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. Author manuscript; available in PMC: 2026 Mar 11.
Published before final editing as: Psychol Addict Behav. 2026 Mar 9:10.1037/adb0001129. doi: 10.1037/adb0001129

The Feasibility and Acceptability of LIFFE: A Web-Based Vaping Intervention and Smoking Prevention Program for Young Adults

Denise D Tran 1, Clara Mintzer 2, Keegan D Buch 1, Jordan P Davis 3, Eric R Pedersen 1
PMCID: PMC12974235  NIHMSID: NIHMS2141568  PMID: 41801705

Abstract

Objective.

E-cigarette use (i.e., vaping) among young adults increases risk for significant health consequences and combustible cigarette uptake. Although there are a growing number of vaping cessation interventions for young adults, there are no known evidence-based e-cigarette use treatments that include smoking uptake prevention. The Live Free From E-Cigarettes (LIFFE) digital program was developed to help young adults stop or reduce their use of e-cigarettes and reduce their cigarette smoking susceptibility.

Method.

Twenty young adults (ages 18–24) who vape, but do not smoke combustible cigarettes, were recruited via social media. They completed an initial survey and the single session, 30-minute intervention on their mobile devices, followed by quantitative measures of intervention feasibility and acceptability. One week later, participants completed an interview to provide feedback about the program and a follow-up survey.

Results.

All participants completed all seven intervention modules. Participants rated LIFFE as feasible in terms of delivery, usability, and logistics. Participants were satisfied with the content, design, and potential to help them and other young adults who vape to stop or reduce use. Some participants reported reductions in their susceptibility to smoke and vaping behaviors, including via quitting, one week after the intervention.

Conclusions.

Quantitative and qualitative results indicate that LIFFE is a feasible and acceptable program for engaging young adults in cessation efforts. Participants also included suggestions for potential changes to enhance the LIFFE program. Next steps will include building upon these suggestions for intervention refinement and testing the refined version in a randomized controlled trial.

Keywords: Electronic cigarettes, vaping, youth, treatment, mHealth, intervention, smoking

Background

The use of e-cigarettes (i.e., vaping) among young adults ages is prevalent, with 10.3% and 15.5% reporting currently vaping in 2023 among individuals ages 18–20 and 21–24, respectively (Vahratian et al., 2025). Over half of young adults who vape want to quit vaping, and over 60% have reported a past quit attempt (Cuccia et al., 2021; Dai, 2021). Importantly, e-cigarettes may be a gateway into combustible cigarette smoking among young adults (Dunbar et al., 2019; Levy et al., 2019; Loukas et al., 2022).

Given that many young adults own a smartphone, mobile-based interventions may offer scalable vaping cessation support; however, there are few evidence-based mobile vaping cessation interventions. A recent systematic review and meta-analysis identified only seven vaping cessation interventions that have undergone a randomized controlled trial; among them, only three were digital interventions (Heshmati et al., 2025). This Is Quitting (TIQ) is among them, which offers nine weeks of daily text messages and was trialed among young adults who reported motivation to quit within the next 30 days (Graham et al., 2021). Those who were not ready to quit received their own set of daily texts for four weeks focused on increasing skills and confidence. Newly developed interventions (but have not yet been tested in a randomized trial) include a 2-week contingency management program and a 5-week social media intervention (Lyu et al., 2022; Raiff et al., 2022), both of which also require participants to indicate their intention to quit to participate in the studies examining these interventions. However, limited user engagement and high attrition have been identified as key barriers to vaping digital interventions (Graham et al., 2024; Krishnan et al., 2023).

Given these existing interventions require engagement over the course of several weeks or months, offering briefer programs may address an unmet need among those who find one-time or brief programs more feasible. Brief, online interventions are advantageous because they can reach wide audiences, require less staffing, are easily accessible, and can engage individuals in treatment who may have never otherwise used such services (Moock, 2014; Mundt, 2006). For instance, those who are not yet ready to quit may be more willing to engage in brief programs as they require less of a commitment. To reach a large and varied group of young adults who vape, including those who may not be considering quitting, and to address attrition issues, future interventions may need to be brief. Much like the level of personalization in previously successful interventions, such as TIQ, including personalized components that foster motivation to engage in healthy behavior change for those ambivalent about quitting while also including components personalized to those who are ready to quit vaping will also be essential (Graham et al., 2021). Further, the potential for transitioning to combustible cigarettes supports the need for interventions to also tackle both vaping and future smoking initiation risk among young adults (Soneji et al., 2017).

