Health Promotion International, 2025, 40, daaf007

[Link]
Review

Review
Perspectives, motivations, and experiences of adolescents
and young adults using nicotine vapes: a qualitative
review
Jessica Biles1,*, , Rachel Kornhaber1, , Pauletta Irwin2, , Andreia Schineanu1, ,
Myra Kavisha Sookraj-Baran1, and Michelle Cleary3,
1
School of Nursing, Paramedicine and Healthcare Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, 2650, New South
Wales, Australia
2
School of Nursing, Paramedicine and Healthcare Sciences, Faculty of Science, Charles Sturt University, Port Macquarie, 2444, New South
Wales, Australia
3
School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, 2000, New South Wales, Australia
*
Corresponding author. School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
E-mail: jbiles@[Link]

Abstract
The emergence of vaping represents a novel phenomenon, highlighting its distinctive role within contemporary society. Nevertheless, the
comprehensive understanding of the cultural significance and social norms associated with vaping remains incomplete. This scoping review
aimed to report the perspectives, motivations, and experiences of adolescents and young adults (10–25 years) engaging in the use of nicotine
vapes. Peer-reviewed primary research published in English from 2003 to February 2024 was identified using the databases PubMed, Scopus,
CINAHL, and PsycINFO. Qualitative studies reporting on the perspectives, motivations, and experiences of adolescents and young adults who
currently engage in nicotine and tobacco vape use were included. Thematic analysis revealed three key themes in adolescents and young adults
vaping: understanding and reasons for vaping, the challenges of addiction and withdrawal, and varied responses from families and caregivers.
Adolescents and young adults are often introduced to vaping by peers and siblings, drawn by the desire to fit in and the appealing flavours.
Despite awareness of potential health risks, addiction makes quitting difficult, leading to intense cravings and withdrawal challenges. Families
show a spectrum of responses, from ignorance to reluctant acceptance, indicating a need for better awareness and intervention strategies to
address adolescent vaping. Establishing a withdrawal pathway for vaping is imperative as an intervention strategy to address the prevalence of
vaping among adolescents and young adults.
Keywords: electronic nicotine delivery systems; nicotine; vaping; young adult; adolescent behaviour; consumer behaviour; perception; social norms

Contribution to Health Promotion

• The cultural significance and social customs surrounding vaping remain poorly understood.
• Insights into young people’s vaping motivations support targeted strategies to lower its prevalence among adolescents.
• Vaping signifies a novel phenomenon, underscoring its emergence as a distinctive aspect within contemporary societal dynamics.
• This review highlights key influences on adolescent vaping, offering insights for targeted health promotion strategies to curb
vaping initiation and addiction inclusive of vaping cessation pathways.
• This review contributes to our understanding of the need to change the social norms of this health-related behaviour, to facilitate
a reduction of vaping among adolescents and young people.

INTRODUCTION World Health Organization 2024). They are particularly

Vaping, the behaviour and act of inhaling an e-cigarette was attractive and marketed to adolescents and young people due
first developed in 2003 (Nayir et al. 2016, Greenhalgh et al. to their cost (Feeney et al. 2022), smell, flavour (Krüsemann
2023) and has rapidly become one of the world’s most criti- et al. 2021), and accessibility mainly related to negligent reg-
cal public health concerns for adolescents and young adults. ulation and governance (Morphett et al. 2023).
E-cigarettes are electronic devices that heat e-liquid from Vaping liquids contain various harmful substances,
a cartridge into vapour for inhaling (Marques et al. 2021, including nicotine, toxins such as arsenic, chromium, lead,

© The Author(s) 2025. Published by Oxford University Press.

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2 Biles et al.

