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. 2024 Oct 24;42(1):604–614. doi: 10.1111/phn.13464

Public Health Interventions Targeting the Prevention of Adolescent Vaping: A Scoping Review

Jamie DiCasmirro 1,2,✉, Joan Tranmer 1, Colleen Davison 3,4, Kevin Woo 1, Danielle Toon 1, Michael Hubeny 2, Amanda Ross‐White 5,6, Catherine Goldie 1,5
PMCID: PMC11700949  PMID: 39449246

ABSTRACT

Objective

Despite a brief decline during the COVID‐19 pandemic, vaping behaviors among adolescents continue to be an international public health concern because of associated health risks and harms. A thorough investigation of existing interventions preventing adolescent vaping is needed to help address this public health crisis and reduce serious and avoidable vaping‐related health risks. We reviewed the literature to identify public health interventions aimed at preventing adolescent vaping and summarized their key components and outcome measures.

Design

We conducted a scoping review of the literature using the Joanna Briggs Institute methodology searching in MEDLINE, CINAHL, Embase, PubMed, PsycINFO, ProQuest, and Web of Science. Two reviewers screened 589 records for relevance. Studies from any location, reported in English, and described vaping prevention interventions targeting adolescents were included. Records were excluded if they were reported in other languages, published outside the review timeframe, lacked an evaluation, focused on cessation‐based interventions, or were review articles. Data extracted included intervention type, key components, and outcome measures.

Results

Thirty‐eight included articles were identified and categorized into three intervention categories: school‐based, public education/risk communication campaigns, and public policies/government regulations. Key components of the interventions included format, duration, and topics. Formats varied from single to multi‐sessions. Prominent topics covered included risks and harms associated with vaping, and the most frequently reported outcome measures used were knowledge, attitudes, and beliefs.

Conclusion

Our findings summarize existing public health interventions found in the literature and insights into approaches used to address the global adolescent vaping crisis.

Keywords: Adolescents, e‐cigarettes, public health interventions, tobacco, vaping, youth

1. Background

Vaping behaviors among adolescents continue to be a public health concern, with e‐cigarettes (also known as vaping devices) becoming one of the most commonly used nicotine products among this population (Birdsey et al. 2023). Data from the International Tobacco Control Youth Tobacco and Vaping Survey, an ongoing study across Canada, the United States, and England, indicate that vaping behaviors remain prevalent among young people despite a brief decline during the COVID‐19 pandemic. Results from the 2022 study cycle indicate 27% of Canadian, 26% of American, and 38% of English youth between the ages of 16 and 19 reported past year vaping (Hammond et al. 2023).

There is a growing body of literature describing the potential harms and risks associated with vaping. Most e‐cigarette products contain and emit numerous potentially toxic substances. For example, e‐cigarette aerosol contains metals such as lead, nickel, and chromium, which can cause disruption in the cells, lining the blood vessels and other chemicals such as formaldehyde and acrolein, which have the potential to cause damage to DNA and genetic mutations (National Academies of Sciences, Engineering, and Medicine 2018). Long‐term exposure to chemicals from e‐cigarette aerosols could increase the risk for certain cancers or lead to adverse reproductive outcomes (National Academies of Sciences, Engineering, and Medicine 2018). E‐cigarette use also negatively affects the respiratory system and can cause coughing, wheezing, and exacerbations of asthma among adolescents’ users (Chadi, Hadland, and Harris 2019; National Academies of Sciences, Engineering, and Medicine 2018; Tzortzi et al. 2020). Furthermore, adolescent vapers were found to have five times greater odds of acquiring COVID‐19 compared to their non‐vaping counterparts (OR = 5.0; 95% CI 1.8‐14.0) (Gaiha, Cheng, and Halpern‐Felsher 2020).

Moreover, e‐cigarette use has been found to be a risk factor for subsequent combustible cigarette smoking among youth (National Academies of Sciences, Engineering, and Medicine 2018) and can act as a gateway to future nicotine dependence through the sustained delivery of high concentrations of nicotine and normalization of consumptions behaviors (Bracken‐Clarke et al. 2021). A recent study reported that non‐smokers who have previously tried vaping are three times more likely to initiate smoking combustible cigarettes compared to those who have never vaped (Bracken‐Clarke et al. 2021). Data from a longitudinal study found nearly half of the Canadian adolescents who vaped reported smoked conventional cigarettes 2 years later, compared to their non‐vaping counterparts (Aleyan et al. 2018).

