The scenario-based guide is designed to help prevent vaping uptake and support nicotine cessation in both adolescents and adults.
Practical, patient-centred strategies to support health professionals address vaping and nicotine dependency are the focus of new guidance released by the Thoracic Society of Australia and New Zealand.
The TSANZ launched its Guidance for the Management of Electronic Cigarette Use, which builds on its 2020 Position Statement on Electronic Cigarettes, with a paper published in Respirology.
In the paper, the authors said the TSANZ “accepts the recommendation for selective use of EC [electronic cigarettes] in smoking cessation attempts within the guidance outlined by the RACGP”, but noted that this “position may change as knowledge accrues”.
“At the same time, the pervasive use of EC for purposes other than smoking cessation is of great concern,” the authors wrote.
“There is widespread use in young people who have never smoked but, just as concerningly, also in persons who have ceased smoking for a long period but remain long-term EC users in a perpetuated pattern of nicotine dependence.
“EC use has proliferated rapidly in Australia and New Zealand. In 2023, an estimated 1.5 million Australians were current EC users, and 400,000 New Zealanders used EC daily. Only 21% of people reported using EC for smoking cessation, and only 13% of people obtained their EC through a prescription pathway.”
They said it was likely that an even smaller proportion of EC use for smoking cessation was accompanied by personalised cessation support (counselling), a key element in cessation success.
The new guidance is designed to offer health professionals across Australia and New Zealand an evidence-informed roadmap for addressing vaping and nicotine dependence in clinical practice.
Specifically, it aims to help clinicians protect their patients’ lung and general health by:
- Preventing EC uptake in children, adolescents and young adults;
- Providing guidance for ceasing EC use in adolescents and adults who have never smoked;
- Providing guidance for ceasing EC use in people who currently or formerly smoke(d) who now use EC long-term.
Professor Matthew Peters, Professor of Respiratory Medicine at Macquarie University, said it was an important guideline for all clinicians.
“Vaping-associated nicotine addiction is a problem that has been created by the calculated design of the product, the strategic use of social media platforms, and its ready accessibility in recent years,” he said.
“This guidance helps clinicians counter those forces with informed, patient-centred care.”
Dr Moya Vandeleur, TSANZ Tobacco and Other Substances Special Interest Group convenor and paediatric respiratory physician, warned that modern nicotine addiction was being driven by the deliberate targeting of youth through flavoured, highly concentrated nicotine products packaged to appeal to younger demographics.
Health professionals are urged to challenge the narrative of “freedom of choice” promoted by the vaping industry and instead highlight the reality of corporate profit at the expense of public health.
“Nicotine addiction is simply about the industry getting as many people hooked as possible,” said Dr Vandeleur.
“It’s not a question of choice—it’s a public health issue with severe long-term consequences.”
The TSANZ commended recent regulatory reforms that have curtailed vape availability and restricted flavourings and nicotine content.
However, it called on the re-elected Albanese Labor government to further limit nicotine concentrations and prohibit flavour manipulations, arguing such measures would rapidly reduce smoking and vaping initiation, assist in cessation and prevent relapse among ex-smokers.
The authors of the guidance said most young Australian EC users reported they had a desire to quit and many had already attempted to do so.
“To date there has been minimal research investigating the channels, methods and tools that adolescents use or seek to use for support with EC cessation,” they wrote in Respirology.
“As with tobacco smoking cessation, unassisted or ‘cold-turkey’ quit attempts are reported to be one of the most common methods of cessation of vaping. Adolescents have described self-managing their quit attempts with distraction techniques (including video games), limiting access to an EC (e.g., not buying, or giving away ECs) or avoiding contact with peers who use ECs.
“Adolescents seek advice and support for quit attempts from friends. This suggests that peer networks are a significant factor in the continuation and discontinuation of EC use.”
Nicotine replacement therapy has not been reported as a prevalent EC cessation aid for adolescents, and the use of social media, quit lines and text-based cessation support to assist with quitting has also been shown to be minimal, the researchers said.
“The lack of utilisation of professional cessation support by adolescents highlights the absence of quit support methods endorsed by governing bodies,” they wrote.
“This further suggests that resources and quit messaging must be effectively tailored and delivered to resonate with this demographic.”
Research into how adults attempt to quit EC remains limited. A US survey found that most adults try to quit unassisted or by reducing their use, such as lowering nicotine levels or puff frequency.
Some also turn to pharmacological aids like nicotine replacement therapy or varenicline and seek clinical support. There is growing interest in digital tools, including smartphone apps, live counselling and text message support.
“Further research on quitting vaping in adults and youth is urgently required,” the researchers wrote.
“This should assess the context and setting of the intervention, as well as the intensity and frequency of behavioural support and type, strength and duration of pharmacotherapy and NRT.”
Despite the apparent lack of support, the news is not all grim. According to the researchers, “several well-designed clinical trials are currently underway exploring a range of behavioural interventions for EC cessation, but results and clinical translation are pending”.
“Many are focused on adolescents, but research is also needed on adults and those who both smoke and use ECs (‘dual use’).
“The well-powered RCT of text message intervention, ‘This is Quitting’, for EC cessation in young adults demonstrated a 39% increase in 30-day abstinence but is only available in the US.”
The guideline examines existing supports that can help a person quit the EC habit – including counselling, and the use of services such as Quitline and a new interactive e-learning resource for clinicians developed by the Sydney Children’s Hospital Network, known as the KidsQuit: e-cigarettes program.
Other resources include iCanQuit, Alcohol and Drug Foundation, Headspace and the eheadspace support service in Australia.
The guidance also discusses the use of medications for smoking cessation “which, by extrapolation, can be used ‘off label’ for EC cessation (currently there are no TGA or MedSafe approved medications for EC cessation)”.
It also offers advice on how to approach patients using EC to start the conversation about cessation.
“Patients may feel guilt or be fearful of judgement about their EC use,” the authors wrote.
“Experiencing guilt or shame is a powerful barrier to developing effective clinical relationships and seeking timely help in future encounters. Population groups that feel socially excluded are more likely to have low levels of interpersonal and institutional trust.
“Even the anticipation of stigma is negatively associated with levels of trust in clinicians, communication experience, and acceptance of advice to quit smoking.”