and nickel, as well as high concentrations of propylene gly- end users, it is imperative to understand the motivators
col and glycerol (known airway irritants), and diacetyl (a behind usage, and therefore the aim of this scoping review is
known cause of bronchiolitis obliterans) (Feeney et al. 2022). to cultivate an expansive knowledge repository to explore the
Although some consider it a supportive strategy for tobacco perceptions, motivating factors, and experiential dimensions
withdrawal (Nayir et al. 2016, Islam et al. 2022, Wise 2023), surrounding the utilization of nicotine vaping among youth.
vaping has resulted in a 3.6 times increase in the likelihood of This scoping review incorporates extant qualitative literature
adult nicotine usage (Jenssen and Wilson 2019). Of concern concerning the perspectives, experiences, and motivations of
is that over 1.3 million non-smokers also die each year due to adolescents and young adults currently engaging in the use of
the harmful effects of secondary smoke inhalation (Institute nicotine vapes.
of Health Metrics and Evaluation 2019). It is known that
­second-hand vape exposure increases the prevalence of bron-
METHOD
chitic symptoms, shortness of breath and wheeze (Islam et
al. 2022). In 2022, it was estimated that 82 million people Design
worldwide engaged in vaping, though it is unknown what In order to identify and map the available evidence, key con-
percentage of these individuals are adolescents and young cepts, and knowledge gaps addressing what is known about
people (Mason et al. 2023). the perceptions, motivations, and experiences of adolescents
There is a growing consensus that the prevalence of vaping and young adults engaging in the use of nicotine vapes, a
among adolescents and young people has become widespread scoping review approach was adopted using Arksey and
(Hammond et al. 2019). Global sales have seen an unexpected O’Malley (2005) framework. The framework consists of five
increase (Jerzyński and Stimson 2023), with a significant por- stages: identifying the research question, identifying pertinent
tion of this demographic gaining their knowledge about vap- studies, selecting the studies, charting the data, and organiz-
ing through social media (Jones and Salzman 2020). Early ing, condensing, and reporting the findings accordingly. The
exposure to nicotine in young people has been linked to reported findings identified in this scoping review reflect the
outcomes such as cognitive deficits, impairment in executive Preferred Reporting Items for Systematic Reviews and Meta-
function (Jones and Salzman 2020), cardiovascular disease Analysis (PRISMA) extension for scoping reviews (Tricco et
(Espinoza-Derout et al. 2022), burns (Biondi‐Zoccai et al. al. 2018).
2019, Banks et al. 2023), lung disease, hypertension, diabetes
(Caponnetto 2020), behaviour changes, hyperactivity, depres- Eligibility criteria
sion, and suicidal ideation (Tobore 2019). Despite awareness The inclusion and exclusion criteria are articulated in Table 1.
of its risks, global vaping regulations remain inconsistent and This scoping review focused on studies related to nicotine
fragmented. Despite the known risk of tobacco usage world- vapes only. The parameter of 2003 was set as the starting point
wide, the World Health Organization reports that only 34 for the search strategy as this was when the first commercial-
countries have banned sales of e-cigarettes, 88 countries do ized e-cigarette product was developed and became commer-
not regulate the minimum age to purchase an e-cigarette, and cially available in China (Grana et al. 2013, Greenhalgh et
74 countries have no current regulations (Feeney et al. 2022). al. 2023).
Alarmingly, e-cigarettes have been marketed to young peo-
ple, with social media platforms advertising a range of candy Search strategy
flavours and designs that appeal to the younger consumer In February 2024, a comprehensive search was conducted
(Gaiha et al. 2022). using the online databases PubMed, Scopus, Cumulative
In Australia, for example, disposable vapes were only offi- Index to Nursing and Allied Health Literature (CINAHL),
cially banned for the general population as of 1 January 2024. and PsycINFO. Boolean terms AND/OR facilitated combin-
Starting 1 July 2024, vapes can only be legally sold in pharma- ing medical subject headings terms and keywords. Table 2 is
cies. Any non-pharmacy sales are illegal. Nicotine vapes will an example of the search strategy performed using PubMed.
require a prescription until 30 September 2024, and minors After the removal of duplicates, 931 records were iden-
must always have a prescription. The UK has cited plans to tified. Independently, the titles and abstracts of all records
ban disposable vapes by April 2025 (McMurray 2024), while were screened for suitability for inclusion (by J.B., R.K., A.S.,
the USA and Canada have restricted the use of flavours that M.S.B., and M.C.). Following this, the same authors con-
may be more enticing to the younger consumer (Gravely et al. ducted a review of full-text articles (see Fig. 1 for a PRISMA
2020). While legislation worldwide slowly moves to protect flow diagram of decisions). Discrepancies encountered were

Table 1. Inclusion and exclusion criteria

Inclusion criteria Exclusion criteria

Peer-reviewed primary qualitative research published in the English lan- Editorials, theoretical papers, reviews, theses, and papers published in
guage and retrieved from 2003 to February 2024. languages other than English.
Research where the focus was on perspectives, motivations, and experi- Quantitative and mixed-method research articles where the focus was
ences of adolescents and young adults’ nicotine vape use. not on adolescents, young adults, and non-vaping, non-nicotine drugs.
Adolescents and young people aged between 10 and 25 yrs who cur- Research where the focus was on evaluating flavours of vapes.
rently identify as vapers and are currently engaging in the act of vaping.
Articles where 80% of usable data is included in the study. Research that investigated perceptions of marketing campaigns, social
media, and/or prevention interventions related to vapes.
Adolescents and young adults using nicotine vapes 3