Misperceptions of social norms, such as overestimating how prevalent and how accepted vaping is among same-aged peers, is associated with greater nicotine use behaviors in young people (Awua et al., 2024; East et al., 2019). Personalized normative feedback (PNF), has shown promise as a tool for promoting alcohol cessation and reduction among young adults (Agostinelli et al., 1995; Saxton et al., 2021). In PNF, the individual is shown information about their own behavior (e.g., you reported vaping 4 days per week) alongside their beliefs about what the norms of that behavior are (e.g., you believe that others vape 7 days per week) alongside the true norms (e.g., survey data indicate that 90% of people your age do not vape and among those who do vape, they vape on only 1 day per week on average) (Dempsey et al., 2018). Moreover, PNF may be able to address the risk for transitioning to combustible cigarette smoking, as the use of cigarettes has been linked to the influence of social norms (East et al., 2021; Echeverria et al., 2015). PNF is cost-effective, brief, and easily delivered online. Yet, there are currently no known interventions utilizing PNF to address nicotine use.

We have developed Live Free From E-cigarettes (LIFFE), which is a brief, mobile-accessible intervention targeting vaping and the transition to smoking combustible cigarettes among young adults. It is grounded in best practices from smoking cessation research with young adults (Villanti et al., 2020), informed by formative research with young adults who vape (Tran et al., 2023), and based on Social Norms Theory (Berkowitz, 2003) and components of Motivational Interviewing (Miller & Rollnick, 2012). In brief, LIFFE contains nine short modules and was designed to be completed in 30 minutes (Tran et al., 2025). See Supplementary Materials for a detailed description of the intervention and Figures 1 and 2 for example images. The present study will test the feasibility and acceptability of this novel web-based intervention that combines vaping intervention and smoking prevention content (including PNF, education about the harms of vaping and smoking, personal anecdotes from other young adults who vape, and vaping cessation strategies). Through interviews with young adults who use e-cigarettes and completed an initial test of LIFFE, we will assess the strengths and limitations of the beta version of LIFFE and explore additional avenues for improvement and refinement.

Figure 1.

Figure 1.

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Images of Motivational Enhancement, Harms Education, and a Testimonial from LIFFE

Figure 2.

Figure 2.

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Images of Personalized Normative Feedback and Cessation Strategies from LIFFE

Methods

Procedure

This study was approved by the university’s institutional review board. Potential participants clicked on our social media advertisements and were redirected to a five-minute screening survey. Individuals who were considered eligible from the screening survey were then contacted by a research team member via phone to ensure their eligibility. If they passed both the screening survey and phone screen, the study procedures and consent form were reviewed and informed consent was obtained.

The 20 participants who were enrolled into the study were then emailed a 20-minute baseline survey to complete. The baseline survey contained items assessing e-cigarette use, smoking susceptibility, and motivation to vape and smoke. After completing the baseline survey, participants were emailed a link and unique PIN code that gave them access to LIFFE and asked to review the 30-minute intervention on the same day that they completed the baseline survey.

Immediately after completing the intervention, participants also completed the System Usability Scale (SUS), which measures perceived ease of use of a digital platform (Sauro, 2011). One week later, participants completed a follow-up online survey, which contained the same items presented in the baseline survey, and an individual interview lasting 30–45 minutes via Zoom. During the interview, participants were asked to describe their reactions to the intervention, changes in their thoughts and behaviors related to e-cigarette use and smoking, and suggestions to improve the intervention. Participants received $100 total as compensation.

Participants

Participants were recruited between April 2024 to June 2024. Inclusion criteria were having to be between ages 18 to 24, reporting vaping nicotine on at least one day per week in the last month, and reporting no history of combustible cigarette smoking. Exclusion criteria included current engagement with nicotine cessation services (e.g., counseling, apps or other online supports for quitting vaping). Those who indicate having been diagnosed with a serious mental illness (e.g., schizophrenia, bipolar disorder), having used an illicit drug in the past 30 days (e.g., cocaine, heroin), or screening positive for an alcohol use disorder in the past year were also considered ineligible, as they likely required a higher level of care. We did not exclude participants based on their level of motivation to quit vaping.

