Keywords
Vaping; Recreational nicotine use; Interventions; Treatment preferences; Best practice; Vaping treatment; Barriers and facilitators; Recreational treatment.
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Coyne R, Zhang M, Valentelyte G et al. International best practice in the management and cessation of vaping and recreational nicotine use, and barriers, facilitators and treatment preferences: A rapid review protocol [version 1; peer review: awaiting peer review]. HRB Open Res 2025, 8:130 (https://doi.org/10.12688/hrbopenres.14293.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Study Protocol
International best practice in the management and cessation of vaping and recreational nicotine use, and barriers, facilitators and treatment preferences: A rapid review protocol
[version 1; peer review: awaiting peer review]
PUBLISHED 12 Dec 2025
OPEN PEER REVIEW
REVIEWER STATUS
Abstract
Corresponding author:
Rory Coyne
Competing interests:
No competing interests were disclosed.
Grant information:
This work is supported by the Health Services Executive Tobacco Free Ireland Programme, under collaborative agreement TFIRCA-2024.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:
© 2025 Coyne R et al.
This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Coyne R, Zhang M, Valentelyte G et al. International best practice in the management and cessation of vaping and recreational nicotine use, and barriers, facilitators and treatment preferences: A rapid review protocol [version 1; peer review: awaiting peer review]. HRB Open Res 2025, 8:130 (https://doi.org/10.12688/hrbopenres.14293.1)
First published: 12 Dec 2025, 8:130 (https://doi.org/10.12688/hrbopenres.14293.1)
Latest published: 12 Dec 2025, 8:130 (https://doi.org/10.12688/hrbopenres.14293.1)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Introduction
The use of vapes, also commonly referred to as ‘e-cigarettes’, has risen considerably in recent years. A recent examination of changes between 2015 and 2023 in Ireland found that vaping and dual-use (i.e., smoking and vaping) had more than doubled, with the largest increase seen among 15–24-year-olds (Brennan et al., 2025). A recent estimate from the 2024 Irish Health Survey indicates that 13.6% young adults in Ireland aged 18 to 34 are using vapes daily, whereas a further 10% vape occasionally (Central Statistics Office, 2025). A wide variety of reasons for vaping have been reported in the literature. They include switching from cigarettes or other tobacco products, long-term nicotine dependence, or flavour/taste-related influences (Ledgerwood et al., 2024). Among adolescents, factors such as attractive packaging, peer influence, or socialising with friends may be more influential (Pbert et al., 2024; Weinstein et al., 2024). The precise health consequences of vaping, beyond forming a nicotine dependency (or perpetuating it, when used as a cigarette substitution) are currently unclear. However, exposure to hazardous chemicals contained in vapes can introduce considerable respiratory and cardiovascular problems, and vaping has been associated with several (Bieganek et al., 2024). Developing approaches to help individuals quit vaping is therefore important not only in terms of becoming nicotine-free, but also in terms of limiting exposure to the litany of harmful substances that are also contained within vapes.
A distinction can be made in terms of pathways to vaping, between those who are using vaping as a smoking cessation tool, and others (largely children and young people) who have never smoked (Notley et al., 2021). These differential pathways are also reflected in the approaches to vaping taken internationally, with countries such as the United Kingdom offering vapes as a smoking cessation aid – in stark contrast from India, where vaping is illegal (Kokabisaghi et al., 2023). The market is constantly shifting; in 2017, refillable tank devices were the most popular form of vapes, prior to being overtaken by disposable vapes in 2023 (Hammond et al., 2025). The rise in vaping has also coincided with the influx of a litany of alternative recreational nicotine products onto the market. Most notably, nicotine pouches (which involve the placement of a sachet between the gum and lip for potent nicotine delivery) are increasingly commonplace. Recent data indicated that among a large sample of 15–18-year-olds in Ireland, 8.9% had used nicotine pouches, whilst 13.1% had used moist snuff (Hanafin et al., 2025).