There is an urgent need to prevent vaping among adolescents, and public health interventions are required to combat the current vaping epidemic and to protect the next generation (Lyzwinski et al. 2022; Onrust et al. 2016). Previous tobacco control research indicates that nicotine dependence usually begins during adolescence, and those who use nicotine at an early age have greater difficulty quitting later in life (U.S. Department of Health and Human Services 2012). A recent study investigated the onset of symptoms and milestones of e‐cigarette dependence among young Canadian vapers and found most milestones for vaping dependence emerged approximately two years after vaping initiation. Furthermore, non‐smoking vapers were found to attain the same dependence milestones such as cravings and waking at night to vape faster compared to dual users (vapers who report concurrently smoking combustible cigarettes) (Pienkoski et al. 2024). These findings suggest non‐smokers may be at a higher risk of becoming dependent on e‐cigarettes sooner because they attained nicotine dependence milestones faster than those who were smokers. For these reasons, preventing vaping (and escalation to regular use) remains a key public health priority.

The current literature highlights several interventions aimed at preventing youth vaping. For example, Liu, Gaiha, and Halpern‐Felsher (2020) conducted a web‐based search using Google in 2020 to review the available e‐cigarette prevention and cessation programs. Sixteen programs were identified and organized into three categories: prevention (n = 8), cessation (n = 7), and dual prevention and cessation (n = 1). They found that the key components addressed in the programs were flavored products, industry‐targeted marketing. Most programs were found online, few included stand‐alone e‐cigarette curricula, and not all used a theoretical framework. A limitation of this study was the methodological approach, as the authors only used Google to identify existing programs. Furthermore, this review only included programs published up until 2020. The Ontario Tobacco Research Unit also provided a valuable report in 2019 describing a variety of interventions for preventing harm associated with vaping (O'Connor 2019). The strengths of this review were the 10 categories of interventions identified in the academic and gray literature. Most interventions were school‐based or public education. However, limitations to this report included the methodology approach, as few details were provided, and the timeframe, as the review was conducted in 2019, and the literature has evolved significantly since then. A more recent review was conducted to examine the efficacy of school‐based e‐cigarette prevention interventions (Gardner et al. 2024). The strengths of this study were its comprehensive search strategy and rigorous methodology; however, only school‐based interventions were included in this review. Last, Mylocopos et al. (2024) conducted a systematic review to evaluate and summarize the effectiveness of interventions aimed at preventing e‐cigarette use among children and youth. They identified 39 studies and extracted data on study characteristics, sample characteristics, intervention components, and outcomes related to e‐cigarette prevention, all of which provide valuable insights for the development and implementation of effective prevention strategies. The strengths of their study were their rigorous methodological approach and the inclusion of various study designs such as randomized controlled trials and non‐randomized studies. A limitation of this study was the inclusion criteria, as only studies with individuals who did not vape were included, whereas studies that included individuals who vaped at least one time in the past 30 days were excluded. As youth often will experiment with vaping before adopting it as a regular habit, preventing occasional experimentation from evolving into frequent use is also important for preventing the risk of early addiction (Liu, Gaiha, and Halpern‐Felsher 2020). Therefore, missing from the literature is a comprehensive summary of existing public health interventions aimed at preventing adolescent vaping. This scoping review examined the emerging literature to identify public health interventions aimed at preventing adolescent vaping, described their key components, and summarized outcome measures to inform practice efforts, research, and policies aimed at mitigating vaping‐related harms among adolescents.

1.1. Review Questions

This review aimed to address the following global research question: What public health interventions targeting the prevention of adolescent vaping have been described in the literature?  Sub‐questions were also posed: (1) What are the key components of the public health interventions? (2) What outcome measures have been reported with vaping prevention interventions?

2. Methods

This scoping review was conducted using the Joanna Briggs Institutes methodology for scoping reviews (Peters et al. 2020) and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Review (PRISMA‐ScR) guidelines (Tricco et al. 2018). For full details on methods, please refer to our published study protocol (DiCasmirro et al. 2023).

2.1. Search Strategy

The literature search strategy was developed in consultation with a library scientist (A.R.W.) and was designed to locate both published studies and gray literature identified from database inception (1946) up to October 2022. Seven databases were searched, including MEDLINE (Ovid), CINAHL (EBSCO), Embase (Ovid), PubMed, PsycINFO (Ovid), ProQuest (Health and Medicine and Sociology Collections), and Web of Science Core Collection. The full electronic search strategy for MEDLINE (Ovid) is provided in Appendix A. All articles that included a public health intervention targeting adolescent participants between the ages of 10 to 18 years old were screened for inclusion in this review. Public health interventions are actions intended to promote health and prevent illness among populations (Rychetnik et al. 2002). For this review, public health interventions were defined as any efforts made to prevent the initiation of vaping and/or prevent the escalation to more frequent use or additional behaviors (Liu, Gaiha, and Halpern‐Felsher 2020; Villanti et al. 2019). Literature from all countries was included if published in English. Studies were excluded for the following reasons: (1) they did not include outcome measures evaluated; (2) they described individual cessation interventions delivered to established tobacco users; (3) they were literature reviews of other works; or (4) they were letters, commentaries, or opinion‐based articles. No restrictions were placed on country, publication status, or outcomes measured.

