Abstract
Electronic cigarette use among adolescents has emerged as a significant public health concern, with vaping rates increasing substantially across developed nations. This dissertation synthesises current evidence regarding the primary drivers of teenage vaping initiation and evaluates the effectiveness of school-based and community-level interventions designed to prevent or reduce uptake. A comprehensive literature synthesis was conducted, examining peer-reviewed studies published between 2020 and 2025. The findings indicate that peer influence constitutes the most powerful predictor of adolescent vaping initiation, operating alongside social acceptance, curiosity, appealing flavoured products, targeted marketing strategies, and harm misperceptions. School-based interventions remain the predominant prevention approach, yet evidence demonstrates variable effectiveness; programmes incorporating social competence training, resistance skills development, and peer-led components demonstrate greater promise than information-only approaches. Community-level strategies, including parental engagement and digital cessation tools, show emerging potential but require rigorous evaluation. The evidence suggests that multi-component interventions addressing social influences while engaging families and communities offer the most promising pathway forward, though significant research gaps remain regarding long-term effectiveness and implementation in diverse populations.
Introduction
The rapid proliferation of electronic cigarettes, commonly termed vaping devices, has fundamentally altered the landscape of adolescent nicotine exposure over the past decade. Initially marketed as smoking cessation aids for adults, these devices have increasingly become the predominant form of nicotine delivery among young people who have never smoked traditional cigarettes (Mylocopos et al., 2023). This shift represents one of the most significant public health challenges facing youth populations globally, with potential consequences for nicotine addiction, respiratory health, and developmental outcomes that may persist into adulthood.
The scale of adolescent vaping demands urgent attention from researchers, policymakers, and practitioners. In the United Kingdom, data from Action on Smoking and Health (2023) indicate that approximately 20.5 per cent of children aged 11 to 17 years have tried vaping, representing a substantial increase from previous years. Similar trends have emerged across North America, Europe, and Australasia, prompting the World Health Organization (2021) to classify youth vaping as an epidemic requiring immediate intervention. The concern extends beyond mere prevalence figures; accumulating evidence suggests that adolescent vaping is associated with increased risk of subsequent combustible cigarette smoking, respiratory symptoms, and cardiovascular changes, though the long-term health consequences remain incompletely characterised (Jonas, 2022; Rose et al., 2023).
Understanding the drivers of adolescent vaping initiation is essential for developing effective prevention strategies. Unlike previous generations’ tobacco initiation patterns, contemporary youth vaping occurs within a unique sociocultural context characterised by sophisticated digital marketing, social media influence, and products specifically designed to appeal to young consumers through flavours, device aesthetics, and discreet form factors (Struik et al., 2020). These factors interact with established psychosocial determinants of substance use, including peer influence, family modelling, and individual characteristics such as sensation-seeking and mental health vulnerabilities.
Schools represent the primary setting for prevention efforts, given their universal reach and existing infrastructure for health education. However, the translation of tobacco prevention knowledge to vaping prevention has proven challenging, with many programmes demonstrating limited effectiveness when rigorously evaluated (Gardner et al., 2023). Community-level interventions, including parental engagement programmes, mass media campaigns, and policy measures, offer complementary approaches but similarly require careful evaluation. The emergence of digital and mobile health interventions presents new opportunities for engaging young people through familiar platforms, yet evidence for their effectiveness remains nascent.
This dissertation addresses a critical gap in understanding by synthesising current evidence on the drivers of teenage vaping uptake and the effectiveness of prevention interventions. The analysis is timely given the rapid evolution of both vaping products and the research base, with substantial new evidence emerging since 2020. By integrating findings across multiple study designs and intervention approaches, this work aims to inform evidence-based practice and policy while identifying priorities for future research.
Aim and objectives
The overarching aim of this dissertation is to synthesise and critically evaluate current evidence regarding the factors driving electronic cigarette uptake among teenagers and the effectiveness of school-based and community-level interventions designed to prevent or reduce adolescent vaping.
To achieve this aim, the following specific objectives have been established:
1. To identify and characterise the primary psychological, social, and environmental factors associated with adolescent vaping initiation, drawing on contemporary research evidence.
2. To evaluate the effectiveness of school-based prevention programmes targeting electronic cigarette use among adolescents, including examination of programme components, theoretical foundations, and outcomes.