There is ample evidence that many vape users want to quit. A study by Jongenelis et al. (2024) found that 61% of young Australian vape users expressed desire to quit, with 55% have made at least one quit attempt (Jongenelis et al., 2024). Another qualitative study (Pbert et al., 2024) found that nearly all of their participants had experienced multiple failed quit attempts, with quit strategies including seeking social support and using distraction techniques. Ultimately, however, vape users will face difficulties quitting in the absence of dedicated services and supports. A review by Tan et al. (2025) identified barriers and facilitators experienced by health professionals in providing vaping cessation support, with lack of knowledge and training identified as key barriers. Some early work has also been conducted to identify barriers and facilitators to quitting vaping among service users. Barriers can include normalisation or the ease of access to vapes (Rahman et al., 2024a), whereas facilitators may include factors such as health concerns about vapes (Sanchez et al., 2021). However, to date, there is no comprehensive investigation of barriers and facilitators internationally.
Interventions for quitting vaping can take many forms: they include behavioural interventions (such as those which draw on cognitive-behavioural or motivational interviewing techniques), pharmacological interventions (such as Nicotine Replacement Therapy (NRT; Buela et al., 2025)) and interventions that seek to change the characteristics of vapes, such as reducing nicotine content (Sahr et al., 2019). The types of interventions which have emerged as having the strongest supportive evidence for vaping cessation include text message based-interventions and varenicline (a medication which binds to nicotine receptors in the brain to reduce cravings; Butler et al., 2025). However, the majority of vaping cessation interventions have to date shown limited evidence of effectiveness, with many simply adapting smoking cessation approaches to vaping (Kundu et al., 2023). A review by Huerne & Eisenberg (2023) stressed the need for intervention protocols which are specific to vaping cessation. Moreover, there is currently a lack of evidence-based clinical guidelines for vaping cessation (Rahman et al., 2024b), and no approved vaping cessation aids currently exist (Heshmati et al., 2025). This risks a splintered approach to vaping cessation interventions being taken internationally, which could at least partially explain the weak evidence for their effectiveness.
While there is a substantial evidence base to assist the design and delivery of effective stop smoking services, health systems are struggling to determine how best to respond to the needs of people who vape and want advice and support to stop smoking. As the types of nicotine products, and as patterns of product use (i.e., vaping versus dual-use) become more varied, there will be an increasing need for nicotine cessation services to adopt a nuanced and complex approach – one that is sensitive to the factors which serve as barriers or facilitators to their successful implementation. Additionally, identifying best practice in public health interventions (i.e., one that shows evidence of effectiveness in a particular setting, and is likely to be replicable in other settings; Ng & De Colombani, 2015) is crucially important in developing standardised recommendations and avoiding resource waste. This review therefore seeks to pull together findings from interventions which have targeted a range of nicotine product types, in order to establish a rich, nuanced set of recommendations to inform practice. Furthermore, synthesising the international evidence for the extent to which these interventions align with best practice will identify tangible ways in which the impact of interventions can be maximised.
Review questions
This rapid review seeks to evaluate the extent to which interventions for the management and cessation of vaping and alternative recreational nicotine products align with best practice, and to identify the factors which influence their implementation. These findings will allow the identification of areas of opportunity as well as areas of difficulty that have been reported in previous interventions. As this is an area of research which is continuously emerging, particularly as new products continue to enter the market (e.g., nicotine lozenges, tablets, gummies, and gum), this work aims to provide timely recommendations using a streamlined approach to evidence synthesis, for which rapid reviews are particularly useful (Moons et al., 2021).
The central research question of this rapid review therefore is ‘What can be considered best practice in the management and cessation of vaping and recreational nicotine use, and what barriers, facilitators and treatment preferences have been reported to these practices?’
This central question will be addressed through synthesising the results of included studies according to the following sub-questions:
RQ1: Which approaches to the management and cessation of vaping and/or recreational nicotine product use can be considered best practice?
RQ2: What are the perceived or actual barriers and facilitators to the implementation of interventions for vaping cessation and/or recreational nicotine product use?
RQ3: What treatment preferences have been reported by those who vape and/or use recreational nicotine products (excluding forms of combustible tobacco such as cigarettes)?
Methods
This protocol is reported in adherence with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P) guidelines (Shamseer et al., 2015). This is recommended as the preferred method of reporting rapid review protocols, in advance of dedicated guidelines for this type of review being made available (Stevens et al., 2018; Stevens et al., 2025). The protocol for the review has also been registered on PROSPERO (ID: CRD420251141677). A PRIMSA-P checklist for this protocol has also been uploaded to the Open Science Framework: https://doi.org/10.17605/OSF.IO/5X9R6 (Coyne et al., 2025).
