Quitting the quit-aid: people trying to stop vaping nicotine need more support – here are some strategies to help

New Zealand is among a number of countries that encourage vaping (the use of e-cigarettes) as a tool to help people stop smoking tobacco. But what happens when people want to quit vaping?

Nicotine vapes can be addictive. While they have helped many New Zealanders quit smoking cigarettes, others – including people who never smoked – now find themselves wanting to quit vaping.

To better understand how and why people try to quit, we surveyed more than 1,000 people in Aotearoa New Zealand who have used nicotine vapes.

The findings from our study point to a need for support that treats vaping cessation like quitting smoking because for many, the challenges are similar.

We focused on New Zealanders aged 16 and over who had vaped nicotine. Of the 1,119 respondents, 401 currently vaped and 718 had quit vaping. Around one in eight had never smoked tobacco at all.

We found using vapes for more than two years and with nicotine concentrations above 3% was linked to higher dependence on vaping. Most current or past vapers wanted to stop, and more than three-quarters of participants had made up to three serious attempts to quit vaping.

How people try to stop vaping

Some people wanted to quit vaping because what began as a tool to support quitting smoking has become a new source of frustration or worry.

The most common reasons to stop vaping were concerns about current or future health, disliking the feeling of being dependent, and the cost of vaping products. These motivations echo the reasons many people cite for quitting smoking, suggesting that people who vape (like most people who smoke) do not want to remain hooked on nicotine, even if it helped them quit cigarettes.

Participants used a variety of strategies to quit, including abrupt cessation (“cold turkey”), switching to other forms of reduced-harm nicotine (such as nicotine patches, gums, lozenges, mouth sprays), and tapering down nicotine levels. Many also relied on support from whanau (family) and friends.

These strategies mirror those used in smoking cessation.

Our participants reiterate the importance of personal strategies, building on previous work on interventions that target vaping cessation.

Some people did quit vaping and had no problem quitting. However, others struggled. Triggers that cause a relapse to vaping are similar to those many people who smoke experience, including stress and symptoms of nicotine withdrawal.

Being around others who vape is also a trigger for relapse. These factors highlight the social and psychological effects of vaping, just as they have long been recognised in tobacco addiction research.

Importantly, these triggers appeared consistent across different groups regardless of age, gender, cultural background or smoking history. Whether someone vaped to stop smoking or whether vaping was the first nicotine product they tried, quitting came with similar challenges.

Better support for vaping cessation

Our study suggests many New Zealanders are now trying to quit nicotine vapes, and some face real barriers to doing so.

We think existing smoking-cessation support and medications could play a useful role. These tools include behavioural support, such as building self-belief in the ability to quit, identifying key triggers (and strategies to avoid them), stress management strategies, and access to tapering schedules (cutting down the frequency of vaping over time or gradually reducing nicotine concentration).

As previous work shows, the type of support needed may differ between older tobacco smokers and the growing population of teens taking up vaping.

Vaping as an exit from tobacco smoking should still be offered to people who smoke. Once vaping is taken up, it should be promoted as a medium-term, step-down tactic (3–12 months), while ensuring that relapse to smoking is avoided. Such a strategy aligns with vaping-cessation guidance provided in the United Kingdom, Canada and New Zealand.

But it’s clear the landscape has shifted. Vaping is no longer just used to quit smoking; vapes are used by people who have never smoked.

For some, vaping becomes a habit they want to quit in its own right, but it may not always be easy given the addictive nature of nicotine. We need dedicated support for vaping cessation to address this growing concern.

Findings from our survey have been key to the development of a New Zealand vaping-cessation clinical trial currently underway. People who are interested in quitting vaping can find out more and register their interest.

This study was supported by a grant from the University of Auckland, Faculty of Medical and Health Sciences Research and Development Fund.

Amanda Palmer has received funding from the US National Institutes of Health and Hollings Cancer Center at the Medical University of South Carolina.

Bodo Lang has received funding from the Health Research Council of NZ.

Chris Bullen receives funding from the Health Research Council of NZ, Ministry of Health and US NIH for research projects on smoking and vaping and personal funding from Kenvue Asia for cochairing ASEAN smoking-cessation leadership meetings. He co-chairs the smokefree expert advisory group for Health Coalition Aotearoa.

George Laking has received funding from the Health Research Council of NZ.

Jamie Brown has received (most recently in 2018) unrestricted funding to study smoking cessation from Pfizer and J&J, which manufacture medically licensed smoking cessation medications.

Lion Shahab received personal fees from a grant funded by the US National Cancer Institute as part of his role as a member of an external scientific advisory committee outside of the submitted work. He also acted as a paid reviewer for grant awarding bodies and as a paid consultant for health-care companies and, in the past, has received honoraria for talks, an unrestricted research grant, and travel expenses to attend meetings and workshops by producers of smoking cessation medication (Pfizer/Johnson&Johnson).

Natalie Walker has received personal fees from a grant funded by the US National Cancer Institute as part of her role as a member of the external scientific advisory committee. She is involved in a grant (in-kind) supported by the National Health and Medical Research Council of Australia. She also received grants from the Health Research Council of NZ and funds from the US National Institute for Health and the Food and Drug Administration tobacco regulatory science grant. She has acted as a paid reviewer for grant awarding bodies. She has no financial links with tobacco companies, e-cigarette manufacturers, or their representatives.

Vili Nosa has received funding from the Health Research Council of NZ.