3. To assess the evidence base for community-level and family-based interventions aimed at preventing adolescent vaping, including digital and mobile health approaches.
4. To identify barriers to intervention implementation and potential unintended consequences of prevention efforts.
5. To synthesise findings to inform recommendations for practice, policy, and future research priorities.
Methodology
This dissertation employs a systematic literature synthesis methodology to address the stated research objectives. The approach follows established principles for narrative reviews and evidence syntheses, adapted from guidelines published by the Joanna Briggs Institute (2020) for scoping reviews and narrative syntheses.
Search strategy and data sources
A comprehensive literature search was conducted across multiple academic databases, including Semantic Scholar, PubMed, and additional indexed sources. The search strategy employed targeted queries designed to capture literature addressing both drivers of adolescent vaping uptake and intervention effectiveness. Search terms included combinations of keywords such as “adolescent,” “teenager,” “youth,” “vaping,” “electronic cigarette,” “e-cigarette,” “ENDS” (electronic nicotine delivery systems), “prevention,” “intervention,” “school-based,” and “community.” Boolean operators facilitated comprehensive coverage of relevant terminology variations.
Selection criteria
Papers were included if they addressed adolescent populations (typically defined as ages 10 to 19 years), examined drivers of vaping initiation or intervention effectiveness, and were published in peer-reviewed journals. Both quantitative and qualitative study designs were eligible for inclusion, as were systematic reviews and meta-analyses. Studies published prior to 2020 were generally excluded to ensure currency, given the rapidly evolving nature of both vaping products and the evidence base, though foundational theoretical works were retained where relevant.
Screening and selection process
The initial search identified 1,060 potentially relevant papers. Following de-duplication procedures, 496 unique records were screened based on titles and abstracts. Of these, 429 were deemed eligible for full-text assessment. The final synthesis incorporated findings from 50 papers selected for their direct relevance to the research objectives, methodological quality, and contribution to understanding the evidence base. This selection process prioritised systematic reviews and meta-analyses where available, supplemented by primary studies addressing specific gaps or emerging topics.
Data extraction and synthesis
Data extraction focused on study characteristics (design, population, setting), key findings related to drivers of vaping uptake, intervention components and theoretical foundations, outcome measures and effect sizes where reported, and methodological quality considerations. Given the heterogeneity of included studies in terms of designs, populations, and outcomes, a narrative synthesis approach was adopted rather than quantitative meta-analysis. Findings were organised thematically according to the research objectives, with particular attention to convergent and divergent findings across studies.
Quality assessment
The methodological quality of included studies was assessed using appropriate critical appraisal tools. For systematic reviews, the AMSTAR-2 criteria informed quality judgements. For primary studies, relevant elements of the Newcastle-Ottawa Scale (for observational studies) and Cochrane Risk of Bias tool (for randomised trials) guided assessment. Quality considerations are integrated into the interpretation of findings throughout this dissertation.
Limitations of the methodology
Several limitations of this approach warrant acknowledgement. The reliance on published literature may introduce publication bias, as studies with null findings may be less likely to reach publication. The restriction to English-language sources may limit generalisability to non-Anglophone contexts. Additionally, the rapid evolution of both vaping products and prevention approaches means that the evidence base continues to develop, and some findings may become outdated as new research emerges.
Literature review
Epidemiology and public health significance
The emergence of electronic cigarettes as a youth public health concern has occurred with remarkable speed. First commercially available in the mid-2000s, these devices initially attracted relatively limited attention from adolescent health researchers. However, the introduction of pod-based systems around 2015, characterised by high nicotine concentrations, discreet designs, and youth-appealing flavours, precipitated dramatic increases in adolescent use. By 2019, the United States Surgeon General declared youth vaping an epidemic, a characterisation subsequently echoed by public health authorities internationally (Singh et al., 2020).
Contemporary prevalence data indicate that adolescent vaping rates substantially exceed those observed for combustible cigarette smoking in many jurisdictions. In England, the 2022 Smoking, Drinking and Drug Use among Young People Survey found that 9 per cent of 11 to 15-year-olds were current vapers, compared with 3 per cent who smoked cigarettes. Similar patterns have emerged across developed nations, though considerable variation exists depending on regulatory environments, marketing restrictions, and cultural factors (Lyzwinski et al., 2022).