2.2. Source of Evidence Selection

A three‐step search strategy was used, comprising an initial search, screening of reference lists, and a search for gray literature. Figure 1 displays the article identification and selection process that was followed by the first author (JD) and sixth author (MH). All citations were compiled and imported into Endnote v.20 (Clarivate Analytics, PA, USA), and duplicates were removed. Title and abstracts were independently screened by two reviewers (JD and MH) to assess their eligibility against the inclusion criteria. Any conflicts were resolved by a third reviewer (CG). Potentially relevant sources were retrieved, and citations were imported into Covidence (Veritas Health Innovation, Melbourne, Australia), a web‐based software.

FIGURE 1.

FIGURE 1

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PRISMA flow diagram. [Colour figure can be viewed at wileyonlinelibrary.com]

2.3. Data Extraction

Two reviewers (JD and DT) extracted data from the articles by using a modified template for scoping reviews (Tricco et al. 2018). The extracted data encompassed the following dimensions: article characteristics (e.g., title, author, journal, year, country, aim, study design), intervention type/program name (or concise intervention description if not named), main intervention components (dose, program elements), intervention providers (e.g., research team, health educator, public health professional), and evaluation components (e.g., sample size, primary outcome measures, and key findings).

An iterative process was employed, which included a pilot phase (i.e., data from 10 studies were extracted and assessed for congruency between reviewers) (Levac, Colquhoun, and O'Brien 2010). Once congruency was established, two independent reviewers conducted a detailed assessment of the full text of included citations. Discrepancies were resolved through discussion, and if necessary, a third reviewer (CG) resolved any disagreements between the reviewers.

2.4. Data Analysis and Presentation

Two reviewers (JD and CG) examined the findings for relevance. The extracted data are presented in a descriptive format with tables to summarize the findings. The presentation of data aligns with the objective of this scoping review, which was to identify the scope of public health interventions that exist in the literature targeting the prevention of adolescent vaping. A methodological appraisal is not usually necessary in scoping review methodology, and because this study aimed to provide an overview of the literature in this field, quality appraisal of included sources was not included in this review (Munn et al. 2020; Peters et al. 2021). To complement tabular data, a narrative summary describes how the results relate to the review objective and questions.

3. Results

The search retrieved 722 records. An additional 217 records were identified through supplemental search strategies (websites, citation list searching, and content experts). After duplicates were removed, 589 titles and abstracts were screened, and 152 records were reviewed in full. Thirty‐eight articles were included in the final review, 32 from databases and 6 from other methods. Figure 1 shows the PRISMA diagram and outlines the selection process.

3.1. Study Characteristics

Table 1 available in Appendix B summarizes the characteristics of the studies included in the review. Included studies were published between January 2015 and October 2022 and involved various study designs: randomized controlled trial (n = 4); controlled clinical trial (n = 8); cohort analytic (n = 2); cohort (n = 8); interrupted time series (n = 6), qualitative (n = 2), and other study designs such as cross‐sectional (n = 8). Most studies were conducted in the United States (n = 33). However, this review includes studies from five other countries: Canada, the Netherlands, Switzerland, Taiwan, and South Korea.

3.2. Participant Demographics

There were variations in samples and sample sizes among the studies, with reported sample sizes ranging from as low as 8 to 62,276 participants. Most articles reported that adolescent participants were enrolled in middle and high school (12–18 years old).

3.3. Intervention Types

Across all studies, three main categories of interventions emerged: (1) school‐based (n = 19); (2) public education and risk communication campaign (n = 12); and (3) public policy and government regulations (n = 7). Table 2 available in Appendix C describes the types of interventions, key components, reported outcome measures, and key findings.