Measures

The System Usability Scale (SUS) is a 10-item measure of the usability and satisfaction of digital products with a range of 0–100 (Sauro, 2011). In addition, we used two metrics of feasibility: the number minutes each participant engaged with the program and number of completed modules of the nine available. The Expanded Susceptibility to Smoke Index (ESSI) was used to measure susceptibility to smoke. Response options ranged from “definitely not” to “definitely yes.” Participants who selected “definitely not” to all four items were categorized as “committed never-smokers,” and those who did not select “definitely not” to all items were considered “susceptible.” The ESSI is known to be a valid and reliable predictor of future smoking initiation (Strong et al., 2015). E-cigarette use was measured by two items asking (1) whether e-cigarette use occurred within the past 30 days (yes or no) and (2) for the average number of days per week e-cigarette use occurred (0 to 7 days). Motivation to vape was measured with one item with four potential responses (see Table 2).

Table 2.

Motivation to Quit E-cigarettes at Baseline and Follow-up

Item Baseline: N (%) Follow-up: N (%)
I plan to stop using e-cigarettes 9 (45.0%) 12 (60%)
I plant to decrease my use of e-cigarettes. 9 (45%) 7 (35.0%)
I plan to continue using e-cigarettes. 1 (5.0%) 1 (5.0%)
I plan to increase my use of e-cigarettes. 0 (0%) 0 (0%)
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Analysis

All interviews were audio recorded, transcribed verbatim, and cross-checked for fidelity. Two research team members independently coded the validated transcripts using both deductive and inductive coding approaches (Pandey, 2019) with NVivo. The deductive approach involved coding that was guided by a codebook listing codes and subcodes that were based on the interview guide. The inductive approach allowed for the emergence of new themes directly from participants’ responses. Predetermined codes and subcodes were operationally defined to ensure a shared understanding among the coding team. Team members then met to discuss any discrepancies until consensus was reached. Survey responses were downloaded into SPSS Version 29 for descriptive analyses.

Results

Quantitative Results

We recruited 20 eligible individuals (7 male, 10 female, 3 transgender or nonbinary; see Table 1). Participants rated LIFFE above average in usability on the SUS with a mean score of 82.75 (SD = 7.9) out of 100 (a score greater than 68 represents an “above average” rating). All 10 items received mean scores that are indicative of general satisfaction with LIFFE (see Table 3). All 20 participants completed the program, having reviewed all nine modules in an average of 24.29 minutes (SD = 7.7).

Table 1.

Sample Characteristics

All Participants (N = 20)
N/Mean %/SD
Age (19–24) 22.05 1.67
Race
 Black 3 15%
 Asian 2 10%
 White 11 55%
 Multiracial 4 20%
Ethnicity
 Hispanic 5 25%
 Non-Hispanic 15 75%
Gender
 Male 7 35%
 Female 10 50%
 Nonbinary/Transgender 3 15%
College Status
 Full-Time Student 8 40%
 Part-Time Student 0 0%
 Not College Attending 12 60%
U.S. Region of Current Residence
 Mid-Atlantic 3 15%
 Southeast 6 30%
 Midwest 3 15%
 Rocky Mountains 3 15%
 Southwest 2 10%
 Pacific Coastal 3 15%
Average Number of Days Per Week of E-Cigarette Use (1–7) 3.75 2.63
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Table 3.