discussed, and a resolution was sought by consulting with review question (Braun and Clarke 2006). A second research
all authors. From this systematic process, eight studies were meeting supported the clustering of initial codes into prelim-
included in this scoping review. inary themes. Themes were reviewed by the team to support
Author, year, country, study aims, study type, participants, reflexivity, and consider confirmability, and trustworthiness,
data collection, data analysis, and key findings were extracted resulting in three major themes.
(by J.B. and R.K.) that represented the characteristics of
included studies (see Table 3). Included papers were themat-
RESULTS
ically analysed (by J.B. and A.S.) using the Braun and Clarke
(2006) framework. This involved two researchers (J.B. and The thematic analysis resulted in three main themes, namely,
A.S.) independently reading and rereading the results of each ‘What they know and why they vape’, ‘Addiction and with-
paper. Points of meaning were highlighted and shared in a drawal’, and ‘Response from family and caregivers’, and sev-
research discussion, which led to initial systematic inductive eral sub-themes as illustrated in Fig. 2.
coding. Coding was semantic in that it sought to understand
through the interpretation of the data in relation to our Theme 1: What they know and why they vape
The primary theme, What they know and why they vape,
is a recurring motif throughout all the studies included
Table 2. PubMed search strategy
in the review. This theme encompasses the sub-themes of
Introduced by siblings and peers, Sense of belonging and fit-
(Qualitative study [tiab] OR attitude* [tiab] OR motivation* [tiab]
ting in, Pleasurable taste and sensations, and a Substitute for
OR Perception [mh] OR Interviews as Topic [mh] OR Focus Groups
[mh] OR Qualitative research [mh] OR Social Perception [mh] AND healthy coping mechanism.
(english[Filter])) AND ((Cigarette Smoking [mh] OR JUUL* [tiab] OR
Tobacco Use Disorder [mh] OR vaping [mh] OR Electronic Nico- Introduced by siblings and peers
tine Delivery Systems [mh] OR Tobacco Products [mh] OR Tobacco Peer influence and sibling introduction appear to be the pre-
Use [mh] OR Nicotine [mh] OR vaping [tiab] OR E-cigarette [tiab] dominant pathways through which adolescents are initiated
OR electronic cigarette* [tiab] AND (english[Filter])) AND (Young into vaping, a phenomenon that is likely driven by youthful
adult [mh] OR Adolescent [mh] OR Adolescent Behavior [mh] AND
(english[Filter])) AND (english[Filter]))
curiosity and risk-taking behaviours. Initially, adolescents per-
ceive vaping as a practice engaged in by others, as illustrated

Figure 1. Flow diagram of selection of studies process (Tricco et al. 2018).

4 Biles et al.

Table 3. Summary of included studies

Author, year, Aims Sample and study Data collection and Key findings
country population analysis

Alexander et al. To target a hard-to-reach pop- Youth (N = 43), 14–17 yrs Qualitative, focus Four main themes:
(2019), USA ulation: youth who regularly (mean = 15.8 yrs) who groups. 1. Initiation.
use e-cigarettes, exploring and were regular e-cigarette 2. Current and future use.
describing patterns of use, social users. 3. Nicotine.
and familial norms, and percep- 4. Family norms and perceptions.
tions of health effects.
Cheney et al. The objective of this study was Undergraduate univer- Overall study— Compared vaping to more harmful
(2021), USA to determine the association sity students (N = 51), explanatory habits like cigarette smoking and
between three types of beliefs 18–24 yrs who used sequential downplays health risks. Aware of
about JUUL use (risks to JUUL at least once a mixed-method potential lung damage and concerns
individual health, control by the week. design. Qualita- minimized by trust in the product’s
tobacco industry, and harm to tive component, regulation and quality from reputa-
others) and intentions to reduce semi-structured ble manufacturers.
or quit JUULing. interviews.
Gupte et al. This qualitative study explored Adolescents (N = 24), Interviews, thematic Four main themes:
(2022), India adolescents’ perceptions and 11–16 yrs (14 male, analysis. 1. Knowledge about e-cigarettes.
practices to gain a better 10 female) who were 2. Initiation of and continued use.
understanding of e-cigarette use current users of 3. Patterns of use.
among school-going adoles- ­e-cigarettes. 4. Harmful health effects.
cents.
Kechter et al. The current study analyses data Undergraduate univer- Semi-structured Two main themes:
(2022), USA from young adults who vape sity students (N = 62), interviews. 1. Pairing vaping with routine.
and how they describe their 18–25 yrs (M-20.9 yrs) ­Lifestyle behaviours.
relationship with food and or vaped at least once 2. Vaping as a tool in appetite
weight in the context of vaping. per week. ­suppression.
Young adults are relying on vaping
when studying to help concentrate
and using vaping as food replacement
to manage weight, suppress appetite,
and avoid binge eating.
Robertson et To examine Electronic Nicotine Young adults (N = 16), Semi-structured, Two psychosocial themes:
al. (2022), New Delivery Systems (ENDS) 18–24 yrs (9 males, in-depth inter- 1. Connection and belonging.
Zealand uptake among young adult 7 females) who were views, thematic 2. Balancing social cachet and stigma.
­never-smokers to develop a current ENDS users. analysis. Three functional themes for ENDS use:
richer understanding of their 3. Stimulation and engagement.
lived experiences of ENDS use. 4. Self-management.
5. Rationalizations relative to
­smoking.
Sandhu et al. To document the social factors Latino college students Semi-structured Two main themes with sub-themes:
(2023) USA encouraging and discouraging (N = 20), 18–24 yrs interviews, the- Factors that contribute to e-cigarette
e-cigarette use amongst Latino who were current or matic analysis. use in regular and infrequent smok-
college students. infrequent e-cigarette ers.
users. (Mean age regular 1. Repeated peer exposure to
users = 21.1 yrs; Mean ­e-cigarettes.
age infrequent = 20.9 2. Scepticism of the harmfulness of
yrs). recreational e-cigarette use.
3. Disagreement with familial views
of substance use.
Factors that deter e-cigarette use in
regular and infrequent smokers:
1. High costs.
2. Weak nicotine euphoria.
3. Evidence of health risks.
Schiff et al. To explore with young adults who Young adults (N = 61), Interviews, content Four main themes:
(2021), USA vape to better understand how 18–25 yrs, 13 females, analysis. 1. Early experimentation of
they obtained vaping prod- 48 males (Mean = 20.9 ­e-cigarettes with peers often
ucts while underage, and their yrs). occurred in a school setting.
thoughts and opinions on access 2. Continued use of e-cigarettes com-
to vaping products for young monly obtained through peer sales.
people. 3. Inconsistent implementation of age
restrictions at in-person retailers.
4. Inconsistent implementation of age
restrictions at online retailers.
Adolescents and young adults using nicotine vapes 5