3.4. School‐Based Interventions

School‐based interventions emerged as a category identified in 19 studies (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Chu et al. 2021; Fitzwater et al. 2020; Gaiha et al. 2021; Guo et al. 2021; Hieftje et al. 2021; Kelder et al. 2020; Ly 2015; McMenamin et al. 2018; Meienberg et al. 2021; Moreno 2021; Morrill et al. 2017; Pentz et al. 2019; Rozema et al. 2018; Weser et al. 2021a; Weser et al. 2021b; Williams et al. 2022). We defined school‐based interventions as in‐person or virtual educational activities delivered or facilitated within the context of the school setting, either within or outside regular school hours. The format of school‐based interventions varied greatly ranging from a single didactic session to interactive multi‐sessions. The components of these interventions varied across the studies and included a combination of classroom‐based educational lessons and/or sessions, guest presentations, interactive workshops, multimedia videos, video games, virtual reality activities, or school ground policies.

The interventions in this category primarily addressed various topics, specifically (1) educating participants about the ingredients found in vaping products, (2) creating awareness of the risk and harms associated with vaping and/or tobacco use, (3) informing participants about existing vaping/tobacco policies and regulations, (4) highlighting tobacco industry marketing techniques, and (5) building personal refusal skills.

The delivery method of interventions varied across studies, with some delivered virtually and others conducted in person by various providers, including school staff (teachers and guidance counselors), healthcare providers (physicians and nurses), public health professionals, community professionals (police resource and tobacco enforcement officers), and research staff. Some school‐based interventions were facilitated by student peer leaders or in conjunction with them.

A range of outcome measures were reported in the school‐based intervention studies. The most frequently reported outcome measures were (1) knowledge (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Fitzwater 2020; Gaiha et al. 2021; Guo et al. 2021; Hieftje et al. 2021; Kelder et al. 2020; Meienberg et al. 2021; Morrill et al. 2017; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b), (2) attitudes and beliefs (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Fitzwater 2020; Hieftje et al. 2021; Kelder et al. 2020; Ly 2015; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b), (3) behavioral intentions to use e‐cigarettes (Asdigian et al. 2022; Brown, Bandiera, and Harrell 2019; Gaiha et al. 2021; Guo et al. 2021; Ly 2015; Meienberg et al. 2021; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b), (4) current use (Asdigian et al. 2022; Baker et al. 2022; Chu et al. 2021; Gaiha et al. 2021; Kelder et al. 2020; Ly 2015; McMenamin et al. 2018; Meienberg et al. 2021; Morrill et al. 2017; Moreno 2021; Rozema et al. 2018; Weser et al. 2021a; Weser et al. 2021b; Williams et al. 2022), (5) perceived harms (Asdigian et al. 2022; Gaiha et al. 2021; McMenamin et al. 2018; Morrill et al. 2017; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b), (6) susceptibility (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Kelder et al. 2020; Ly 2015; Weser et al. 2021a), and (7) refusal self‐efficacy (Asdigian et al. 2022; Ly 2015; Weser et al. 2021a; Weser et al. 2021b).

Among the 19 studies in this intervention category, 15 measured vaping knowledge (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Fitzwater 2020; Gaiha et al. 2021; Guo et al. 2021; Hieftje et al. 2021; Kelder et al. 2020; Ly 2015; Meienberg et al. 2021; Moreno 2021; Morrill et al. 2017; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b) and all studies reported findings that school‐based programs increased vaping knowledge compared to non‐program groups or exhibited post‐intervention improvements. For example, a quasi‐experimental study involving grade 6 students at 12 middle schools was conducted to evaluate the effectiveness of a school‐based intervention called “Catch My Breath.” “Catch My Breath” is a vaping prevention program designed to prevent the initiation of vaping by providing students with the skills to resist peer pressure and media influences. The program consists of four, 35‐minute sessions (Kelder et al. 2020). Six schools participated in the intervention, while the other six received the usual tobacco programming. Students at the intervention schools showed significantly greater improvements in e‐cigarette knowledge from baseline and to 16‐month follow‐up compared to the students in the control group (β = 0.71; 95% CI, 0.21‐1.21; P = 0.01) (Kelder et al. 2020).

Eight studies in this category measured attitudes and beliefs (Asdigian et al. 2022; Baker et al. 2022; Brown, Bandiera, and Harrell 2019; Fitzwater 2020; Hieftje et al. 2021; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b). Overall, findings suggest that positive attitudes toward vaping decreased when compared to the control group or between pre‐ and post‐surveys (Asdigian et al. 2022; Brown, Bandiera, and Harrell 2019; Fitzwater 2020; Pentz et al. 2019; Weser et al. 2021b). However, three studies found no change in attitudes toward vaping between intervention and control groups or between pre‐ and post‐surveys (Baker et al. 2022; Hieftje et al. 2021; Weser et al. 2021a).