Overview of the System Usability Scale

All Participants (N = 20)
Item Strongly Disagree (1) N (%) Disagree (2) N (%) Neither Agree nor Disagree (3) N (%) Agree (4) N (%) Strongly Agree (5) N (%) Mean (SD)
I think that I would like to use this system frequently. 0 (0%) 4 (20%) 5 (25%) 7 (35%) 4 (20%) 3.55 (1.050)
I found the system unnecessarily complex. 10 (50%) 6 (30%) 2 (10%) 1 (5%) 1 (5%) 1.85 (1.137)
I thought the system was easy to use. 0 (0%) 1 (5%) 1 (5%) 4 (20%) 14 (70%) 4.55 (0.826)
I think that I would need the support of a technical person to be able to use this system. 16 (80%) 3 (15%) 0 (0%) 0 (0%) 1 (5%) 1.35 (0.933)
I found the various functions in this system were well integrated. 0 (0%) 0 (0%) 0 (0%) 13 (65%) 7 (35%) 4.35 (0.489)
I thought there was too much inconsistency in this system. 10 (50%) 9 (45%) 1 (5%) 0 (0%) 0 (0%) 1.55 (0.605)
I would imagine that most people would learn to use this system very quickly. 0 (0%) 0 (0%) 0 (0%) 13 (65%) 7 (35%) 4.35 (0.489)
I found the system very cumbersome to use. 8 (40%) 9 (45%) 2 (10%) 0 (0%) 1 (5%) 1.85 (0.988)
I felt very confident using the system 0 (0%) 0 (0%) 1 (5%) 7 (35%) 12 (60%) 4.55 (0.605)
I needed to learn a lot of things before I could get going with this system. 12 (60%) 6 (30%) 0 (0%) 1 (5%) 1 (5%) 1.65 (1.089)
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The 19 participants who completed the ESSI (measure of smoking susceptibility) at baseline were considered susceptible to smoking; failing to indicate “definitely not” to all four items. During follow-up one week later, eight participants (42.1%) reported they were “committed never smokers” (selected “definitely not” to all four items), which categorizes them as no longer susceptible to smoking. Three of the participants were classified as “susceptible to smoking” because they selected “probably not” rather than “definitely not” to one of the ESSI items but otherwise selected “definitely not” to all other ESSI items.

At baseline, all participants indicated they had used an e-cigarette in the past 30-days on an average of 4.2 days per week (SD = 1.42). At follow-up, one participant reported that they have not used an e-cigarette in the past 30 days. At follow-up, e-cigarettes were used on an average of 3.95 days per week (SD = 1.40). A paired sample t-test indicated that the number of e-cigarette use days in the past 7 days did not significantly differ between baseline and follow-up (p > .05; Cohen’s d = .234). For motivation to quit vaping, at baseline, 9 participants reported “I plan to stop using e-cigarettes” compared to 12 who reported this at follow-up.

Qualitative Results

Feasibility

Intervention length.

Participants found the intervention length with brief modules quite feasible. Participants noted that had the intervention been any shorter, it may not have been possible to include all the useful content that they reviewed. On the other hand, participants noted that had the intervention been any longer, they expect that the majority of users will “not be able to complete it in one sitting.” See Supplemental Materials for participant quotes.

Ease of use.

Participants shared that they were pleased with the intervention setup, describing it as interactive and easy to navigate. Participants found the content to be interesting, which helped them to maintain their attention throughout and enjoyed being able to track their progress toward completion. They also described the visual content to be appealing and eye catching.

Acceptability

Satisfaction.

Participants shared their satisfaction with the intervention. One participant intended to recommend the program to others. Participants were also satisfied with the educational nature of some of the content and appreciated that the program did not make them feel pressured to make behavioral changes. Others shared how enjoyable the program was and that they found it engaging and entertaining, which helped to maintain their focus throughout the program.

Content to keep.

Participants described the helpfulness of including information about the social norms around vaping and smoking. Many described how surprised they were by the PNF portion and enjoyed learning something new. They thought the reflective questions were helpful, specifically questions asking about potential benefits of quitting vaping and reasons to quit. Participants noted that having structured time to make these reflections pushed them to think more deeply about the importance of quitting. Several noted that prior to this program, they had only considered cutting down and believed that quitting was not feasible. However, they have since changed their perspective and felt more confident about their ability to quit.

Testimonials.

Participants shared having enjoyed watching testimonials of young adults at different stages of quitting vaping. Others indicated that they were able relate to at least one of the testimonials. Several indicated the testimonials were their favorite part of the intervention.

Suggested modifications.

Participants offered varying suggestions on components to modify in the next iteration of the intervention. Some participants expressed interest in including subsequent “refresher” sessions “a month later or a couple months later” to “refresh [my] memory [or a way] to revisit this again” rather than limiting this to a one-time intervention. One male participant made another suggestion for additional help in the form of community support, such as through a message board allowing users to communication with and learn from other people in the process of quitting. Another participant enjoyed the interactive features throughout the program and suggested adding additional opportunities for interactive engagement, such as “pop quiz questions.” Lastly, some participants suggested modifications to the few sections in the intervention where there were “longer chunks of text” by “breaking it up a little more.”