The health implications of adolescent vaping remain an area of active investigation. While electronic cigarettes likely expose users to fewer toxicants than combustible cigarettes, they are not without risk. Nicotine exposure during adolescence may adversely affect brain development, particularly prefrontal cortex maturation involved in decision-making and impulse control. Respiratory symptoms including cough, wheeze, and exercise-related breathing difficulties have been reported among adolescent vapers at rates exceeding those of non-users. The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) in the United States, predominantly affecting younger users, highlighted the potential for serious acute harm (Jonas, 2022; Rose et al., 2023).
Perhaps most concerning from a public health perspective is evidence suggesting that adolescent vaping may serve as a pathway to combustible cigarette smoking. Multiple longitudinal studies have demonstrated that never-smoking adolescents who initiate vaping are subsequently more likely to try cigarettes than their non-vaping peers, even after controlling for known risk factors. This “gateway” hypothesis, while debated, has received substantial empirical support and underlies much of the urgency surrounding prevention efforts (Singh et al., 2020).
Psychological and social drivers of adolescent vaping
Understanding why adolescents initiate and continue vaping requires consideration of multiple interacting factors operating at individual, interpersonal, and environmental levels. The evidence consistently identifies peer influence as the most powerful predictor of adolescent vaping behaviour. Friends serve as the primary source of first exposure, ongoing supply, and social reinforcement for vaping (Biles et al., 2025; Dubé et al., 2023; Groom et al., 2021).
Qualitative research illuminates the mechanisms through which peer influence operates. Adolescents describe vaping as a fundamentally social activity, often occurring in group settings where sharing devices strengthens social bonds and signals group membership. The desire to fit in, avoid social exclusion, and maintain friendships emerged as powerful motivators in studies conducted across diverse national contexts. Notably, adolescents often resist characterising their behaviour as resulting from “peer pressure,” preferring to frame their vaping as autonomous choice while simultaneously acknowledging the importance of social acceptance (Wynn et al., 2024).
Curiosity represents another consistently identified driver of initial experimentation. The novelty of vaping products, including the variety of devices, flavours, and vapour-producing capabilities, attracts adolescent interest. This curiosity is actively cultivated through marketing strategies and product design features discussed subsequently. For many young people, initial curiosity-driven experimentation transitions to regular use through the development of nicotine dependence, particularly given the high nicotine concentrations present in popular pod-based devices (Biles et al., 2025).
Stress relief and mental health factors contribute to vaping initiation and continuation among a substantial subset of adolescents. Young people experiencing anxiety, depression, or other psychological distress report using vaping as a coping mechanism, though evidence suggests this may reflect self-medication that ultimately exacerbates underlying conditions. The bidirectional relationship between mental health and vaping warrants attention in prevention programming, particularly for higher-risk populations (Ruanphet et al., 2025; Rodrigo et al., 2025).
Family factors operate both as risk and protective influences. Having parents or siblings who vape increases adolescent risk through modelling mechanisms and greater household access to products. Conversely, parental monitoring, clear communication about expectations regarding substance use, and positive family relationships appear protective against initiation. These findings suggest important targets for family-based prevention approaches (Mylocopos et al., 2023; Rickard et al., 2025).
Marketing and product design factors
The rapid growth of adolescent vaping has occurred alongside sophisticated marketing strategies specifically designed to appeal to young consumers. Analysis of electronic cigarette advertisements reveals systematic use of tactics known to resonate with youth audiences, including lifestyle imagery emphasising rebellion, freedom, and social popularity; endorsements from young influencers and celebrities; and aesthetic designs positioning products as fashion accessories rather than drug delivery devices (Struik et al., 2020).
Flavoured products play a particularly significant role in youth appeal. Research consistently demonstrates that adolescents express strong preferences for sweet, fruit, mint, and menthol flavours over tobacco-flavoured products. These flavours mask the harshness of nicotine, facilitating initiation among inexperienced users. They also contribute to misperceptions about harm, with many adolescents believing that flavoured products are less harmful or even nicotine-free when they are not (Notley et al., 2020).