Table 3. Continued

Author, year, Aims Sample and study Data collection and Key findings
country population analysis

Simpson et al. We aimed to better understand Young adults (N = 62), Semi-structured Two main themes:
(2021), USA how young adults who vape 18–25 yrs, (Mean = 20.9 interviews, the- 1. Nicotine/tobacco dependence
experience, manifest, develop, yrs), 49 males, 13 matic analysis. a. Cravings and urgency to use.
and conceptualize symptoms of females. b. Increased quantity and fre-
dependence in their everyday quency of use to achieve desired
lives. effects.
c. Unsuccessful quit attempts and
withdrawal symptoms.
2. e-cigarette dependence
a. Greater nicotine consumption
due to ease of accessibility and
lack of vaping restrictions.
b. Habitual vaping: Inability to
track vaping frequency.
c. Immediate gratification and
comfort from vaping devices
d. Social acceptability and chang-
ing norms.
e. Awareness of vaping depen-
dency.

by these quotes ‘… My sister [gave me my first one]. She does Furthermore, the propensity for risk-taking, a characteris-
it or she did it a lot in the house’ (Alexander et al. 2019, p. tic trait during adolescence, not only contributes to the initi-
96) and ‘…like when I came here to [school], I see it, every- ation of vaping but also sustains it. This is evidenced by the
one does it’ (Sandhu et al. 2023, p. 1559). This suggests that frequent instances of adolescents violating legal age restric-
vaping enjoys a level of social acceptability that traditional tions to procure vapes, as illustrated by the following quotes:
combustible cigarettes do not. This perception is further rein- ‘Super easy. I was definitely underage when I bought it, but I
forced by a general lack of knowledge about the potential went to the local store by my high school that everyone went
harms associated with vaping. Many adolescents rely on their to and I [asked], Can I get an e-cig? And [the store clerk]
peers: ‘Well, I actually don’t know. My friend, she said there [asked], Are [you] 18? And I [said], Yeah but don’t have my
wasn’t any [harmful effects]’ (Alexander et al. 2019, p. 95) or driver’s license [with me]’ (Schiff et al. 2021, p. 839). It is
social media for information when deciding to initiate vaping: also noteworthy that adolescents often circumvent the law
‘I was [in] high school, working out, and there was some guy to provide vapes to their younger peers: ‘People get [vapes]
online who was saying like…This is good if you have cravings shipped from Arizona [a state where you purchase vaping
for dessert. You get a chocolate flavor, and instead of having products at 18 years instead of 21], so they get [a vape] for
to eat a whole chocolate cake, you can take like 2 puffs, and $20 [from Arizona] and sell [the vape] to their friends for $24
you’ll be fine’ (Kechter et al. 2022, p. 3). [in California]’ (Schiff et al. 2021, p. 838). Vaping is a social
bonding activity, used as a group bonding activity: ‘and then
Sense of belonging and fitting in we’ll just pass it around kind of thing’ (Robertson et al. 2022,
The initiation sub-theme is heavily mediated by young peo- p. 4).
ple seeking a sense of belonging and desire to fit in, which
became an additional motivator for young people to try and Pleasant flavours and sensations
keep using vapes ‘I guess I just saw some of my friends doing The flavours and scents of vapes increased their appeal:
it, and I hit theirs’ (Sandhu et al. 2023, p. 1559) and ‘I only ‘when it went in my mouth it tasted like strawberry, it felt
do it because my friends do it’ (Alexander et al. 2019, p. 95). as if I ate a strawberry’ (Gupte et al. 2022, p. 2993) and
The psychosocial dynamics of adolescence can create an envi- ‘I’ve got a black one. Just because it was a sleek looking
ronment where vaping is perceived as a means of fostering kind of thing… it’s just my kind of style’ (Robertson et
connection and achieving a sense of belonging and fun ‘…it al. 2022, p. 5). Some young people acknowledged that the
is best to vape with friends… when using alone it is not fun; diverse flavours are a key factor that keeps them engaged
with friends it is comedy’ (Gupte et al. 2022, p. 2994). in vaping:
The initial passive exposure to vaping among adolescents
eventually succumbs to their inherent curiosity, leading them … there’s lots of flavours out there, which I’m looking to
to experiment with it ‘Yeah, just regularly seeing it. Like try… lots of blends of fruits and menthol and everything…