Discussion

LIFFE was designed as an easy-to-complete, interactive, and educational digital intervention to support e-cigarette cessation or reduction and reduce their risk for smoking. It is among the first to engage a wide audience of young adults who use e-cigarettes and are susceptible to smoking, but who are not actively receiving any intervention. A unique focus of this intervention is to lower the risk for transitioning to cigarette smoking. The intervention was tailored to the user’s level motivation to quit, such as including motivational enhancement techniques used to appeal to those who were more ambivalent about quitting. Thus, the intervention was intended to engage all young adults who use e-cigarettes, regardless of their level of motivation to quit. In an upcoming randomized trial of LIFFE, we intend to include participants with both high and low motivation to quit and examine whether outcomes differ. If found to be effective even among those who indicated not being ready to quit at baseline, LIFFE may be a useful and low-cost tool recommended by counselors, practitioners, and others serving young adults who vape, including those who may initially indicate ambivalence over quitting. In fact, it is possible that young adults who are ambivalent about quitting may be more willing to engage in a program recommended to them that requires less commitment, which can be viewed as less burdensome. Pending further research, LIFFE may also serve as a potential standalone treatment or as an initial treatment option/supplement that allows those who are ready to quit to engage in cessation services before committing to more intensive existing support.

The young adults who completed the initial testing of LIFFE expressed their satisfaction with LIFFE’s visuals, content, relevance, and brief length. Quantitative results identified young adults’ willingness to complete the intervention in one sitting, which was supported by the 100% completion rate. Given the high early dropout rates reported by studies of other digital vaping interventions (Graham et al., 2021; Krishnan et al., 2023), this completion rate and participants’ appreciation of the brief length offer additional support for briefer treatment options for young adults who vape. This is in line with prior studies indicating that briefer interventions are appealing, not only because of the brevity, but also the ability to complete them in varied environments, the cost-effectiveness, and the ability to be conveniently delivered (Neighbors et al., 2010; Wutzke et al., 2001).

Our mean usability score of 82.75 on the System Usability Scale exceeded the cutoff for an above average rating of 68 (Hyzy et al., 2022) with any score above 80.3 considered to be among the top 10% in usability (Sauro, 2011). All participants were all susceptible to smoke pre-intervention. Post-intervention, eight participants were classified as no longer susceptible. One participant indicated that they have not used e-cigarettes since completing the intervention. Further, there was a reduction in e-cigarette use days at follow-up, albeit the difference was not significant. It is possible that the one-week difference between baseline and follow-up was too short of a time frame to capture meaningful change. However, it is worth noting that there was a small effect (Cohen’s d = .234) despite the short study period.

Although LIFFE in its current form was developed specifically for young adults who use e-cigarettes, the increasing concurrent use of multiple nicotine products (e.g., oral nicotine pouches) represents an important area for future adaptation (Coleman et al., 2022; Han et al., 2025). Individuals who engage in multiple-product use may differ from those who exclusively use e-cigarettes in their nicotine dependence patterns, motivations for use, and experiences and challenges with cessation (Cooper et al., 2016; King et al., 2018; Morean et al., 2018). Future iterations of the intervention could be refined to address these differences by including content that acknowledges overlapping dependence mechanisms, potential substitution behaviors across different nicotine products, and tailored recommendations for cessation. Broadening the intervention to address the needs of young adults who use multiple nicotine products may enhance the intervention’s reach and ecological validity in real-world contexts where dual and poly-nicotine product use are increasingly common (Coleman et al., 2022; Han et al., 2025).

Limitations

Limitations include the small sample size and short follow-up period. A larger pilot trial with longer follow-up is currently underway to evaluate the potential for sustained effects. Further, given the intervention’s brief nature, it is unknown whether the benefits of LIFFE will be maintained or wane over time. Many brief interventions are typically not designed to provide a full treatment regimen but, rather, are intended to motivate and provide support and resources to individuals who may then subsequently seek more intensive treatment options (Tanner-Smith & Lipsey, 2015). Therefore, even modest effects from a single session intervention can be essential as the individual is able to reflect on their own behavior and consider making a healthy change. Notably, brief interventions have been shown to produce benefits comparable to longer treatment options (Kulesza et al., 2010; Petry et al., 2008).