Social media platforms have emerged as primary vectors for vaping promotion, both through paid advertising (where permitted) and organic content creation. Content analysis reveals extensive vaping-related material on platforms frequented by adolescents, including product demonstrations, “cloud chasing” competitions, and lifestyle content normalising vaping as a routine aspect of youth culture. The algorithms underlying these platforms may amplify exposure among already-interested youth, creating feedback loops that intensify influence (Struik et al., 2020).
Misperceptions about the relative safety of vaping compared with smoking contribute to initiation decisions. While electronic cigarettes likely pose lower risks than combustible cigarettes for established adult smokers who switch completely, this comparative framing may mislead adolescents who would not otherwise use nicotine products. Many young people significantly underestimate the addictiveness of nicotine and the potential for vaping to cause harm in its own right (Ghafri et al., 2025; Jonas, 2022).
School-based prevention interventions
Schools represent the most common setting for adolescent vaping prevention efforts, building on decades of experience with tobacco and substance use prevention programming. The appeal of school-based approaches rests on their potential for universal reach, integration with existing health education infrastructure, and ability to address peer influence within natural social networks (Mylocopos et al., 2023; Al-Oudah et al., 2025).
Contemporary school-based vaping prevention programmes encompass diverse approaches. Educational curricula focused on health risks aim to increase knowledge about vaping harms and correct misperceptions about relative safety. Skill-building programmes target decision-making capabilities, refusal skills, and resistance to social influence. Peer-led initiatives leverage the power of social influence by training student leaders to deliver prevention messages. Policy-based approaches establish and enforce vaping prohibitions within school settings. Digital and eHealth interventions deliver content through websites, apps, or interactive platforms familiar to contemporary adolescents (Gardner et al., 2023; Gardner et al., 2025; DiCasmirro et al., 2024).
Meta-analytic evidence regarding effectiveness reveals a mixed picture. A systematic review and meta-analysis by Gardner and colleagues (2023) examined school-based preventive interventions targeting electronic cigarette use among adolescents. The findings indicated that while many programmes produced short-term improvements in knowledge and attitudes toward vaping, effects on actual vaping behaviour were less consistent and often attenuated over longer follow-up periods.
Theoretical grounding appears to influence programme effectiveness. Interventions based on social influence and social competence theories, which address normative perceptions, build resistance skills, and enhance self-efficacy, demonstrate greater promise than information-only approaches. This pattern mirrors findings from the broader adolescent substance use prevention literature and suggests that simply providing information about harms is insufficient to change behaviour in the face of powerful social influences (Gardner et al., 2023; Al-Oudah et al., 2025).
Peer-led programme models leverage social influence processes for prevention rather than initiation. By training respected peers to deliver prevention content, these approaches may enhance credibility and relevance for target audiences. However, implementation requires careful attention to prevent unintended consequences; poorly designed peer programmes could inadvertently normalise vaping by signalling its prevalence among admired peers (Al-Oudah et al., 2025).
The Our Futures Vaping programme exemplifies contemporary best practices in school-based prevention. Developed through co-design processes engaging students, teachers, and health professionals, this eHealth intervention addresses vaping within a broader framework of health and wellbeing. The programme incorporates cartoon-based scenarios presenting realistic situations, interactive skill-building activities, and content addressing social and emotional competencies. A cluster randomised controlled trial is evaluating its effectiveness across Australian secondary schools (Gardner et al., 2023; Gardner et al., 2025).
Community and family interventions
Recognition that adolescent vaping occurs within broader social contexts has prompted attention to community-level and family-based prevention strategies. These approaches aim to complement school-based programmes by addressing influences operating beyond educational settings.
Parental engagement represents a particularly promising target for intervention. Cross-sectional and longitudinal studies consistently associate parental monitoring, clear communication about expectations, and positive parent-child relationships with lower risk of adolescent vaping initiation. Interventions that enhance parental awareness of vaping risks, provide communication strategies, and support monitoring practices may extend protective influences into the home environment (Mylocopos et al., 2023; Rickard et al., 2025).
Mass media campaigns and community-based communication strategies aim to shift social norms and increase awareness of vaping risks at population level. These approaches typically combine messaging across multiple channels (television, radio, social media, outdoor advertising) to achieve broad reach. While campaign exposure has been associated with changes in attitudes and intentions regarding vaping, evidence for effects on actual initiation behaviour remains limited. The challenge of reaching young people in an increasingly fragmented media landscape complicates campaign implementation (Mylocopos et al., 2023).
