Key messages
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School-based programmes may prevent adolescents from starting to use electronic cigarettes (e-cigarettes) and a community-based programme delivered by text message probably helps adolescents quit using e-cigarettes.
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The evidence is very limited because only three studies contributed to the results.
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Another 30 studies are underway, and we have five more published studies to check. They may provide more answers in the future.
What are electronic cigarettes?
E-cigarettes, also known as vapes, are battery-operated devices that heat a liquid and produce an aerosol (a mix of small particles released in the air) which is inhaled through the mouth into the lungs. They can include electronic cigars, 'snus' (a Swedish tobacco device) or water pipes, and may or may not contain nicotine.
It was generally thought that these devices might lead to people stopping smoking ('current-users') and it is clear that they help adults to quit. However, young people who are not smoking ('never-users') are more likely to try these devices, and they can cause harm to the lungs, such as asthma and effects on development and learning.
What type of programmes are used to stop children and adolescents from using e-cigarettes?
The types of programmes included: education, training and communication (either community- or school-based) or public announcements; other programmes could include family strategies, medicines or counselling, all designed to influence children or adolescents to prevent or stop e-cigarette use.
What did we want to find out?
We wanted to find out:
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whether programmes designed to prevent children and adolescents from starting to use e-cigarettes, or to quit using them, are effective;
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if the programmes had any unwanted effects on children's and adolescents' health, or on the organisations that delivered them.
What did we do?
We searched for studies that investigated programmes to prevent children and adolescents from starting to use e-cigarettes (never-users) or to help them quit using e-cigarettes (current-users).
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Studies could compare programmes with no programme, being on a waiting-list for a programme or another general health programme. The programmes had to be delivered in the community, school, health services, hospitals, or the home.
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People had to be children or adolescents aged 19 years or younger, but also included their parents or caregivers and health professionals.
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The use of tobacco was measured either in the laboratory or by parent- or self-reports, questionnaires or surveys.
We compared and summarised the results, and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We found three studies with 10,510 adolescents.
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All participants in the studies were adolescents, with an age range from 12 to 17 years.
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Two of the studies (undertaken in Sweden and Australia) targeted never-users and were delivered in schools. The Swedish study (1176 adolescents) lasted three years and required an agreement signed between caregivers or parents and the adolescent pledging to not take up smoking; they also received an annual education session. This programme was compared with four annual educational sessions. The Australian study (7654 adolescents) had four weeks of programmes (40-minute lessons) and was compared with the usual health curriculum.
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One US prevention study (with 1681 current-users), delivered in the community, used a text-based message system which lasted four or 14 weeks (depending on whether a quit date was given or no quit date was given, respectively). It was compared with either monthly text messages that reported e-cigarette use or a waiting-list control (that is, people on a waiting list to receive treatment).
Main results
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The two combined studies of never-users found that school-based programmes may help prevent adolescents from ever trying e-cigarettes, but we are very uncertain about the results: 33% of ever-users on school programmes started trying using e-cigarettes compared to 31% of those having an alternative programme (two studies, 8830 people).
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The remaining study found that a community-based programme (for current-users) probably helps adolescents quit e-cigarette use: 45% of adolescents on the programme reported continuing the use of e-cigarettes compared to 62% with an alternative programme or a waiting-list (1 study, 1681 people).
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No studies provided information on the unwanted effects of the programmes.
What are the limitations of this evidence?
Given that the review only included three studies, very limited evidence is available for us to determine what programmes may work to help prevent or stop adolescent e-cigarette use. Our confidence in the evidence was very low-to-moderate because there were very few studies found, the programmes were different, and the studies lasted for different time periods.
How up-to-date is this evidence?
This evidence is current to September 1, 2025. This updates our previous review published in 2024.
Read the full abstract
The prevalence of e-cigarette use has increased globally amongst children and adolescents in recent years. In response to the increasing prevalence and emerging evidence about the potential harms of e-cigarettes in children and adolescents, leading public health organisations have called for approaches to address increasing e-cigarette use. Whilst evaluations of approaches to reduce uptake and use regularly appear in the literature, the collective long-term benefit of these is currently unclear.
