Overview
As electronic cigarettes (e-cigarettes) remain a public health concern, researchers are turning to digital health interventions (DHIs) as scalable tools to promote cessation. This systematic review and meta-analysis synthesizes randomized controlled trials (RCTs) that evaluate how DHIs—ranging from text-message programs to online coaching and AI-based tools—impact abstinence from e-cigarette use. The study also examines digital determinants of health (DDOH) and their relationship to intervention success.
Scope and Methods
The review focused on RCTs where DHIs were used specifically to promote e-cigarette cessation and reported cessation outcomes. Ten trials (n ≈ 7,424 participants) met eligibility, with the majority conducted in the United States. Interventions were largely mobile-health (mHealth) approaches, especially SMS-based programs such as This Is Quit (TIQ). Trials varied in duration—from 4 weeks to 15 months—and often compared DHIs against standard information, counseling, or pharmacological aids like nicotine replacement therapy in some arms. A random-effects model was used to pool odds ratios (ORs) for cessation outcomes, while a correlation heatmap explored the relationship between DDOH indicators and intervention success.
Eligibility and Data Extraction
Eligible studies were randomized and reported e-cigarette–specific cessation outcomes. Data extraction captured intervention characteristics, control conditions, participant demographics, and DDOH-related indicators. A standardized approach allowed synthesis despite heterogeneous reporting across trials.
Key Findings: Efficacy of DHIs
The meta-analysis included six trials with compatible outcome data. DHIs were associated with a meaningful improvement in e-cigarette cessation, with an overall odds ratio (OR) of 2.29 (95% CI 1.45–3.63), indicating that participants receiving DHIs were more than twice as likely to abstain from e-cigarette use at the end of the intervention compared with controls. However, substantial heterogeneity was observed (I2 ≈ 92%), suggesting variability in study populations, intervention design, follow-up duration, and outcome definitions.
What Works Within DHIs?
Across studies, interactive, tailored text messaging—often using structured, theory-based content—emerged as a common and effective modality. TIQ-based SMS programs were highlighted as cost-effective, scalable options capable of reaching broad populations, including adolescents and young adults. Some trials reported stronger short-term quit rates that waned over longer follow-up, underscoring the need for ongoing reinforcement or booster strategies to sustain abstinence.
Digital Determinants of Health (DDOH) and Intervention Success
Beyond efficacy, the review examined how DDOH shaped outcomes. The correlation analysis revealed moderate to strong positive associations between several DDOH components and cessation success. Notably, ease of use, digital accessibility, digital affordability, usefulness, and data accessibility showed the strongest links to successful vaping abstinence. Personalization and algorithmic fairness also contributed meaningfully, while overall digital literacy and availability influenced results indirectly through user engagement.
Quality and Limitations
Overall study quality was variable. Most trials adhered to CONSORT or eHealth reporting guidelines, though some lacked clear trial registration details or fully described randomization methods. High heterogeneity limited the precision of pooled estimates, and several trials lacked long-term follow-up data to assess sustained cessation. The predominance of US-based studies highlights geographic and health-system variations, and suggests a need for evidence from diverse settings, including low- and middle-income countries.
Implications for Practice and Policy
DHIs offer a promising avenue to scale e-cigarette cessation efforts, particularly when designed to be user-friendly, interactive, and personalized. Programs like TIQ demonstrate how simple, meshed SMS content can achieve meaningful outcomes at a population level. Policymakers and implementers should prioritize accessible, affordable digital tools and ensure equitable access—addressing DDOH dimensions such as digital literacy and internet connectivity—to maximize impact across sociodemographic groups.
Future Research Directions
Future work should expand to diverse populations and longer follow-ups, assess cost-effectiveness, and explore how emerging technologies (AI chatbots, adaptive messaging, and VR-based coping strategies) influence long-term abstinence. Standardized measures of DDOH within DHIs would also enhance cross-study comparability and help tailor interventions to varying digital determinants of health.
