Background

Tobacco use presents a global public health challenge. In response to this, and in line with World Health Organization (WHO) measures to reduce tobacco use globally, many countries have established stop smoking services, the evidence base for which is well-established¹. The use of vapes, also commonly referred to as ‘e-cigarettes’, has recently seen a sharp increase in uptake which both threatens to undo decades of progress made by tobacco cessation initiatives, and introduce the highly addictive chemical nicotine to individuals who would previously not have interacted with it. In addition, the number of alternative nicotine products available on the market has also grown in recent years. These forms of nicotine consumption do not rely on combustion for nicotine delivery, and include products such as heated tobacco (or ‘heat-not-burn’), oral nicotine pouches, and smokeless tobacco (such as snus). Young adults, amongst whom vape use has increased nine-fold from 2021 to 2023, are particularly vulnerable, both to developing a nicotine dependence and progressing to smoking^2,3. This presents a dilemma for services that have traditionally delivered smoking cessation supports, and need to respond to this growing challenge.

Across many countries, there is currently a lack of dedicated cessation services to support users of vapes and non-combustible nicotine products who want to quit. Evidence suggests that the concurrent use of vapes alongside non-combustible forms of nicotine is currently low, but is steadily rising⁴. Individuals have a variety of motivations for using these products, including as a smoking cessation aid. At the same time, those who are motivated to quit, and thus become nicotine-free, may struggle to do so without readily available, dedicated cessation services. In its recommendations for treatment approaches to tobacco cessation, the WHO found moderate-to-low certainty for the use of behavioral support and pharmacological approaches designed to help users of non-combustible nicotine products quit¹. The use of products such as snus, snuff and dip, predate the proliferation of vaping; however, both types of products deliver nicotine without the combustion of tobacco, thus diverging distinctly from traditional smoking in similar ways. Furthermore, the use of vapes in tandem with non-combustible nicotine products is rising slowly over time in regions such as England⁴. Qualitative evidence also suggests that individuals are using products such as nicotine pouches (which deliver synthetic nicotine orally through a small sachet placed in the mouth) as a substitution for other products⁵. It could therefore be of significant value to consider both types of products in tandem by adopting a broader nicotine dependence perspective, rather than considering vaping in isolation.

The rise of novel nicotine products requires standardized, best-practice guidelines to aid clinicians in supporting those who want to quit. Ng and De Colombani⁶ developed a framework for identifying best practices in public health interventions. The framework provides eight clear criteria for evaluating alignment with best practice among public health interventions – relevance, community participation, stakeholder collaboration, ethical soundness (defined by the authors as ensuring equitable distribution of resources, considering vulnerable groups, and demonstrating respect for local norms), replicability, effectiveness, efficiency, and sustainability. The framework provides examples for how each criterion may be evidenced in various ways – for instance, an intervention may demonstrate relevance by evaluating disease burden in the community, or involving target groups and stakeholders in a needs assessment. The use of a framework to identify best practice is consistent with international public health policy approaches. The Organization for Economic Cooperation and Development (OECD) Guidebook on Best Practices in Public Health recommends that best practice be identified based on multiple criteria⁷. The framework by Ng and De Colombani⁶ was cited as an example. Therefore, it provides a structured multi-criteria assessment framework which is consistent with international public health best practice evaluation approaches.

Many vape users face significant barriers to engaging with cessation programs, such as fear of relapsing to smoking, particularly when the precise health consequences of nicotine delivered in these novel forms are still largely unclear. While what is currently known primarily relates to motivational influences, barriers to implementation also exist, and this has been underexplored to date. The extent to which an intervention is implemented successfully has a sizeable influence on engagement. Sustained engagement with interventions is also associated with the success of smoking cessation interventions⁸. Relatedly, supporting engagement by tailoring interventions to users’ preferences could also maximize the effectiveness of vaping and non-combustible nicotine product cessation programs. Engagement is a multifaceted construct, and requires taking a broader view by examining user-reported preferred modes of delivery, intervention duration, and intervention content, to understand of how best to support nicotine cessation.

Aims of this study

This rapid review aimed to assess the extent to which interventions for vaping and non-combustible nicotine product cessation align with best practice. In doing so, it sought to make a distinct contribution to the literature over previous reviews which have simply evaluated the effectiveness of these interventions. The second aim of this review was to synthesize the barriers and facilitators that are affecting the implementation of these interventions. The third aim was to synthesize the user-reported treatment preferences for intervention features, which can have a sizeable bearing on sustained engagement and adherence. This review focused on interventions targeting both vaping and non-combustible nicotine products. This is both of practical value and is in step with an increasingly poly-nicotine landscape, whereby users frequently switch or combine products.