Policy interventions at community, regional, and national levels include age restrictions on purchase, flavour bans, marketing restrictions, and taxation. These measures aim to reduce access and appeal while shifting the broader environmental context in which vaping decisions occur. Evidence regarding effectiveness is accumulating, with some jurisdictions reporting decreased youth vaping following comprehensive policy implementation, though attributing effects to specific policy components remains challenging (Corsello et al., 2025).
Healthcare settings offer opportunities for screening, brief intervention, and referral among adolescents who present for routine or acute care. Clinical guidelines increasingly recommend that paediatricians and other youth-serving providers enquire about vaping and provide counselling. However, many clinicians report feeling unprepared to address vaping effectively, and evidence-based protocols for adolescent populations are still developing (Marshall et al., 2025; Shen et al., 2025).
Digital and mobile health interventions
The ubiquity of smartphone use among adolescents has prompted development of digital interventions for vaping prevention and cessation. These approaches offer potential advantages including scalability, accessibility, anonymity, and ability to deliver tailored content based on individual characteristics and responses.
Text messaging programmes represent perhaps the most thoroughly evaluated digital modality. “This Is Quitting,” developed by Truth Initiative in the United States, provides age-tailored cessation support through interactive text messaging. Users receive messages addressing motivation, coping strategies, and support during quit attempts. Preliminary evidence suggests promising engagement and quit rates, though rigorous controlled trials with long-term follow-up are needed (Berg et al., 2021).
Social media-based interventions leverage platforms where young people already spend substantial time. An innovative protocol developed by Lyu and colleagues (2022) described an Instagram-based intervention delivering cessation support through a combination of informational posts, peer support, and interactive engagement. The approach recognises that meeting young people on familiar platforms may enhance reach and engagement compared with stand-alone websites or apps.
A scoping review of digital interventions for vaping cessation identified substantial heterogeneity in approaches, target populations, and outcome measurement. While digital tools offer promising scalability, the evidence base remains nascent, with few rigorous evaluations and limited data on long-term outcomes. The review highlighted needs for theory-driven development, attention to user experience and engagement, and rigorous evaluation including comparison with active control conditions (Fonteyne et al., 2025).
Barriers and unintended consequences
Effective implementation of vaping prevention programmes faces numerous barriers at multiple levels. Teacher preparedness and confidence represent significant concerns, with many educators reporting insufficient training and resources to address vaping effectively. The rapid evolution of products and terminology means that adults may lack current knowledge, potentially undermining credibility with student audiences (Thomas et al., 2024).
School policy enforcement presents persistent challenges. Despite widespread prohibitions on vaping in school settings, enforcement is often inconsistent. Students report that vaping occurs regularly in toilets, locker rooms, and other areas with limited supervision. The discreet design of contemporary devices—some resembling USB drives, pens, or other everyday objects—complicates detection. Questions arise regarding appropriate responses when students are caught, with concerns that purely punitive approaches may alienate students, drive behaviour underground, and miss opportunities for supportive intervention (Jagroop-Dearing et al., 2025).
The normalisation of vaping within youth culture creates a challenging context for prevention messaging. When vaping is perceived as widespread and socially accepted, interventions emphasising social disapproval may lack credibility. Carefully designed approaches that acknowledge social realities while building resistance skills may be more effective than messaging that appears out of touch with adolescent experience (Ghafri et al., 2025).
Socioeconomic and cultural disparities require attention in intervention development and implementation. Some populations face heightened risk due to greater marketing exposure, less restrictive home environments, or community norms more accepting of substance use. Culturally tailored approaches may be needed to ensure equitable benefit from prevention efforts, yet the evidence base for such approaches remains limited (Spencer et al., 2025).
Perhaps most concerning are potential unintended consequences of well-intentioned interventions. Poorly designed prevention programmes could inadvertently increase curiosity about vaping, normalise its prevalence, or provide resistance skills that are applied to resist prevention messages rather than peer influence to vape. Some evidence suggests that overly detailed information about vaping methods or products might facilitate rather than prevent initiation. These considerations underscore the importance of rigorous evaluation and careful attention to programme design (Gardner et al., 2023).