nobody ever forced me to do it. It [repeated exposure] just there’s lots of, like, really interesting flavours, like custard
built interest’ (Sandhu et al. 2023, p. 1559). The pleasant pie and there’s a Turkish delight one, which looks really
smell of the vapours also aroused curiosity and contributed nice, and, um…just all these different desserts you can get
to adolescent interest in trying vaping ‘It just has a really (Robertson et al. 2022, p. 6).
nice smell which is, I think, the reason why people want to
try it because it just smells so good’ (Robertson et al., 2022, Vaping is used to seek external validation by doing tricks
p. 6). with the exhaled vapour ‘when we post photos or videos of
6 Biles et al.

Figure 2. Thematic map demonstrating the relationship between the themes and sub-themes.

e­ -cigarette smoke, we get likes’ (Gupte et al. 2022, p. 2993) Strong cravings
and ‘That’s still sort of why I only do it, is to sort of get the Central to young people’s conversations surrounding vaping
tricks and stuff. My friends are always really impressed’ were the strong cravings. The cravings were unexpected and
(Robertson et al. 2022, p. 5). often resulted in higher doses of nicotine being required: ‘I have
50 [mg] cause I started with the 30 and then I was like let me
Substitutes for healthy coping mechanisms go up and see if I can feel any more light-headedness and I do’
Young people reported the use of vapes to help with social (Simpson et al. 2021, p. 4) to attain the level of satisfaction that
anxiety ‘… just keeps you busy when you’re in a crowd and they were seeking. There was a clear progression in the dos-
stops you from getting, I don’t know, bored and awkward’ age requirements to attain a nicotine craving or abate an emo-
(Robertson et al. 2022, p. 7) and for relaxation and stress tional discomfort: ‘There was a period where I really craved the
relief ‘…if I was stressed during classes or during an essay or Suorin [vaping device] because it became a thing where if I was
something or some homework, I would definitely take a puff, stressed during classes’ (Simpson et al. 2021, p. 3).
get lightheaded, feel my whole body relax…’ (Simpson et al. Some young people described the cravings as being so strong
2021, p. 3). A proportion of young people, both male and that their vape needed to always be accessible: ‘The worst thing
female, admitted starting to vape with the express purpose of is like - first thing in the morning, it’s under my pillow. This
using the stimulant effects of nicotine to control their appetite is my [rock] bottom, it’s under my pillow [when I sleep so I
and weight: can use it] first thing in the morning’ (Simpson et al. 2021, p.
5). While other young people use the vape for a specific pur-
The reason I started [vaping] was because it suppressed pose, like weight loss and often as a coping strategy: ‘I was
my appetite. [When] I was a freshman in college, and I pretty heavyset when I was [vaping] a lot, I lost all the weight,
[was] very into LA, [and] never had a very positive body stopped vaping, and when I broke my leg, I couldn’t exercise,
image of myself, and [vaping] made me lose a lot of weight started vaping again, gained the weight back, and now it’s kind
(Kechter et al. 2022, p. 3). of hard for me to put it down’ (Kechter et al. 2022, p. 4) the
onset often triggers an ongoing addiction to vaping and other
Vaping was a prop for healthy coping mechanisms and conditions. For many of the young people who engage with
often led to additional addiction problems for young people vapes to suppress appetite, the practice turns into a disordered
(Simpson et al. 2021, Kechter et al. 2022, Robertson et al. eating behaviour ‘I vape to the point where it suppresses my
2022). appetite, so unfortunately, I wake up at two in the morning
Theme 2: Addiction and withdrawal most nights and gorge on food’ (Kechter et al. 2022, p. 3). The
impact of addiction on the lives of young people is powerful.
Central to the studies included the overriding addiction that
vaping presented to young people and the often-unsuccessful
attempts at withdrawal. This theme consisted of three sub- Overriding side effects
themes: strong cravings, overriding side effects, and with- The addiction was cited as hosting a variety of side effects
drawal attempts. that impacted their lives. When a vape was not accessible,
Adolescents and young adults using nicotine vapes 7