Therefore, this rapid review sought to address the following research questions: 1) ‘Which approaches to the management and cessation of vaping and/or non-combustible nicotine product use can be considered best practice?’; 2) ‘What are the barriers and facilitators to the implementation of interventions for vaping cessation and/or non-combustible nicotine product use?’; and 3) ‘What treatment preferences have been reported by those who vape and/or use non-combustible nicotine products?’.

Selection criteria

An overview of the eligibility criteria is provided in Table 1. As identified in a Cochrane review by Butler et al.⁹, interventions can include behavioral or pharmacological approaches, as well as changes in the characteristics of products used – or a combination of approaches. We included individuals who were motivated to quit vaping and/or non-combustible nicotine products, operationalized as volunteering to participate in a cessation intervention or attending a cessation service. Studies which recruited participants who were using these products exclusively as a smoking cessation aid or on the advice of a healthcare practitioner at the time of the study were excluded. Participants who used traditional cigarettes in tandem with vapes and/or non-combustible nicotine products were still included, but participants who used traditional cigarettes only were excluded. ‘Intervention’ refers to individual and/or group-level support for the cessation of vaping and/or non-combustible nicotine products, provided to those who are motivated to quit. Studies that used either quantitative, qualitative, or mixed methods were included. Grey literature (conference proceedings, preprints, etc.) were also considered for inclusion.

Search strategy

We searched three electronic databases of peer-reviewed journal articles (MEDLINE, PsycINFO and Scopus) and one electronic database of grey literature (PsycEXTRA) for records on 18 November 2025. The search strategies for each database (which can be found in Supplementary file Appendix A) comprised three concept blocks. The first block of terms related to products, such as ‘vapes’, ‘electronic nicotine delivery system’, and ‘oral nicotine’. The second block related to intervention types, using terms such as ‘cessation’, ‘quitline’, and ‘trial’. The third and final block centered around barriers, facilitators or treatment preferences, and used a broad set of terms including ‘acceptance’, ‘feasibility’, and ‘engagement’. Terms within each concept block were combined using the OR Boolean operator, and the three concept blocks were then combined with the AND operator. Each database was then queried using their respective date (1 January 2003 until 18 November 2025) and language (English only) filters. The full search strategy for each database can be found in Supplementary file Appendix A.

Screening and data extraction

Once the search had been completed, the results were exported from the respective databases to Zenodo, at which point the references were imported into Covidence. Covidence’s automatic de-duplication method was used, the outcome of which was checked by one reviewer (RC) for accuracy. Screening was then conducted within Covidence in two stages: 1) title and abstract screening, and 2) full-text screening of articles which were deemed eligible at stage 1. All screening was conducted by one independent reviewer (RC), with an additional 10% screened by two independent reviewers (LvdS, RT) meaning that 20% of articles were double screened, in line with best practice guidelines for screening¹⁰. Disagreements were handled through a majority vote among the three reviewers.

We extracted the following information from the final sample of included studies: 1) Study characteristics (authors, year, journal, country, setting, and eligibility criteria); 2) Demographic information (sample size, age, gender); 3) Types of product(s) used; 4) Frequency of product usage (i.e. daily, weekly, past 30 days, etc); 5) Intervention characteristics (intervention content, frequency of intervention, modality of intervention, duration of intervention; 6) Barriers; 7) Facilitators; 8) Treatment preferences (defined in this review as quantitatively or qualitatively explored user responses to included interventions); and 9) Data on intervention effectiveness (cessation rates, changes in product use frequency, etc). Data extraction was conducted by three independent reviewers (RC, LvdS, RT). A data extraction table was used to compile the extracted data, and adapted for publication into a table showing the characteristics of included studies (Supplementary file Appendix B).

Data synthesis and analysis

To evaluate the extent to which interventions aligned with best practice, a framework devised by Ng and De Colombani⁶ was used. Included interventions were assessed according to the eight criteria provided by this framework in a binary, yes/no manner. Examples from the article were provided in a scoring sheet to justify where an intervention was deemed to have fulfilled a given criterion. All assessments were conducted by two independent reviewers (RC, LvdS). To meet the remaining objectives of the review (synthesizing the evidence for barriers, facilitators, and treatment preferences), a narrative synthesis, in which the results are presented textually to generate a common set of themes across studies, was conducted.

