Apps could help people to quit vaping

Vapes are relatively new, very popular, and easy for almost anyone to access. With increasing concerns about their safety, there is more interest in helping people to quit vaping, but there is limited evidence on how to go about quitting.

The increasing use of electronic cigarettes (e-cigarettes or vapes) is a major public health issue, with growing concern regarding potential links between vaping and lung, heart, and brain damage as vapes often contain cancer-causing agents, toxins, heavy metals, and very fine particles. There is also concern that vaping leads to an increase in nicotine addiction, as people who vape are more likely to take up tobacco smoking or other drug use than people who do not vape (here and here). Young adults and teenagers disproportionally comprise the vaping population in Australia, where 19.8% of people aged between 18 and 24 vape, compared with 8.9% of the population over the age of 14.

The Australian Government has recently legislated significant reforms to limit the accessibility of vapes. The reforms remove single-use disposable vapes from retail sale and prevent the vaping industry from targeting young people with digital marketing, enticing flavours, and colourful packaging. Although these reforms are positive and welcomed by public health professionals, many young people already using or addicted to vapes will need help to quit vaping.

There is currently limited evidence on the success of vaping cessation interventions (here and here). Research exploring how people quit smoking has found mobile phone-based interventions are effective and acceptable among young people. Nearly all (99%) of young people in Australia have a smartphone, meaning that phone-based programs designed to assist people to quit vaping could be a potential cessation tool, in addition to support and advice from a medical practitioner. Preliminary research shows that apps are acceptable or preferred as a vaping cessation tool for people aged 14 to 25 years.

Given the recency of vaping as a health issue, there has been limited research on the use of apps for vaping cessation. A review published in 2020 found that most vaping-related apps available on Google Play promoted vaping (eg, they provided instructions on creating e-liquids, finding stores that sell vaping products), and only 3% were for the purposes of supporting vaping cessation. A subsequent Canadian review identified only eight apps that were available on both android and iOS platforms that had been created for vaping cessation.

As medical practitioners are increasingly seeking ways to support people to quit vaping, there is a great need for information on both the quality and behaviour change potential of vaping cessation support apps. Our study aimed to assess vaping cessation apps available in Australia.

Current vaping cessation apps available in Australia

As part of our research, we searched the Australian Apple iTunes and Google Play stores in May 2023 to identify apps for quitting vaping. All apps that were designed to encourage or promote vaping cessation were included. All apps were downloaded for use on an iPhone or Samsung android phone.

We used two scales to rate the apps. The first was the Mobile App Rating Scale, a form of measurement that examines 19 app elements across four domains: engagement, functionality, aesthetics, and information to determine app quality. The second was the App Behaviour Change Scale, which incorporates 21 items and was used to examine the app’s potential to support behaviour change in relation to goal setting, action planning, barrier identification, self-monitoring, and feedback.

Overall ratings

The highest rated app overall was the iOS app Quit Smoking: Stop Vaping app. This had 19 out of 21 features known to help people change behaviour.

The highest rated app for android devices was Quit Tracker: Stop Smoking, with 15 behaviour change features.

The highest rated app for both android and iOS users was the QuitSure Quit Smoking Smartly app. This had 15 behaviour change features for iOS users and 14 for android users.

Provisional guidance to general practitioners

Individuals may seek advice from their GP to assist them with quitting vaping. Although the treatment approaches for tobacco cessation are long established, until recently, there has been limited guidance for clinicians. The recent provisional guidance from the Royal Australian College of General Practitioners has upgraded the evidence for the use of e-cigarettes in cessation of tobacco smoking from low to moderate certainty. However, since e-cigarettes remain an unapproved therapeutic medicine with unclear long term health impacts, the decision to use e-cigarettes to manage nicotine addiction must therefore be made based on an individual’s personal circumstances and medical history (here). 

The provisional guidance recommends that GPs:

• avoid prescribing disposable vapes;
• use the Authorised Prescriber and Special Access prescribing schemes;
• avoid prescribing free-base liquid nicotine at concentrations over 20 mg/mL;
• limit the quantity of nicotine vaping products to a maximum of 3 months’ supply;
• avoid vape flavours, or limit them to mint, menthol or tobacco; and
• provide follow-up and behavioural support.

The provisional guidelines also state that smartphone apps and the “This is Quitting” text messaging program have demonstrated positive early results in reducing vaping among youth (here).  

It is important that vaping cessation apps are developed with an understanding of their target audience and in collaboration with users and clinicians. Users from different age groups will require different features to support their vaping cessation efforts, particularly as they may have different patterns and motivations for vaping.

In Australia, 10.7% of 14–17-year-olds are dual users of tobacco and vapes. Therefore, apps that provide dual support for both vaping and tobacco cessation could be beneficial for some audiences. However, rather than simply adding vaping cessation to existing tobacco smoking cessation app titles, it is important for app developers to create apps with this dual purpose in mind.

Finally, it is important to consider the barriers to uptake of vaping cessation apps. Although most of the apps identified in our study were free, many had in-app purchases to access additional features. If a user is unwilling or cannot afford to pay for the additional features, the effectiveness of the app may be compromised. It is important that cost is not a barrier for people to access health apps and the full level of support for vaping cessation.

A person’s efforts to quit vaping using apps need to be undertaken with medical advice from their GP.

Associate professor Fiona McKay is a public health researcher in the School of Social Development and Institute for Health Transformation at Deakin University.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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