Conclusions and Future Directions

Findings indicate that LIFFE is a feasible and acceptable way to promote e-cigarette cessation or reduction and address smoking susceptibility among young adults. Future directions will include refining LIFFE based on the feedback received from the participants in the current study. Once intervention refinement is complete, we will analyze the preliminary efficacy of LIFFE following a randomized controlled trial of the refined version of LIFFE with 100 young adults. After completion of this pilot trial, a larger randomized controlled trial is planned with longer follow-up periods to evaluate the efficacy of LIFFE in reducing e-cigarette use and likelihood of smoking initiation and increasing point prevalence nicotine abstinence.

Supplementary Material

Supplemental text 1
Supplemental text 2

Public Health Significance.

This study demonstrated the feasibility of, acceptability of, and satisfaction with Live Free From E-cigarettes (LIFFE), a novel brief digital intervention designed to reduce e-cigarette use and susceptibility to smoke cigarettes in young adults.

Funding Sources

This work was supported by the National Institute on Drug Abuse [K01DA056699, 2023–2028]

Footnotes

CRediT Authorship

Denise D. Tran: Writing – original draft, Writing – review and editing, Supervision, Project administration, Methodology, Investigation, Formal analysis, Conceptualization, Funding acquisition, Supervision. Clara Mintzer: Writing – original draft, Formal analysis, Visualization. Keegan Buch: Writing – original draft. Jordan P. Davis: Supervision, Writing – review and editing. Eric R. Pedersen: Supervision, Writing – review and editing.

Declaration of Competing Interests

All authors have no competing interests to declare.

