18B.13 Cessation interventions for e-cigarette users

Last updated: October 2021
Suggested citation:
Greenhalgh, EM. 18B.13 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; 2021. Available from:  https://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes/18b13-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 18B.5.5). 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

18B.13.1 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 18.3), 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

18B.13.2 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 7.19.12). 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 18B.12) 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 18B.12.8.

18B.13.3 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 June 2022)

References

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