Seven studies in the school‐based category measured behavioral intentions to use e‐cigarettes (Brown, Bandiera, and Harrell 2019; Gaiha et al. 2021; Guo et al. 2021; Meienberg et al. 2021; Pentz et al. 2019; Weser et al. 2021a; Williams et al. 2022). Among these studies, the reported findings suggest positive outcomes, indicating lower intentions to use tobacco in the program group compared to the control group or post‐intervention evaluation (Brown, Bandiera, and Harrell 2019; Gaiha et al. 2021; Guo et al. 2021; Meienberg et al. 2021; Weser et al. 2021a). However, two studies reported their programs had no impact on intentions to try e‐cigarettes (Pentz et al. 2019; Williams et al. 2022).

Five studies measured current tobacco/e‐cigarette use (Kelder et al. 2020; McMenamin et al. 2018; Rozema et al. 2018; Weser et al. 2021b; Williams et al. 2022). Among these studies, the reported findings suggest positive outcomes as lower rates of tobacco use were reported for participants in the program group when compared to the control group (Kelder et al. 2020; McMenamin et al. 2018). However, higher rates of vaping or no change in vaping behaviors in schools with programming compared to control schools were reported in three studies (Rozema et al. 2018; Weser et al. 2021b; Williams et al. 2022).

Six studies measured the perceived harmfulness of e‐cigarettes (Asdigian et al. 2022; Gaiha et al. 2021; Morrill et al. 2017; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b), and the reported findings suggest the programs increased participants' perceptions that vaping was harmful (Gaiha et al. 2021; Pentz et al. 2019; Weser et al. 2021a; Weser et al. 2021b).

Susceptibility to vaping was investigated in two studies (Baker et al. 2022; Brown, Bandiera, and Harrell 2019) but reported findings were conflicting as a reduction in the odds of tobacco susceptibility for the intervention group compared to the control group was reported (Brown, Bandiera, and Harrell 2019) and an increase or no change in susceptibility to vaping was also reported (Baker et al. 2022).

Finally, four studies in this category measured vaping refusal self‐efficacy in resisting peer pressure to vape (Asdigian et al. 2022; Ly 2015; Weser et al. 2021a; Weser et al. 2021b). An increase in self‐efficacy to refuse e‐cigarettes in the program group compared to the control group was reported in one study (Ly 2015). However, findings reported from the other three studies found no change, although high levels of self‐efficacy were already reported prior to intervention (Asdigian et al. 2022; Weser et al. 2021a; Weser et al. 2021b).

3.5. Public Education and Risk Communication Campaigns

Public education and risk communication campaigns represent another category of interventions identified in the review, comprising 12 studies (Andrews et al. 2019; Boynton et al. 2022; England et al. 2021; Kowitt et al. 2023; Lazard 2021; MacMonegle et al. 2022; Noar et al. 2019; Noar et al. 2020; Noar et al. 2022; Roditis et al. 2020; Stevens et al. 2021; Walker et al. 2022). These interventions aim to raise awareness and educate the public about the health risks of vaping while promoting healthy behaviors. They are often disseminated through communication channels such as social media, mass media, and print advertisements.

The components of these interventions primarily consist of prevention advertisements in the form of social media posts (Instagram), online video advertisements, television advertisements, text messages, and print advertisements. These interventions conveyed similar messaging, providing information on the chemical composition of vaping products and vapor, the associated risks and harms of vaping, and the marketing and deception tactics of the tobacco industry. Most of these interventions were disseminated by the research or program teams leading the studies, utilizing technologies such as text messages or social media platforms.

Outcome measures reported in the 12 studies within this intervention category included: (1) perceived message effectiveness (PME) (Boynton et al. 2022; Lazard 2021; Noar et al. 2019, 2020; Roditis et al. 2020), (2) susceptibility (Andrews et al. 2019; Kowitt et al. 2023), (3) knowledge (England, et al. 2021; Lazard 2021; Noar et al. 2019), (4) attitudes and beliefs/ perceived harms/risks (Noar et al. 2020; Noar et al. 2022), and (5) behavioral intentions to try vaping (Noar et al. 2020, 2022; Stevens et al. (2021).

Among the 12 studies, five measured the PME of the campaign messages (Boynton et al. 2022; Lazard 2021; Noar et al. 2019, 2022; Roditis et al. 2020). PME is used to assess the likely impact of persuasive messages on the target audience and is used as a tool for message selection (Noar et al. 2018). Overall, the reported findings of the studies show promising results suggesting the effectiveness of advertisements containing warnings about addiction, chemicals (Noar et al. 2019), negative health symptoms such as fatal lung disease/damage (Boynton et al. 2022; Lazard 2021; Roditis et al. 2020), uncontrolled moods (Lazard. 2021), and harm to the adolescent brain (Noar et al. 2019). For example, Lazard (2021) investigated the impact of social media e‐cigarette messages among a sample (n = 928) of 15‐to‐18‐year‐olds. Participants were exposed to six mock social media posts with vaping warning content, and PME was significant (p ≤ 0.001) for all mock posts.

