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СпутникиРНSpaceXРоскосмосNASAKey messages
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.
The evidence is very limited because only three studies contributed to the results.
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:
whether programmes designed to prevent children and adolescents from starting to use e-cigarettes, or to quit using them, are effective;
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).
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.
People had to be children or adolescents aged 19 years or younger, but also included their parents or caregivers and health professionals.
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.
All participants in the studies were adolescents, with an age range from 12 to 17 years.
Two of the studies (undertaken in Sweden and Australia) 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.
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
The two combined studies found that school-based programmes may help prevent adolescents from ever trying e-cigarettes, but we are very uncertain about the results: 31% of adolescents on school programmes may be prevented from using e-cigarettes compared to 33% of those on an alternative programme (two studies, 8830 people).
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).
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.