Patient and public involvement
This research is part of a HSE Tobacco Free Ireland funded project, titled ‘Vaping/alternate non-medicinal nicotine products and Dual-use along with regular Tobacco use: Integrated Interventions and Economic Modelling in Ireland’ (VAPE-INTERVENE). Public and patient representatives were not specifically involved in the design of this review protocol, but informed the overall conceptualisation of the project and application for funding. A Public Health Advisor for HSE Tobacco Free Ireland (PK) is also included as a co-author, providing a natural pathway for addressing relevant policy aspects and ensuring adaption of the findings into national and local policy.
Eligibility criteria
Population: We will seek to include studies which recruited human participants who identify as being either a ‘single’ user (i.e., user of either vapes or alternative recreational nicotine products) or ‘dual user’ (i.e., user of both vapes and alternative recreational nicotine products). Participants who use traditional cigarettes in tandem with vapes and/or alternative recreational nicotine products will still be included, but participants who use traditional cigarettes only will be excluded. As the focus of this review is on nicotine vaping and other forms of recreational nicotine use, we will exclude studies which focus solely on cannabis/tetrahydrocannabinol (THC) vaping or other illicit substances. No restrictions regarding gender, the presence of comorbid medical conditions, or frequency of vaping/alternative recreational nicotine product use (e.g., frequent user versus ever used) will be applied. We will also seek to include participants from a broad range of settings, such as healthcare, community-based, and other contexts. As such, there will be no restrictions regarding the study site. Studies will not be eligible for inclusion if they recruited animal subjects or did not recruit participants who either vape or are a user of alternative recreational nicotine products.
Intervention(s) or exposure(s): Eligible studies will focus on an intervention of any type which targets vaping and/or alternative recreational nicotine product use. As noted previously, these may include (but are not limited to) behavioural interventions, pharmacological interventions, or interventions which seek to change the characteristics of the product(s) used.
Comparator(s) or control(s): Study selection will not be guided by the use of comparators. Therefore, the sample may include studies which have involved the use of a comparator/control group, as well as those which did not employ a comparison group, so long as the intervention targets vaping or alternative recreational nicotine product use.
Outcome(s): The intervention must target vaping and/or alternative recreational nicotine product use as a target behaviour. Interventions which do not target either vaping or alternative recreational nicotine product use (e.g., those that target tobacco smoking only) will be excluded. Where available, we will also collect information regarding barriers and facilitators (both in terms of author-reported barriers and facilitators to implementation, and user-experienced barriers and facilitators to engagement with or adoption of the intervention), similar to previous research (Gargaritano et al., 2020; Pilch et al., 2021; Sharpe et al., 2018). Data concerning treatment preferences (i.e., qualitative data on experiences, perspectives or attitudes to the intervention, or quantitative measures of acceptability, perceived utility, or perceived efficacy) will also be examined where available.
Study: We will include peer-reviewed journal articles and grey literature on primary research published between 2003 and the date of the search in the English language. Studies not published in English and studies published before 2003 will be excluded (this cut-off roughly coincides with the introduction of commercially available e-cigarettes – as such, eligible articles are unlikely to be published before this date). Review papers (systematic reviews, scoping reviews, etc.) will be excluded. Studies that used either quantitative or qualitative methods will be included.
Information sources and search strategy
A systematic search of three electronic databases of peer-reviewed journal articles (MEDLINE, PsycInfo and Scopus) as well as an electronic database of grey literature (PsycEXTRA) will be searched for records published between January 1st, 2003 and the date of the search (estimated to be November 2025). The search strategies that will be used for each database are included in Appendix A. The search strategy was developed in consultation with previous reviews of vaping cessation (e.g., Belon et al., 2025; Butler et al., 2025; East et al., 2025), as well as a library information specialist. A combination of subject headings (where available in the respective database) and free terms will be used. In the first block, search terms related to vaping and alternative recreational nicotine products will be entered (e.g., vaping, electronic cigarette, heat-not-burn, etc.) and combined using the OR Boolean operator. The NOT operator will also be applied in this block, to exclude articles that are indexed under ‘tobacco smoking’ using the relevant subject heading. It was decided not to exclude articles that mention tobacco smoking in the title and/or abstract, as this may inadvertently exclude articles potentially relevant to the review. The second block will include terms related to the type or aim of the intervention (e.g., cessation, stop, discontinue, etc.). The third and final block will consist of terms related to attitudes, experiences or perceptions of vaping cessation interventions. These three blocks will be combined using the AND Boolean operator, and the results of this combined search will be filtered according to English-language articles published between 2003 and the date of search.