Barriers and facilitators were predominantly identified and extracted from included studies in the form of author-reported factors which helped or hindered intervention implementation, and were mainly found in the strengths and limitations portion of the article. Barriers were therefore defined as any factor related to the study’s methodology which was deemed to have hindered or impeded successful implementation of the intervention. Facilitators, on the other hand, were defined as any factor related to the study’s methodology which was deemed to have supported or enabled successful implementation. Treatment preferences were presented as either quantitative measures of acceptability or perceived efficacy of the intervention, or qualitative data on experiences or attitudes towards the intervention. Barriers and facilitators are presented in tandem to facilitate a richer narrative synthesis, as a common set of factors were identified across included studies.

Study characteristics

A full summary of study characteristics can be found in Supplementary file Appendix B. Some general characteristics of the included studies are provided below.

Which approaches can be considered best practice, according to a framework for public health interventions?

An overview of the findings concerning the extent to which included interventions were in alignment with best practice, evaluated by screening studies using the framework developed by Ng and De Colombani⁶, is presented in Table 2. Overall, the main areas in which included interventions demonstrated the greatest alignment with best practice were: relevance (16/23), replicability (14/23), and effectiveness (12/23). The areas in which alignment with best practice was poorest were: ethically sound (4/23), stakeholder collaboration, and sustainability (both 3/23). Where each of the eight criteria were demonstrated across the reviewed studies, this was evidenced in the following ways (accompanied by the percentage of included studies which evidenced the relevant criterion).

What are the perceived or actual barriers and facilitators to implementation?

Five main factors that acted as barriers or facilitators to the successful implementation of included interventions were identified. They were as follows: methodological factors, participant engagement, intervention accessibility, psychosocial factors, and scalability and sustainability. An overview is provided in Table 3.

Methodological factors

The use of objective abstinence measures (i.e. biochemical verification) was a consistent factor that authors of the included studies considered when evaluating the accuracy of their findings. Caponnetto et al.¹² cited salivary cotinine-derived measures as a means of objectively verifying abstinence from vaping in their study. Where biochemical validation was not used, this was speculated to have resulted in potential recall bias due to over-reporting of abstinence rates by relying on self-report¹⁷. Moreover, the need for vaping-specific biochemical verification was raised²⁵. This lack of objective validation served to limit the internal validity of included studies, and overall confidence in the cessation outcomes. Another methodological constraint concerned limits to the external validity of findings. This was primarily due to study samples not being representative of various groups: dual-users¹⁵; those less motivated to quit²⁰; users of other nicotine products¹⁶ and adolescents¹². These limits to generalizability could impinge the extent to which findings can be translated to real-world contexts or broader populations.

Engagement

Participant engagement, when discussed as a barrier, mainly presented itself in terms of lower than expected levels of interaction with the intervention¹⁵, or challenges measuring engagement of users who passively accessed, rather than actively used, digital interventions³². Noonan et al.²³ also stated that 51.9% of their participants reported the intervention timeframe in their study as being too short. Long waiting times can also result in a drop-off in engagement, as discussed by Rasool et al.²⁷. By contrast, interventions that offered a degree of flexibility and autonomy were received favorably, particularly in youth-focused programs. For instance, choice and empowerment were fostered by encouraging participants to set or reset a quit date¹⁸.

Accessibility

A few studies highlighted issues that were encountered in terms of poorly optimized intervention design and accessibility. These issues were mainly apparent when messages delivered during text-based programs were reported as being too long or repetitive, and thus less accessible¹⁹. Interventions that were designed to initiate abrupt abstinence were also found to have resulted in higher withdrawal symptoms and relapse rates³⁰. In terms of high-accessibility interventions, which was the most consistently reported facilitator, this was especially prominent in studies that used text-based, app-based, or social media-based programs^{15,19,23,25,32}. These programs also circumvented a need for clinic visits, which had the advantage of being able to reach members of rural or underserved communities²³.

Psychosocial factors

A number of psychosocial barriers were mentioned in included studies. Caponnetto et al.¹² found that anxiety was associated with reduced odds of successful continuous abstinence, in addition to living with other vape users. By contrast, placing emphasis on positive social interactions was a strong facilitator, when social support was leveraged. For instance, the high levels of engagement observed in Do et al.³² were primarily attributed to the availability of social support in their online program. The use of counsellors who were matched in age with participants was also highlighted as a strength¹⁵. Other methods of developing trust and rapport, such as through the use of online communities³² were also highlighted as a means of promoting high intervention uptake.