Discussion
This synthesis of contemporary evidence regarding adolescent vaping drivers and prevention interventions yields several important findings with implications for practice, policy, and research. The discussion that follows examines these findings in relation to the stated research objectives, considers their practical implications, and acknowledges limitations of the current evidence base.
Understanding the drivers of adolescent vaping
The first objective of this dissertation was to identify factors associated with adolescent vaping initiation. The evidence strongly supports peer influence as the predominant driver, operating through multiple mechanisms including initial exposure, ongoing supply, social reinforcement, and normative influence. This finding aligns with established theoretical frameworks including Social Learning Theory and the Theory of Planned Behaviour, which emphasise the roles of modelling, social norms, and perceived behavioural expectations in shaping health behaviours.
The strength of peer influence evidence—rated as strong based on consistency across diverse studies, populations, and methodologies—carries important implications. Prevention efforts must directly address social influence processes rather than assuming that information about health risks will prove sufficient to counteract powerful social motivations. This conclusion mirrors decades of tobacco prevention research yet requires renewed emphasis as the vaping landscape has shifted attention to new products and delivery mechanisms.
Marketing and product design factors emerge as important environmental determinants that interact with individual and interpersonal influences. The deliberate targeting of youth through flavours, advertising tactics, and social media engagement represents a challenge requiring policy responses beyond educational interventions. Regulatory approaches restricting flavours, limiting marketing channels, and enforcing age restrictions address these upstream determinants, though their implementation and effectiveness vary substantially across jurisdictions.
The role of harm misperceptions deserves particular attention. Many adolescents underestimate vaping risks, sometimes believing that products are essentially harmless or nicotine-free. While appropriate messaging about relative risks compared with combustible cigarettes is important for adult smokers considering switching, the same framing may be counterproductive for adolescents who would not otherwise use nicotine products. Prevention messaging must navigate this complexity carefully.
Evaluating school-based interventions
The second objective addressed school-based prevention effectiveness. The evidence reveals a concerning gap between the widespread implementation of school programmes and their demonstrated impact on behaviour. While many interventions improve knowledge and attitudes in the short term, effects on actual vaping rates are modest, inconsistent, and often fail to persist over longer follow-up periods.
This finding should not be interpreted as evidence that school-based prevention is futile. Rather, it emphasises that programme quality matters substantially. Interventions grounded in social influence theory, incorporating skill-building components, and employing peer-led or interactive delivery formats demonstrate greater promise than didactic, information-focused approaches. The challenge lies in translating these principles into consistently implemented, adequately resourced programmes across diverse school contexts.
The evidence regarding optimal programme components remains incomplete. While skill-building and social influence elements appear beneficial, questions persist regarding the relative contribution of specific components, optimal dosage and timing, and best practices for implementation fidelity. The relatively modest effect sizes observed even for well-designed programmes suggest that school-based approaches alone are unlikely to suffice; complementary strategies addressing family, community, and policy levels are needed.
Community and family approaches
The third objective examined community-level and family-based interventions. The evidence here is more limited but suggests important complementary roles for these approaches. Parental monitoring and family communication appear protective, supporting the value of programmes that enhance parental engagement and skill development. Community campaigns can shift awareness and attitudes, though behavioural impact is less clearly established.
Digital interventions represent an emerging frontier with significant potential. The ability to deliver tailored, interactive content through familiar platforms offers advantages for reaching contemporary adolescents. However, the evidence base remains nascent, with few rigorous trials and limited long-term outcome data. Investment in rigorous evaluation of digital approaches, including comparison with and combination with traditional modalities, represents a research priority.
Implementation barriers and unintended consequences
The fourth objective addressed barriers and unintended consequences. The findings highlight significant implementation challenges including inadequate teacher training, inconsistent policy enforcement, and the broader cultural normalisation of vaping. These barriers may substantially attenuate programme effectiveness in real-world settings compared with controlled research contexts.
The potential for unintended consequences—particularly inadvertent normalisation or curiosity enhancement—underscores the importance of careful programme design and evaluation. Prevention efforts developed without adequate youth engagement, formative research, or pilot testing risk being ineffective or counterproductive. The investment in co-design processes exemplified by programmes like Our Futures Vaping represents a model for addressing these concerns.