Objectives
The co-primary objectives were to: (1) evaluate the effectiveness of interventions to prevent e-cigarette use in children and adolescents (aged 19 years and younger) with no prior use, relative to no intervention, waiting-list control, usual practice, or an alternative intervention; and (2) evaluate the effectiveness of interventions to cease e-cigarette use in children and adolescents (aged 19 years and younger) reporting current use, relative to no intervention, waiting-list control, usual practice, or an alternative intervention. Secondary objectives were to: (1) examine the effect of such interventions on child and adolescent use of other tobacco products (e.g. cigarettes, cigars, chewing tobacco and pouches); and (2) describe the unintended adverse effects of the intervention on individuals, or on organisations where such interventions were being implemented.
Search strategy
We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL and Europe PMC on 1st September 2025. Additionally, we searched two trial registry platforms (WHO International Clinical Trials Registry Platform; ClinicalTrials.gov), and reference lists of relevant systematic reviews. We contacted corresponding authors of articles identified as ongoing studies.
Selection criteria
We included randomised controlled trials (RCTs), including cluster-RCTs, factorial RCTs, and stepped-wedge RCTs. To be eligible, the primary targets of the interventions must have been children and adolescents aged 19 years or younger. Interventions could have been conducted in any setting, including community, school, health services, or the home, and must have sought to influence children or adolescent (or both) e-cigarette use directly. Studies with a comparator of no intervention (i.e. control), waitlist control, usual practice, or an alternative intervention not targeting e-cigarette use were eligible. We included measures to assess the effectiveness of interventions to: prevent child and adolescent e-cigarette use (including measures of e-cigarette use amongst those who were never-users); and cease e-cigarette use (including measures of e-cigarette use amongst children and adolescents who were e-cigarette current-users). Measures of e-cigarette use included current-use (defined as use in the past 30 days) and ever-use (defined as any lifetime use).
Data collection and analysis
Two review authors independently screened the titles and abstracts of references, with any discrepancies resolved through consensus. Pairs of review authors independently assessed the full-text articles for inclusion in the review. We planned for two review authors to independently extract information from the included studies and assess risk of bias using the Cochrane RoB 2 tool. We planned to conduct multiple meta-analyses using a random-effects model to align with the co-primary objectives of the review. First, we planned to pool interventions to prevent child and adolescent e-cigarette use and conduct two analyses using the outcome measures of 'ever-use' and 'current-use'. Second, we planned to pool interventions to cease child and adolescent e-cigarette use and conduct one analysis using the outcome measure of 'current-use'. Where data were unsuitable for pooling in meta-analyses, we planned to conduct a narrative synthesis using vote-counting approaches and to follow the Cochrane Handbook for Systematic Reviews of Interventions and the Synthesis Without Meta-analysis (SWiM) guidelines.
Main results
The search of electronic databases identified 7141 citations, with a further 287 records identified from the search of trial registries and Google Scholar. Of the 110 studies (116 records) evaluated in full text, we considered 88 to be ineligible for inclusion for the following reasons: inappropriate outcome (27 studies); intervention (12 studies); study design (31 studies); and participants (18 studies). The remaining 22 studies (28 records) were identified as ongoing studies that may be eligible for inclusion in a future review update. We identified no studies with published data that were eligible for inclusion in the review.
Authors' conclusions
Given only three randomised studies were included in the review, there is limited evidence, of very low-to-moderate-certainty, that interventions may be effective in preventing or ceasing adolescent e-cigarette use. As findings of the 30 ongoing studies are published, certainty of evidence of effects may improve. Until then, the findings of this review should be considered together with evidence from studies employing other trial designs not eligible for inclusion in this review to guide actions to prevent or cease e‐cigarette use.
This is a living systematic review. We search for new evidence every month and update the review when we identify relevant new evidence.
Funding
This review was supported by the NHMRC Centre for Research Excellence (No. APP1153479) – ‘the National Centre of Implementation Science’. NHMRC also provides support for the editorial and author support function of Cochrane Public Health.
Registration
This review is registered in the Cochrane Database of Systematic Reviews. The protocol (https://doi.org/10.1002/14651858.CD015511) and previous version of the review (https://doi.org/10.1002/14651858.CD015511.pub2) are published in the Cochrane Library.