Text‐only warnings for addiction and graphic health warnings and text warnings for fatal lung disease were effective in reducing susceptibility compared to a control group (Andrews et al. 2019). However, vaping advertisements did not affect susceptibility compared to those who viewed the control advertisement were reported in another study (Kowitt et al. 2023).

Three studies measured changes in vaping knowledge, and reported findings show positive improvements in the intervention group compared to the control group or between pre‐ and post‐test assessments (England et al. 2021; Lazard 2021; Noar et al. 2019). Furthermore, advertisements led to higher beliefs about the harms of vaping and more negative attitudes toward vaping compared to participants who viewed the control advertisements (Noar et al. 2020; Noar et al. 2022).

Individuals who viewed vaping advertisements had more negative attitudes toward vaping but did not experience a change in their perceived likelihood of experiencing harm from vaping compared to those who viewed the control advertisement (Kowitt et al. 2023). However, Noar et al. (2019) reported that the perceived risks of e‐cigarettes were significantly higher at the post‐test assessments compared to the pretest assessments. Lastly, Walker et al. (2022) reported that exposure to campaign advertisements resulted in higher levels of agreement regarding harm perceptions and addiction perceptions compared to those not exposed to campaign advertisements.

Participants who viewed vaping advertisements had lower intentions to vape compared to those who watched a control video (Noar et al. 2020). Additionally, another study reported participants in a campaign group reported fewer days of vaping per week at visit four compared to the control group (Noar et al. 2022; Stevens et al. (2021) reported findings that exposure to campaign advertisements was associated with lower odds of dual/poly use of e‐cigarettes and other tobacco products but was not associated with the odds of being exclusive e‐cigarette use.

3.6. Public Policies and Government Regulations

Public policies and government regulations are the third category of interventions identified in this review, comprising seven studies (Katz et al. 2020; Hawkins, Ghiani, and Baum 2019; Hwang et al. 2020; Macinko and Silver 2018; Nicksic, Do, and Barnes 2020; Nikitin, Timberlake, and Williams 2016; Roeseler et al. 2019). These interventions aimed to reduce the availability, accessibility, and acceptability of vaping products among target populations. Examples of public policy and regulation interventions include laws or changes in laws that raise the legal age for purchasing vaping products to 21 years or older. Other examples include requirements for warning labels on vaping products to inform users about the associated risks and harms, and packaging regulations to ensure the safety of unauthorized users.

Public policies and government regulation interventions primarily involve the implementation of vaping/tobacco control policies or changes in policies within defined geographical areas, including local, state, or national levels. The included studies covered various policy and regulation areas including (1) minimum legal purchase age, (2) minimum pricing/taxation, (3) product safety measures (such as child‐resistant packaging), and (4) product‐warning labels.

The implementation locations of the interventions varied among the included studies. Most were implemented at either the state level (n = 3) (Nicksic, Do, and Barnes 2020; Macinko and Silver 2018; Hawkins, Ghiani, and Baum 2019) or national government level (n = 3) (Hwang et al. 2020; Nikitin, Timberlake, and Williams 2016; Roeseler et al. 2019). One exception was an experimental study conducted to evaluate the impact of product‐warning labels on perceptions and behavioral intentions among a group of adolescents aged 14–18 (n = 657) (Katz et al. 2020).

The outcomes measured within this category of interventions also varied. For example, four studies examined the impact of minimum legal sales age, including outcome measures such as past 30‐day tobacco use, and policy implementation indicators (i.e., reported age of initiation, reports of purchasing tobacco from stores, identification requested, quit attempts), and the scope of the policy (Hawkins, Ghiani, and Baum 2019; Macinko and Silver 2018; Nicksic, Do, and Barnes 2020; Roeseler et al. 2019). The impact of minimum pricing or taxation was studied (Hawkins, Ghiani, and Baum 2019), as well as product safety measures and compliance (Nikitin, Timberlake, and Williams 2016). Three studies evaluated the impact of product‐warning labels, with outcome measures including exposure to warning labels, perceived effectiveness of warning labels, risk perceptions, harm minimizing beliefs, novelty perceptions, message comprehension, perceived ambiguity, and tobacco behaviors and intentions (Hwang et al. 2020; Katz et al. 2020; Nikitin, Timberlake, and Williams 2016).