References

  1. Agostinelli G, Brown JM, & Miller WR (1995). Effects of normative feedback on consumption among heavy drinking college students. J Drug Educ, 25(1), 31–40. 10.2190/XD56-D6WR-7195-EAL3 [DOI] [PubMed] [Google Scholar]
  2. Awua J, Tuliao AP, Gabben-Mensah D, Kanjor F, Botor NJB, Ohene L, & Meisel MK (2024). Interpersonal communication and perceived norms as social influence mechanisms of e-cigarette use among adults: a systematic review. Am J Drug Alcohol Abuse, 1–14. 10.1080/00952990.2024.2346928 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berkowitz AD (2003). Applications of social norms theory to other health and social justice issues (Perkins HW, Ed.). Jossey-Bass/Wiley. [Google Scholar]
  4. Coleman SRM, Piper ME, Byron MJ, & Bold KW (2022). Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence. Curr Addict Rep, 9(4), 353–362. 10.1007/s40429-022-00448-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cooper M, Case KR, Loukas A, Creamer MR, & Perry CL (2016). E-cigarette Dual Users, Exclusive Users and Perceptions of Tobacco Products. Am J Health Behav, 40(1), 108–116. 10.5993/AJHB.40.1.12 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cuccia AF, Patel M, Amato MS, Stephens DK, Yoon SN, & Vallone DM (2021). Quitting e-cigarettes: Quit attempts and quit intentions among youth and young adults. Prev Med Rep, 21, 101287. 10.1016/j.pmedr.2020.101287 [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Dai H (2021). Prevalence and Factors Associated With Youth Vaping Cessation Intention and Quit Attempts. Pediatrics, 148(3). 10.1542/peds.2021-050164 [DOI] [PubMed] [Google Scholar]
  8. Dempsey RC, McAlaney J, & Bewick BM (2018). A Critical Appraisal of the Social Norms Approach as an Interventional Strategy for Health-Related Behavior and Attitude Change. Front Psychol, 9, 2180. 10.3389/fpsyg.2018.02180 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dunbar MS, Davis JP, Rodriguez A, Tucker JS, Seelam R, & D’Amico EJ (2019). Disentangling Within- and Between-Person Effects of Shared Risk Factors on E-cigarette and Cigarette Use Trajectories From Late Adolescence to Young Adulthood. Nicotine Tob Res, 21(10), 1414–1422. 10.1093/ntr/nty179 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. East K, McNeill A, Thrasher JF, & Hitchman SC (2021). Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies. Addiction, 116(11), 2953–2967. 10.1111/add.15427 [DOI] [PubMed] [Google Scholar]
  11. East KA, Hitchman SC, McNeill A, Thrasher JF, & Hammond D (2019). Social norms towards smoking and vaping and associations with product use among youth in England, Canada, and the US. Drug Alcohol Depend, 205, 107635. 10.1016/j.drugalcdep.2019.107635 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Echeverria SE, Gundersen DA, Manderski MT, & Delnevo CD (2015). Social norms and its correlates as a pathway to smoking among young Latino adults. Soc Sci Med, 124, 187–195. 10.1016/j.socscimed.2014.11.034 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Graham AL, Amato MS, Cha S, Jacobs MA, Bottcher MM, & Papandonatos GD (2021). Effectiveness of a Vaping Cessation Text Message Program Among Young Adult e-Cigarette Users: A Randomized Clinical Trial. JAMA Intern Med, 181(7), 923–930. 10.1001/jamainternmed.2021.1793 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Graham AL, Cha S, Jacobs MA, Amato MS, Funsten AL, Edwards G, & Papandonatos GD (2024). A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users: A Randomized Clinical Trial. JAMA, 332(9), 713–721. 10.1001/jama.2024.11057 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Han DH, Harlow AF, Miech RA, Bae D, Cho J, Dai HD, Sussman SY, Sanchez LM, Meza L, & Leventhal AM (2025). Nicotine Pouch and E-Cigarette Use and Co-Use Among US Youths in 2023 and 2024. JAMA Netw Open, 8(4), e256739. 10.1001/jamanetworkopen.2025.6739 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Heshmati J, Pandey A, Benjamen J, Furqan M, Salman M, Visintini S, Mullen KA, Guyatt G, Pipe AL, & Mir H (2025). Vaping cessation interventions: a systematic review and meta-analysis. Tob Control. 10.1136/tc-2024-058798 [DOI] [PubMed] [Google Scholar]
  17. Hyzy M, Bond R, Mulvenna M, Bai L, Dix A, Leigh S, & Hunt S (2022). System Usability Scale Benchmarking for Digital Health Apps: Meta-analysis. JMIR Mhealth Uhealth, 10(8), e37290. 10.2196/37290 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. King JL, Reboussin D, Cornacchione Ross J, Wiseman KD, Wagoner KG, & Sutfin EL (2018). Polytobacco Use Among a Nationally Representative Sample of Adolescent and Young Adult E-Cigarette Users. J Adolesc Health, 63(4), 407–412. 10.1016/j.jadohealth.2018.04.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Krishnan N, Berg CJ, Le D, Ahluwalia J, Graham AL, & Abroms LC (2023). A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation. Tob Prev Cessat, 9, 04. 10.18332/tpc/157598 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Kulesza M, Apperson M, Larimer ME, & Copeland AL (2010). Brief alcohol intervention for college drinkers: how brief is? Addict Behav, 35(7), 730–733. 10.1016/j.addbeh.2010.03.011 [DOI] [PubMed] [Google Scholar]