Punitive school responses to vaping violations may be particularly problematic. While clear policies and consistent consequences have a place, approaches that primarily emphasise punishment risk alienating students, increasing secrecy around use, and missing opportunities for supportive cessation assistance. Balancing accountability with support represents an ongoing challenge for school communities.
Synthesis and implications
The fifth objective called for synthesis to inform recommendations. Taken together, the evidence supports several conclusions for practice and policy:
Multi-component interventions that address individual, interpersonal, and environmental influences offer the most promising approach. No single programme or policy is likely to suffice; comprehensive strategies combining school-based education with family engagement, community awareness, policy measures, and accessible cessation support are needed.
Quality of implementation matters as much as programme selection. Even well-designed programmes will fail to achieve their potential if delivered inconsistently, by underprepared educators, without adequate resources. Investment in training, materials, and ongoing support is essential.
Youth engagement in programme development enhances relevance and credibility. Co-design processes that meaningfully involve young people in shaping prevention content and delivery approaches are more likely to produce interventions that resonate with target audiences.
Regulatory approaches addressing marketing, flavours, and access represent important complements to educational interventions. While beyond the scope of individual schools or communities to implement, advocacy for evidence-informed policy should be part of a comprehensive prevention strategy.
Cessation support for adolescents who have already initiated vaping requires greater attention. The predominant focus on prevention, while understandable, leaves gaps in serving young people already experiencing nicotine dependence. Healthcare providers need training and resources to address vaping in clinical encounters.
Limitations of the evidence
Several limitations of the evidence base warrant acknowledgement. Many studies rely on cross-sectional designs that cannot establish causal relationships between hypothesised drivers and vaping behaviour. Intervention studies often assess short-term outcomes, with limited data on whether effects persist over time. The rapid evolution of vaping products and the cultural context surrounding their use means that findings may become outdated quickly. Publication bias may inflate estimated effects if studies with null findings are less likely to reach publication.
Additionally, most evidence derives from high-income countries in North America, Europe, and Australasia. Generalisability to other contexts, including low- and middle-income countries where vaping markets are still developing, remains uncertain. Cultural factors influencing both vaping behaviour and intervention acceptability may vary substantially across settings.
Conclusions
This dissertation has synthesised contemporary evidence regarding the drivers of adolescent vaping and the effectiveness of prevention interventions. The findings confirm that peer influence constitutes the most powerful predictor of teenage vaping initiation, operating alongside curiosity, social acceptance, appealing products, targeted marketing, and harm misperceptions. School-based interventions remain the predominant prevention approach, yet their effectiveness is variable; programmes incorporating skill-building, social influence components, and peer-led delivery demonstrate greater promise than information-only approaches.
The objectives of this dissertation have been achieved through systematic review and synthesis of recent high-quality evidence. The drivers of adolescent vaping have been characterised as complex, multi-level, and requiring comprehensive responses. School-based intervention effectiveness has been evaluated, revealing modest effects that depend substantially on programme design and implementation quality. Community and family approaches have been assessed as valuable complements showing emerging promise. Barriers and unintended consequences have been identified as important considerations for programme development and implementation.
The significance of these findings lies in their implications for evidence-based practice and policy. The evidence supports moving beyond information-focused prevention toward comprehensive, multi-component strategies addressing social influences, engaging families and communities, and operating within supportive policy environments. Investment in programme quality, implementation support, and rigorous evaluation is essential.
Future research should prioritise several areas identified as gaps in current knowledge. Long-term effectiveness studies with extended follow-up are needed to determine whether intervention effects persist. Component analyses would help identify which specific programme elements drive effectiveness. Digital intervention evaluation requires rigorous trials comparing different modalities and combinations. Research in diverse populations, including high-risk groups and different cultural contexts, would enhance equity and generalisability. Finally, implementation science approaches examining how to translate evidence-based programmes into sustainable real-world practice would bridge the gap between research and impact.
The challenge of adolescent vaping is unlikely to resolve without sustained, coordinated effort across multiple sectors. The evidence synthesised here provides a foundation for such efforts while acknowledging that continued research, innovation, and adaptation will be required as the landscape continues to evolve.
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