Among the seven intervention studies included in the public policy and government regulation category, more than half (n = 4) reported findings suggesting that the policies and regulations were ineffective in preventing e‐cigarette use (Hawkins, Ghiani, and Baum 2019; Hwang et al. 2020; Macinko and Silver 2018; Nicksic, Do, and Barnes 2020). For instance, a large study (n = 36,840) conducted by Nicksic, Do, and Barnes (2020) examined the impact of state‐level restrictions on e‐cigarette sales to minors and found youth living in states with no e‐cigarette minimum legal sales age laws were more likely to be never users of tobacco (ARRR  =  1.24; 95% CI 1.01–1.51).

Two studies evaluated the impact of product‐warning labels, and both reported that labels were effective at increasing risk perceptions and lowering intentions to use e‐cigarettes (Hwang et al. 2020; Katz et al. 2020). Two studies evaluated the effectiveness of safety measures such as age verification for purchases (Nikitin, Timberlake, and Williams 2016; Roeseler et al. 2019) and child‐resistant packaging (Nikitin, Timberlake, and Williams 2016); however, neither of these studies reported 100% compliance with the measures (Nikitin, Timberlake, and Williams 2016; Roeseler et al. 2019).

4. Discussion

This scoping review offers an overview of public health interventions used to prevent adolescent vaping. Our objective was to identify categories of interventions implemented and describe the key components and outcome measures reported in the interventions.

Consistent with findings from the broader tobacco literature, schools continue to play a critical role in vaping prevention efforts and provide an opportune setting for disseminating health information to young learners (Singh et al. 2020; Thomas et al. 2013). Children and adolescents spend a substantial portion of their daily time at school (Harris, Duncan, and Boisjoly 2002). Incorporating public health vaping interventions into the curriculum and broader school initiatives provides access to the majority of adolescents in a safe environment that nurtures learning and critical inquiry. Utilizing schools as a platform to enhance knowledge regarding the harms and risks associated with vaping to develop resiliency skills is appropriate, and also an avenue particularly useful in reaching diverse populations (Short and Cole 2021).

Next, the utilization of online digital platforms and social media for vaping prevention interventions has become commonplace, and these platforms are well‐suited for reaching adolescents, who have grown up in a digital world (Moreno et al. 2022). Our findings emphasize the importance of public health organizations continuing to leverage digital platforms and investing in targeted media campaigns to effectively reach this population. American adolescents spend roughly eight and a half hours a day engaged in personal digital media for entertainment watching online videos, using social media platforms such as Snapchat, TikTok, and Instagram, and browsing websites (Rideout et al. 2022). Therefore, digital communication platforms are essential tools for public health professionals to raise awareness and disseminate education.

As demonstrated in the tobacco control literature, public policies and government regulations have the potential to discourage harmful behaviors and promote healthier choices, thus impacting public health. While certain vaping policies have shown positive outcomes, such as the impact of product‐warning labels, the overall effectiveness of policies and regulations in preventing e‐cigarette use remains uncertain. This likely stems from the speed at which vaping devices emerged in the consumer market, underscoring the need for the government to proactively establish effective regulations, keeping pace with tobacco companies. The varying compliance rates with safety measures also highlight the challenges associated with implementation and enforcement (Jongenelis 2023). However, we have witnessed the effect of regulatory measures in reducing conventional cigarette use among adolescents, and these lessons could be applied to vaping products as well (Singh et al. 2020). Furthermore, evaluating the impact of comprehensive policy approaches and considering the dynamic nature of the vaping landscape are difficult but crucial for developing evidence‐based and effective tobacco control strategies.

This review identified a variety of outcome measures used to evaluate the included interventions, many of which focused on individual‐level measures, such as changes in knowledge, attitudes, beliefs, and behavioral norms. Given the emerging nature of this field, assessing individual‐level outcomes is appropriate and feasible at this time. However, according to the Social Ecological Model (SEM) as described by McLeroy et al. (1988), to fully assess the impact of interventions, a broad range of outcome measures need to be considered. The SEM illustrates how health behaviors and public health outcomes are influenced by five levels of factors (intrapersonal, interpersonal, organizational, community, and public policy) and recognizes the interconnectedness within and across all levels (McLeroy et al. 1988). Therefore, in the future, we will need to look beyond individual‐level outcomes and evaluate the effectiveness of vaping interventions at all levels. Figure 2 in Appendix D is a visual display of the reported outcome measures identified and organized into four levels of the SEM model.