  21. Levy DT, Warner KE, Cummings KM, Hammond D, Kuo C, Fong GT, Thrasher JF, Goniewicz ML, & Borland R (2019). Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check. Tob Control, 28(6), 629–635. 10.1136/tobaccocontrol-2018-054446 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Lewis MA, & Neighbors C (2007). Optimizing personalized normative feedback: the use of gender-specific referents. J Stud Alcohol Drugs, 68(2), 228–237. 10.15288/jsad.2007.68.228 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Loukas A, Marti CN, & Harrell MB (2022). Electronic nicotine delivery systems use predicts transitions in cigarette smoking among young adults. Drug Alcohol Depend, 231, 109251. 10.1016/j.drugalcdep.2021.109251 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Lyu JC, Olson SS, Ramo DE, & Ling PM (2022). Delivering vaping cessation interventions to adolescents and young adults on Instagram: protocol for a randomized controlled trial. BMC Public Health, 22(1), 2311. 10.1186/s12889-022-14606-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Miller WR, & Rollnick S (2012). Meeting in the middle: motivational interviewing and self-determination theory. Int J Behav Nutr Phys Act, 9, 25. 10.1186/1479-5868-9-25 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Moock J (2014). Support from the Internet for Individuals with Mental Disorders: Advantages and Disadvantages of e-Mental Health Service Delivery. Front Public Health, 2, 65. 10.3389/fpubh.2014.00065 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Morean M, Krishnan-Sarin S, & O’Malley SS (2018). Comparing cigarette and e-cigarette dependence and predicting frequency of smoking and e-cigarette use in dual-users of cigarettes and e-cigarettes. Addict Behav, 87, 92–96. 10.1016/j.addbeh.2018.06.027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Mundt MP (2006). Analyzing the costs and benefits of brief intervention. Alcohol Res Health, 29(1), 34–36. https://www.ncbi.nlm.nih.gov/pubmed/16767851 [PMC free article] [PubMed] [Google Scholar]
  29. Neighbors CJ, Barnett NP, Rohsenow DJ, Colby SM, & Monti PM (2010). Cost-effectiveness of a motivational intervention for alcohol-involved youth in a hospital emergency department. J Stud Alcohol Drugs, 71(3), 384–394. 10.15288/jsad.2010.71.384 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Pandey J (2019). Deductive approach to content analysis. In Qualitative techniques for workplace data analysis (pp. 145–169). IGI Global. [Google Scholar]
  31. Petry NM, Weinstock J, Ledgerwood DM, & Morasco B (2008). A randomized trial of brief interventions for problem and pathological gamblers. J Consult Clin Psychol, 76(2), 318–328. 10.1037/0022-006X.76.2.318 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Raiff BR, Newman ST, Upton CR, & Burrows CA (2022). The feasibility, acceptability, and initial efficacy of a remotely delivered, financial-incentive intervention to initiate vaping abstinence in young adults. Exp Clin Psychopharmacol, 30(5), 632–641. 10.1037/pha0000468 [DOI] [PubMed] [Google Scholar]
  33. Sauro J (2011). A practical guide to the system usability scale: Background, benchmarks & best practices. Measuring Usability LLC. [Google Scholar]
  34. Saxton J, Rodda SN, Booth N, Merkouris SS, & Dowling NA (2021). The efficacy of Personalized Normative Feedback interventions across addictions: A systematic review and meta-analysis. PLoS One, 16(4), e0248262. 10.1371/journal.pone.0248262 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang J, Primack BA, Andrews JA, Miech RA, Spindle TR, Dick DM, Eissenberg T, Hornik RC, Dang R, & Sargent JD (2017). Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis. JAMA Pediatr, 171(8), 788–797. 10.1001/jamapediatrics.2017.1488 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Strong DR, Hartman SJ, Nodora J, Messer K, James L, White M, Portnoy DB, Choiniere CJ, Vullo GC, & Pierce J (2015). Predictive Validity of the Expanded Susceptibility to Smoke Index. Nicotine Tob Res, 17(7), 862–869. 10.1093/ntr/ntu254 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Tanner-Smith EE, & Lipsey MW (2015). Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis. J Subst Abuse Treat, 51, 1–18. 10.1016/j.jsat.2014.09.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Tran DD, Davis JP, Buch K, Leventhal AM, Ewing SWF, & Pedersen ER (2025). A novel online vaping intervention and smoking prevention program for young adults who vape: protocol for a randomized controlled trial. Addict Sci Clin Pract, 20(1), 36. 10.1186/s13722-025-00566-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Tran DD, Davis JP, Ring C, Buch K, Fitzke RE, & Pedersen ER (2023). Informing the development of interventions for e-cigarette use and prevention of transition to cigarette smoking in young adults: A qualitative study. Prev Med Rep, 35, 102332. 10.1016/j.pmedr.2023.102332 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Vahratian A, Briones E, Jamal A, & Marynak K (2025). Electronic cigarette use among adults in the United States, 2019–2023. [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Villanti AC, West JC, Klemperer EM, Graham AL, Mays D, Mermelstein RJ, & Higgins ST (2020). Smoking-Cessation Interventions for U.S. Young Adults: Updated Systematic Review. Am J Prev Med, 59(1), 123–136. 10.1016/j.amepre.2020.01.021 [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Wutzke SE, Shiell A, Gomel MK, & Conigrave KM (2001). Cost effectiveness of brief interventions for reducing alcohol consumption. Soc Sci Med, 52(6), 863–870. 10.1016/s0277-9536(00)00189-1 [DOI] [PubMed] [Google Scholar]

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