the craving created intense emotions and physical sensations behaviour of young people. Quite simply, they became an easy
that young people struggled to navigate (Simpson et al. 2021, addition to the lives of young people. However, this did not
Kechter et al. 2022, Robertson et al. 2022): ‘I’ve really felt that deter them from considering their parent’s/carers’ responses:
a lot where I get irritable like damn, I really wish I had my ‘[My mother’s] first thing would just be like, “Why are you
vape right now…and overriding emotional and physical with- doing that? It’s not good at all. [Her approach is] More like
drawal symptoms’ (Simpson et al. 2021, p. 3). This created you should stop versus you should find out by yourself”’
situations that triggered the ongoing addiction: ‘If I did not (Sandhu et al. 2023, p. 1561). Despite such consideration,
vape, I would always get mad… get too angry. That flavor… vapes remain hidden.
there is something in that flavor, which gets you addicted’ [9th
Grade participant] (Gupte et al. 2022, p. 2995). Vaping is hidden
Regardless of the reasons why a young person engaged in The act of vaping, although accessible, was known to be a dis-
vaping, the addiction and ongoing cravings were the stimulus cerning choice, with young people being advised to keep the
that sustained the practice: ‘I think by the end of that semester act and the device hidden from parents/carers: ‘I kept it in my
it became less of something I did to “release stress” because cupboard. My brother asked me to hide it from our parents’
of the head buzzes’ (Simpson et al. 2021, p. 3). Participants (Gupte et al. 2022, p. 2994) in places that were known areas
named the overriding cravings: ‘It’s crazy because we call that were safe from prying eyes: ‘kept it in my schoolbag; no
“fiending” when you just, really want to hit something and one touches my bag’ (Gupte et al. 2022, p. 2994). Keeping the
you can’t’ (Simpson et al. 2021, p. 3). device hidden was important, but engaging in the act in a pri-
vate place was also of importance to young people: ‘We bring
Withdrawal attempts it to school sometimes and use it in the school washroom’
Withdrawal was attempted by many young people in their (Gupte et al. 2022, p. 2994). Despite vapes being a part of
studies. However, due to the level of addiction and overrid- young people’s socialization, friendship groups and families
ing side effects, attempts were often unsuccessful: ‘This past (Simpson et al. 2021, Kechter et al. 2022, Robertson et al.
summer… I tried quitting on a family vacation…I was really 2022) they ultimately knew the act was dangerous and thus
killing the vibe for the rest of my family so I went two full took to extensive lengths to keep the vaping hidden.
days without [vaping]and honestly on that second day I was
like I know that I can do this. I know that I can drop it, but I Shaming vs reluctance to acceptance
don’t know how to stop myself from being irritated and angry Despite the lengths taken to hide vapes, inevitably, families/
when I’m off of it’ (Simpson et al. 2021, p. 4). carers were made aware either by schools and/or family
The physical side effects impacted school and home life: ‘I members. While some families wanted young people to com-
get headaches, I get more irritated, it gets a little harder for pletely abstain from vaping, others reluctantly accepted the
me to concentrate in class’ (Simpson et al. 2021, p. 5). Young habit (Sandhu et al. 2023). Parents/carers took on an often-­
people described self-withdrawal strategies involving a grad- ineffective approach by shaming vapers outside of the family:
ual decline in vaping: ‘I’m going to go through some sort of ‘She’ll [My mother] bring up other people, you know. Outside
withdrawals if I try to cold turkey it or wean myself off of it of family members. She’ll say, ‘Look at them. They are just
less and less’ (Simpson et al. 2021, p. 5). Vaping withdrawal being hooligans”’ (Sandhu et al. 2023, p. 1561).
was isolated, often completed without the support of health Other approaches included reluctant acceptance, where
professionals and/or family/carers. Young people were height- parents compared risk-taking behaviour and chose to accept
ened to the impact and effects of withdrawal, with some the habit: ‘My mom smacked me. Now she’s okay with it’
actively discouraging withdrawal: ‘Sometimes if I have diffi- (Alexander et al. 2019, p. 96) and ‘My mom doesn’t trust it
culty sleeping and I know I’ve been using it more, I’ll be like either, but she told me that she’d rather me be doing that than
“it’s probably the nicotine withdrawal”’ (Simpson et al. 2021, other bad things’ (Alexander et al. 2019, p. 96). As previously
p. 5). It was clear that withdrawal was of concern to young cited, some family members actively encouraged vaping, even
people and even feared: ‘I rip it so many times throughout the resorting to purchasing the device for young people: ‘My dad
day that I am scared to stop’ (Simpson et al. 2021, p. 5). gave me my first one, so’ (Alexander et al. 2019, p. 96), rather
than engaging in other risk-taking behaviour.
Theme 3: Response from parents/caregivers
Young people in the included studies were cognisant of the
views (either perceived or actual) (Simpson et al. 2021, Gupte DISCUSSION
et al. 2022, Sandhu et al. 2023) of their parents/caregivers. This scoping review aimed to develop a comprehensive under-
This theme hosted three sub-themes that provide context to standing of the perceptions, motivations, and experiences
the response to vaping from parents/caregivers. associated with nicotine vaping among youth. Through three
key and interrelated themes, we identified that young peo-
Parents knowledge ple and adolescents have knowledge and rationale for vaping
Young people reported that their parents and/or carers which generates a sense of belonging with their peers. Once
were not knowledgeable about vaping: ‘Obviously like an vaping, they often struggle with addiction and withdrawal
­e-cigarette, like it’s fairly new. Didn’t they like pop up, like and may use vaping as a coping mechanism. Adolescents and
2018 or 2016, or something like that?’ (Sandhu et al. 2023, young people are cognisant of the views of parents/caregivers
p. 1561). They attested this to both the currency of the prod- in vaping who may require support in developing knowledge
uct as well as the product adaptability: ‘If you were to show on the mechanism of vaping.
them [parents] like a dab pen or e-cigarette, they wouldn’t be A clear finding from this review is that adolescents and
able to tell the difference’ (Sandhu et al. 2023, p. 1560). This young adults are often introduced to vaping through sib-
made the vapes accessible and responsive to the risk-taking lings and peers or social media with a clear motivation to
8 Biles et al.