More research should focus on the combined effects of interventions across categories, as previous research has shown the effectiveness of multicomponent interventions on tobacco initiation and use (Baker et al. 2022; U.S. Department of Health and Human Services 2012; Kelder et al. 2020). While our review focused on individual interventions and categories, it is likely that the most effective prevention strategies involve a combination of school‐based interventions, public education campaigns, and policy measures. Future studies should explore the synergistic effects of multiple interventions and evaluate their impact on adolescent vaping.

Despite the breadth of interventions identified in this scoping review, several important gaps in the literature should be acknowledged. First, it is important to note limitations related to the methodology, specifically the variation in study designs used to evaluate the included interventions as well as the use of non‐standardized tools to evaluate outcome measures such as knowledge, attitudes, and beliefs. This highlights the need for more high‐quality and rigorous evaluations to understand the efficacy and effectiveness of interventions. Second, the majority of included studies focused on short‐term outcomes, such as changes in knowledge or intentions to vape immediately after engaging in the intervention, rather than long‐term vaping behaviors. Investigating long‐term intervention follow‐up remains a common challenge in public health as implementation research often only uses follow‐up measures that are disseminated within a year or less of an intervention (Farrington 2006; Hailemariam et al. 2019). Not surprisingly, only a few studies in this review included follow‐up assessments that were collected more than three months post‐intervention. Therefore, future research is required to evaluate the long‐term effectiveness of interventions on actual vaping rates among adolescents. Furthermore, longitudinal studies with adequate follow‐up periods are needed to understand the durability and cost‐effectiveness.

It is also essential to consider timing as we emerge from the global COVID‐19 pandemic. Over the past 2 years, several public health resources were redirected away from tobacco prevention to address the urgent needs of the pandemic. However, we are now at a critical juncture where it is time to return to pre‐pandemic priorities and refocus on tobacco prevention as adolescent vaping behaviors continue to remain high. In an era of limited resources, it has become of utmost importance to identify the most effective strategies for addressing the vaping epidemic.

A final notable gap identified in this review is the limited inclusion of geographically and culturally diverse populations. Many studies primarily included participants from high‐income countries and may not reflect the experiences and needs of adolescents from low‐ and middle‐income countries or marginalized communities. Future research should aim to include a more diverse range of populations to understand the effectiveness of interventions for diverse populations and ensure interventions can be culturally sensitive and tailored to the specific needs of different populations.

Our scoping review has certain limitations. First, only articles written in English were reviewed, which could have led to missed papers that met the inclusion criteria but were excluded due to translation limitations. Next, this review sought to examine interventions that included evaluation measures and, therefore, only considered articles that included an evaluation component and interventions that were not excluded. These interventions were excluded because the scoping review was focused on existing interventions to contribute to the evidence‐based and informed public health practice. For example, during the initial literature search, we identified novel vaping prevention interventions in the gray literature. One example is “Not an Experiment,” an open‐sourced interactive website that includes educational materials for teenagers, parents, and teachers. It focuses on educating them about the harms of vaping and marketing strategies employed by the tobacco industry (Simcoe Muskoka District Health Unit 2023). However, they were not included in the final review because they did not meet the eligibility criteria. Finally, quality appraisal is not generally required for scoping reviews, and therefore, the articles included in this review were not evaluated for their methodological quality. Therefore, some studies may have been of low quality and caution must be taken in interpreting the results.

Evidence‐based public health interventions are essential to address the adolescent vaping crisis. Compiling existing programs, key components, and evaluative measures provides valuable insights for public health professionals, equipping them with knowledge of available prevention approaches. Public health professionals play an important role in protecting the health of future generations, and findings from this study will help inform the development of future public health practices, programs, and policies.

In conclusion, various public health interventions are available to address the vaping crisis among adolescents. Understanding what has been done and how interventions have been measured serves as the initial step in ensuring meaningful steps are being taken to actively protect and promote public health. Our findings offer valuable insights into existing interventions found in the literature and the variety of outcomes that have been measured. Additionally, this review will facilitate future scientific investigations, aimed at understanding the effectiveness of prevention interventions.

Ethics Statement

Ethical approval was received from Queens University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board.

Conflicts of Interest

The authors declare no conflicts of interest.

Permission to Reproduce Material From Other Sources

Not applicable.

Supporting information

Supporting Information

PHN-42-604-s001.docx (74.2KB, docx)

Acknowledgments

This review will contribute to the primary reviewer's (JD) PhD thesis.

Funding: The authors received no specific funding for this work.

Data Availability Statement

The list of included studies and associated findings from this scoping review can be found in Appendix C.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting Information

PHN-42-604-s001.docx (74.2KB, docx)

Data Availability Statement

The list of included studies and associated findings from this scoping review can be found in Appendix C.

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