Screening and study selection
The results of the database search will be exported to the Zotero reference management software for de-duplication, before being imported into Covidence for screening. The de-duplicated sample of extracted articles will be screened by one reviewer (RC) in two phases: Stage 1 screening will involve assessing the title and abstract of included studies in accordance with the above eligibility criteria. Articles that are deemed potentially eligible for inclusion at Stage 1 will then undergo screening at Stage 2, which will involve the full-text articles being assessed for eligibility. Articles excluded at both Stage 1 and Stage 2 will be reported in a PRISMA flow diagram, with reasons for exclusion, along with the number of articles deemed eligible at both stages. A second reviewer (MZ) will double screen a random sample of 20% of articles at Stage 1 and Stage 2 to ensure consistency. Disagreements will be resolved in consultation with a third reviewer (GV) where necessary.
Data extraction and management
Once the final sample of included studies has been determined, data will be extracted by one reviewer (RC) and entered into a data extraction form in Microsoft Excel. The types of data extraction from included studies will be: study characteristics (authors, year published, journal published); study setting (country, the setting in which the study was conducted), participant characteristics (demographic information, types of products used (i.e., vapes and/or alternative recreational nicotine products), type of usage (i.e., daily versus weekly use), intervention characteristics (intervention content, frequency, modality and duration of the intervention), information on barriers and facilitators (author or user-reported), and treatment preferences (quantitative measures of acceptability, perceived efficacy, etc., and/or qualitative data on experiences, attitudes, etc.). We will also collect information on intervention effectiveness (e.g., reduction in product use, cessation rates), and attitudes towards financial incentives where available.
Finally, to assess the extent to which the included interventions align with best practice, a checklist developed by Ng and De Colombani (2015) will be used. This framework provides guidance on assessing whether a public health intervention aligns with best practice according to eight criteria – relevance, community participation, stakeholder collaboration, ethical soundness, replicability, effectiveness, efficiency, and sustainability. The framework provides guidance on the precise manner in which each criterion should be implemented in order to align with best practice. The included articles will therefore be evaluated in accordance with this framework based on the full-text article, with the outcome extracted into the data extraction form.
Data analysis and synthesis
The extracted data will be synthesised in accordance with the three sub-questions designed to address the overarching aim of this rapid review. A narrative synthesis will be conducted using the extracted data, in which information will be organised into themes, patterns or discrepancies that are relevant to the review questions. The findings regarding the extent to which interventions align with best practice will be presented in table format, to facilitate common areas of strength as well as areas of opportunity to be identified.
Conclusion
As the nicotine product marketplace becomes increasingly complex, an equally complex and nuanced approach to developing cessation and management services will be required. This rapid review seeks to synthesise the available evidence for the extent to which existing interventions align with best practice. Key information concerning barriers, facilitators, and user-reported treatment preferences will also be examined. The findings of the review will inform the development of vaping and alternative recreational nicotine product cessation services in Ireland and internationally. The findings of the review will also assist in the identification of areas of strengths as well as areas of opportunity for vaping and alternative recreational nicotine product cessation services, and identify patient-related factors which are particularly influential on the success of these vitally important services.
Ethics and dissemination
Ethical approval is not required for rapid reviews. The findings of the rapid review will inform the co-design of services for the management and cessation of vaping and alternative recreational nicotine product use in Ireland. The authors will also ensure that the findings are disseminated amongst key knowledge users by engaging with a variety of channels.
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Coyne R, Zhang M, Valentelyte G et al. International best practice in the management and cessation of vaping and recreational nicotine use, and barriers, facilitators and treatment preferences: A rapid review protocol [version 1; peer review: awaiting peer review]. HRB Open Res 2025, 8:130 (https://doi.org/10.12688/hrbopenres.14293.1)
NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.
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