be included. The influence of peers on determining the may induce epigenetic modifications and heighten stress sen-
behaviours of others is not new. Social learning theory pos- sitivity, potentially contributing to the onset of mood disor-
its that people learn from one another through observation, ders, schizophrenia (Quigley and MacCabe 2019, Riehm et al.
imitation, and modelling (Bandura 2021) where the deci- 2019), and substance use disorders (Iniguez et al. 2009, Yuan
sion to adopt a behaviour depends on perceived benefits and et al. 2015). Our findings are consistent with research indi-
drawbacks. It has been well established in the literature, for cating that vaping may serve as a marker for mental health
example, that modelling behaviours of parents and friends behaviour risks (Becker et al. 2021). In addition, reliance on
can influence adolescents’ smoking behaviours and can also nicotine as a coping mechanism can impede the development
influence the selection of peers (Dickter and Forestell 2012, of healthy adaptive coping skills (Turliuc et al. 2024), which
Vitória et al. 2020). Early intervention/prevention programs is why early, multi-modal intervention strategies with com-
such as ‘Just Say No’ (Meredith et al. 2021) or ‘CATCH My prehensive support are recommended to help youth navigate
Breath’ (Baker et al. 2022) have been successful in increasing the transition into adulthood and reduce the risk of future
youths’ knowledge of the harmful effects of substance use and substance use.
addiction and may lead to a decrease in uptake. Exploring A clear finding of this review is that if an adolescent
the role of social learning theory in the context of vaping, attempts to withdraw from vaping, it is usually attempted
where social networks are leveraged, could provide insights alone, without peers, family, or health professional support.
into how behaviours are modelled and adopted, helping to Recognizing that youth often turn to vaping as a coping
inform strategies that disrupt these patterns. mechanism for mental health, attempting to quit without
Similarly to the findings of this review, social media, which support understandably, frequently leads to failure (Cuccia
is a widely used platform for information sharing and social et al. 2021). Coupled with the severity of known addiction
interaction, simultaneously plays a significant role in influ- and withdrawal symptoms (Soule et al. 2020, Barakat et al.
encing youth to take up vaping (Lee et al. 2021, Vogel et al. 2021) posit the need for research related to withdrawal path-
2024). With limited initial public health messaging of the high ways. Findings from this review support that incorporating
risk of vaping, digital marketing, and social media platforms strategies to help youth withdraw from vaping must consider
have capitalized and contributed to the normalization of vap- factors including social influences, mental health consider-
ing among young people (Jung et al. 2024). There is emerging ations, and the physical symptoms adding to the complexity
evidence suggesting a relationship between smartphone use of withdrawal. Recognized as a public health concern (Berg et
and smoking behaviours (Oh and Heo 2024) raising the ques- al. 2021), effective interventions should provide behavioural
tion of whether similar links exist between vaping (chemical) support, such as peer-led programs (Chu et al. 2021, Wyman
and social media (digital) addictions. Social media also poses et al. 2021) and educational initiatives that target the harmful
a realistic and attainable mode to disseminate information effects of vaping, enhancing harm perceptions among young
regarding the risk associated with vaping not only to adoles- people, which are positively associated with quit attempts
cents and young people but also to their communities such as (Cuccia et al. 2021). Technology-based interventions, includ-
parents and carers. ing text messaging programs (Graham et al. 2022a, 2022b,
Educational campaigns that address the misconceptions Graham et al. 2024), YouTube and TikTok (Rahmann et al.
among young people about the safety of continued vaping are 2024) and gamification approaches (Berg et al. 2021), have
warranted. This review indicates that adolescents and young shown promise in engaging youth and promoting sustained
people are not always aware of the risk associated with vap- cessation. Grant et al. (2019) highlight the complex nature
ing. These campaigns should focus on presenting credible of vaping and its relationship to other substance addiction.
information and evidence (Lee et al. 2024), correcting the It is reasonable, therefore, to also consider interventions that
narrative that vaping is harmless and emphasizing the long- have proven successful in addressing addiction. For exam-
term health risks (de Carvalho et al. 2024) and in a mode ple, non-pharmacological interventions such as cognitive
that is acceptable to the target audience, for example, social behavioural therapy (Lachance and Frey 2020) and mind-
media rather than calling a Quitline (Rahmann et al. 2024). fulness have been demonstrated to reduce cravings, stress
Public health messaging should strategically target vaping reactivity, and reward sensitivity in various substance use dis-
prevention and cessation support among youth and young orders (Balconi and Angioletti 2021).
adults by considering the influence of message elements, the
credibility of sources, the choice of communication channels,
and the specific characteristics of the audience (Wu et al. LIMITATIONS
2024). In addition, campaigns to support parents’ and care- There are a few limitations to this review that are worth
givers’ knowledge are needed. Campaigns such as P-EVER mentioning. We only included studies published in English,
(Abraham et al. 2024), an educational infographic for parents which means we might have missed important perspectives
and families of adolescents and young people, have been evi- from non-English-speaking countries and different cultural
denced as providing strategies in commencing conversations settings. Given that the review relies on self-reported data,
around vaping risk, withdrawal, and cessation. Extending there is a possibility that participants may not have fully dis-
such resources to include conversations around coping mech- closed their experiences or feelings, which could affect the
anisms would further support adolescents and young people. accuracy of the findings. Since we excluded quantitative data,
An important finding from this scoping review suggests this limits our ability to assess just how widespread these
that vaping is being used as a coping mechanism. During ado- behaviours or issues are among young people. Although we
lescence, brain regions integral to executive functions, such concentrated on the experiences of young people, we did not
as decision-making and impulse control, are significantly explore how factors like gender, socioeconomic background,
restructured, modulated in part by nicotinic acetylcholine or geographic location might influence their vaping experi-
receptors (Yuan et al. 2015). Prolonged nicotine exposure ences. These gaps underscore the need for further research
Adolescents and young adults using nicotine vapes 9