Scalability and sustainability

Finally, Palmer et al.²⁵ observed a number of barriers related to the scalability and sustainability of their financial incentive-based intervention. This was mainly discussed in terms of the intervention requiring substantial staff time and infrastructure, as well as the cost of the incentives themselves. Feasibility constraints therefore stood out as a major concern affecting uptake and engagement with cessation interventions.

What treatment preferences have been reported by those who vape and/or use non-combustible nicotine products?

Treatment preferences were addressed (directly or indirectly) in 20 of the 23 included studies. Overall, the available evidence pointed towards participants showing a preference for: digital and remote intervention delivery; low-burden intervention content; the availability of human coaching and support; approaches that empowered participants; and interactive over static intervention content. Text-based programs such as ‘This Is Quitting’ (TIQ) showed high satisfaction and recommendation rates³³. Remote delivery also assisted in expanding the reach of recruitment – 43% of the Palmer et al.²⁵ sample were recruited from outside the local area of their study. App-based interventions also showed continued engagement during and after the set quit date by participants³¹. Therefore, participants generally preferred cessation supports that were private, accessible, and did not require clinic attendance. Interventions that were easy to use and imposed minimal cognitive demand were also well-received. This was most evident among those which provided fast response times and on-demand cessation tips and strategies²³. In the study of Orfin et al.²⁴, 88.9% of participants reported being satisfied or extremely satisfied with the intervention, which prioritized low-effort engagement requirements. Additionally, 83.3% of their participants rated the intervention as providing ‘just the right amount’ of messages. Thus, interventions which could be integrated more seamlessly into the daily lives of participants appeared to be received favorably.

Participants also showed a preference for interventions that provided person-to-person support. The availability of quit coaches was rated as the most helpful component of their app-based intervention³¹. The presence of supportive staff was also reported as the most popular component of the intervention of Raiff et al.²⁶, as well as the availability of regular video calls. Benefits of confidence-building approaches were also observed – in the work of Palmer et al.²⁵, 88% of participants reported improved confidence in quitting vaping, and 80% reported feeling greater control of their vaping behaviors. The intervention of Krishnan et al.²², which explicitly focused on building self-efficacy, had higher program satisfaction rates than standard e-cigarette cessation informational supports (55.6% vs 17.7%, a statistically significant difference). Graham et al.³³ also concentrated on growing ‘behavioral capability’ to quit vaping. Those assigned to the intervention reported higher program satisfaction than participants in the control group who only received text messages, and reported feeling significantly more confident in quitting. These empowerment approaches appeared to be particularly salient among youth and young adult samples^25,33. Lastly, the use of visual, interactive content was preferred over more text-heavy approaches. In the study of Siddiqi et al.³⁰, participants reported that the image-based cards used in the study were both more engaging and more motivating than other components. The authors suggested that as a consequence of using visual and interactive materials, participants had a greater understanding of the harms of non-combustible nicotine, and had greater intentions of quitting.

Finally, the literature on non-combustible nicotine cessation has provided several tangible opportunities which could be applied to enhancing the effectiveness of vaping cessation interventions. These recommendations are outlined in Supplementary file Appendix C.

Strengths and limitations

The key strengths of this review are that it has provided specific guidance on how to improve future interventions through integration of barriers and facilitators, it has evaluated the real-world implementation of these interventions rather than concentrating solely on efficacy, and it has integrated findings that concern diverse nicotine product types. These strengths also serve as novel contributions over other reviews in this area^9,35.

The review also has a number of limitations which should be considered. Firstly, while recommendations for vaping cessation approaches have been drawn from the non-combustible nicotine studies included in the review, including these studies introduced a level of heterogeneity to the findings that made evidence synthesis challenging, particularly given the range of approaches already apparent within studies targeting the same type of product. However, it was decided that inclusion of both types of studies would more accurately reflect real-world, poly-nicotine consumption, which is characterized by repeated substitution of one product for another⁴. There are also a number of limitations inherent to conducting a rapid rather than systematic review, including greater vulnerability to bias through omitting quality appraisal, and a narrower scope reducing comprehensiveness. Finally, no interventions for the cessation of synthetic nicotine products (e.g. pouches) were identified, thus limiting the timeliness of the findings of this review. This absence is likely a consequence of the rapid pace of product development, with newer products such as nicotine pouches developing far more rapidly than the development of corresponding interventions. This raises the need for greater agility in intervention development and evaluation. It also raises the question of whether the effective components of cessation interventions are transferable across nicotine products, or whether product-specific characteristics (e.g. mode of nicotine delivery) require tailored approaches. Addressing this will be of critical importance to ensuring interventions remain relevant in a rapidly changing marketplace.