LAJ, Olofsson H, Nelson KM, and Japuntich SJ. Electronic cigarette cessation among adolescents and young adults. Substance Use and Misuse, 2021; 56(12):1900–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34348566

12. Amato MS, Bottcher MM, Cha S, Jacobs MA, Pearson JL, et al. "It's really addictive and i'm trapped:" A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addictive Behaviors, 2021; 112:106599. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32950927

13. Dyson J, Bhatnagar M, Skinner J, and Crooks M. Helping the quitters quit: A systematic review and narrative synthesis of the barriers and facilitators to e-cigarette cessation and the support that is needed. Patient Education and Counseling, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34579994

14. Unger JB, Rogers C, Barrington-Trimis J, Majmundar A, Sussman S, et al. "I'm using cigarettes to quit JUUL": An analysis of Twitter posts about JUUL cessation. Addictive Behaviors Reports, 2020; 12:100286. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32637562

15. Truth Initiative. Majority of young vapers worry about COVID-19 risk and want to quit. 2020. Available from: https://truthinitiative.org/research-resources/quitting-smoking-vaping/majority-young-vapers-worry-about-covid-19-risk-and-want

16. Almenrala A. As vaping illnesses rise, so do pleas to quit-smoking help lines. Salon,  2019. Available from: https://www.salon.com/2019/10/13/as-vaping-illnesses-rise-so-do-pleas-to-quit-smoking-help-lines_partner/

17. Kalkhoran S, Chang Y, and Rigotti NA. Online searches for quitting vaping during the 2019 outbreak of e-cigarette or vaping product use-associated lung injury. Journal of General Internal Medicine, 2021; 36(2):559–60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32052253

18. Rosen RL and Steinberg ML. Factors associated with past-year attempts to quit e-cigarettes among current users: Findings from the Population Assessment of Tobacco and Health wave 4 (2017-2018). Drug and Alcohol Dependence, 2021; 227:108973. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34482034

19. Kong G, Bold KW, Cavallo DA, Davis DR, Jackson A, et al. Informing the development of adolescent e-cigarette cessation interventions: A qualitative study. Addictive Behaviors, 2021; 114:106720. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33162230

20. Khangura SD and McGill SC. Pharmacological interventions for vaping cessation, in Pharmacological interventions for vaping cessation. Ottawa (ON):  2021.  Available from: https://www.ncbi.nlm.nih.gov/pubmed/34279870.

21. Barkat SS, Tellier SM, and Eloma AS. Varenicline for cessation from nicotine-containing electronic cigarettes. American Journal of Health System Pharmacy, 2019; 76(23):1894–5. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31586415

22. Larcombe A, Allard S, Pringle P, Mead-Hunter R, Anderson N, et al. Chemical analysis of fresh and aged Australian e-cigarette liquids. Medical Journal of Australia, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34528266

23. Sahr M, Kelsh SE, and Blower N. Pharmacist assisted vape taper and behavioral support for cessation of electronic nicotine delivery system use. Clin Case Rep, 2020; 8(1):100–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31998496

24. Graham AL, Amato MS, Jacobs MA, Romberg AR, Diaz MC, et al. Vaping in the workplace: Implications for employer-sponsored tobacco cessation programs. J Occup Environ Med, 2020; 62(12):986–92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32881778

25. Krishnan N, Abroms LC, and Berg CJ. Electronic nicotine product cessation and cigarette smoking: Analysis of waves 3 and 4 from the PATH study. Nicotine & Tobacco Research, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34313780

26. Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone-Banks J, et al. Tobacco cessation interventions for young people. Cochrane Database of Systematic Reviews, 2017; 11(11):CD003289. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29148565

27. Liu J, Gaiha SM, and Halpern-Felsher B. A breath of knowledge: Overview of current adolescent e-cigarette prevention and cessation programs. Curr Addict Rep, 2020:1–13. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33204602

28. Jenssen BP, Hannan C, Kelly MK, Ylioja T, Schnoll RA, et al. Inability to recruit adolescents for a vaping cessation clinical trial within a large pediatric health system. Nicotine & Tobacco Research, 2021; 23(9):1633–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33631005

29. Berg CJ, Krishnan N, Graham AL, and Abroms LC. A synthesis of the literature to inform vaping cessation interventions for young adults. Addictive Behaviors, 2021; 119:106898. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33894483

30. Choi J, Jung HT, Ferrell A, Woo S, and Haddad L. Machine learning-based nicotine addiction prediction models for youth e-cigarette and waterpipe (hookah) users. J Clin Med, 2021; 10(5). Available from: https://www.ncbi.nlm.nih.gov/pubmed/33801175

31. Graham AL, Amato MS, Cha S, Jacobs MA, Bottcher MM, et al. Effectiveness of a vaping cessation text message program among young adult e-cigarette users: A randomized clinical trial. JAMA Internal Medicine, 2021; 181(7):923–30. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33999133

32. Graham AL, Jacobs MA, and Amato MS. Engagement and 3-month outcomes from a digital e-cigarette cessation program in a cohort of 27 000 teens and young adults. Nicotine & Tobacco Research, 2020; 22(5):859–60. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31197320

33. No authors listed. New TikTok challenge kicks off national Truth® campaign underscoring young people’s desire to ditch JUUL and quit vaping. Truth Initiative,  2020. Available from: https://truthinitiative.org/press/press-release/new-tiktok-challenge-kicks-national-truthr-campaign-underscoring-young-peoples?utm_source=Truth+Initiative+Mailing+List&utm_campaign=80cfc39931-Newsletter_181_2020_01_09&utm_medium=email&utm_term=0_c91fd8a5c5-80cfc39931-86471991

34. Raiff BR, Newman ST, Upton CR, and Burrows CA. The feasibility, acceptability, and initial efficacy of a remotely delivered, financial-incentive intervention to initiate vaping abstinence in young adults. Experimental and Clinical Psychopharmacology, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34251841

35. Sikka G, Oluyinka M, Schreiber R, and Galiatsatos P. Electronic cigarette cessation in youth and young adults: A case series. Tob Use Insights, 2021; 14:1179173X211026676. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34211303

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37. Mungia R, Case K, Valerio MA, Mendoza M, Taverna M, et al. Development of an e-cigarettes education and cessation program: A south Texas oral health network study. Health Promotion Practice, 2021; 22(1):18–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32281882

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39. American Heart Association. Talk vaping with your teen resources help parents have conversations about ending teen e-cigarette use.  2020. Available from: https://newsroom.heart.org/news/talk-vaping-with-your-teen-resources-help-parents-have-conversations-about-ending-teen-e-cigarette-use

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