to comprehensively understand vaping among young people Barakat M, Jirjees F, Al-Tammemi AB et al. The era of e-cigarettes: a
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This scoping review provides insight into the perceptions, Becker TD, Arnold MK, Ro V et al. Systematic review of electronic cig-
arette use (vaping) and mental health comorbidity among adoles-
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tance, and the appeal of various flavours. While many are Berg CJ, Krishnan N, Graham AL et al. A synthesis of the litera-
aware of the associated health risks, quitting remains challeng- ture to inform vaping cessation interventions for young adults.
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range from unawareness to unwillingness to accept, high- beh.2021.106898
lighting the need for more public education and intervention Biondi‐Zoccai G, Sciarretta S, Bullen C et al. Acute effects of heat‐
strategies. Developing targeted cessation programs and path- not‐burn, electronic vaping, and traditional tobacco combustion
ways that address both the physical addiction and the social cigarettes: the Sapienza University of Rome‐vascular assessment of
dynamics of vaping is required. Although further research is proatherosclerotic effects of smoking (SUR‐VAPES) 2 randomized
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None declared. enon: a narrative review. Health Psychol Res 2020;8:9463. https://
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impacts of e-cigarette use among medical students at a private uni-
This scoping review explores the use of existing published versity in São Paulo, analysis of influencing factors and long-term
data therefore Human Research Ethics approval is not health implications: a systematic review. Int Seven J Health Res
required. 2024;3:1160–72. [Link]
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