Health and Social Development, Faculty of (Okanagan)
Nursing, School of (Okanagan)
DSpace
UBCO
Fonteyne, Karlee
Master of Science in Nursing - MSN
University of British Columbia
Background: Vaping among youth and young adults (YYAs) has become a significant public health issue, with increasing prevalence and associated health risks. Despite awareness of these risks, many YYAs struggle to quit due to social pressures, stress, and a lack of tailored interventions. Digital tools, including augmented reality (AR), offer an opportunity to address these challenges by creating engaging, personalized support systems. Research Question: What can be learned from YYA vapers who are currently in the process of quitting to inform mobile-based AR intervention designs? Methodology: This qualitative study applied an interpretive descriptive (ID) approach to explore YYA perspectives on vaping cessation and their preferences for digital intervention features. Semi-structured interviews were conducted with participants who shared their experiences with vaping, quitting attempts, and ideas for AR-based support. Data Analysis: Reflexive thematic analysis and ID were used to code the data and identify patterns, leading to the development of themes that reflected the individualized and contextual nature of vaping cessation. Results: Findings revealed that vaping cessation is a deeply personal process influenced by internal motivations (e.g., health improvement, personal milestones) and external factors (e.g., social context). Participants identified AR as a promising tool for cessation, valuing features such as gamified rewards, health visualizations, and anonymous support. Gamification and progress tracking were seen as engaging and motivational, while health visualizations offered reinforcement of quitting benefits. However, participants emphasized the need for sensitive design to avoid negative or punitive content. Stress management and coping strategies were also highlighted as critical components of successful and sustainable cessation interventions. Discussion: This study provides actionable insights for designing YYA-centered digital health tools that leverage AR to support vaping cessation. By addressing the unique sociocultural and behavioural needs of YYAs, AR-based interventions can bridge gaps in traditional cessation strategies. These findings contribute to the development of innovative public health approaches aimed at reducing vaping prevalence in vulnerable populations.
YOUTH AND YOUNG ADULT PERSPECTIVES ON AUGMENTED REALITY-DRIVEN VAPING CESSATION INTERVENTIONS: AN INTERPRETIVE DESCRIPTION STUDY by Karlee Fonteyne B.S.N., The University of Alberta, 2022 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING in THE COLLEGE OF GRADUATE STUDIES (Nursing) THE UNIVERSITY OF BRITISH COLUMBIA (Okanagan) April 2025 ©Karlee Fonteyne, 2025 ii The following individuals certify that they have read, and recommend to the College of Graduate Studies for acceptance, a thesis entitled: YOUTH AND YOUNG ADULT PERSPECTIVES ON AUGMENTED REALITY-DRIVEN VAPING CESSATION INTERVENTIONS: AN INTERPRETIVE DESCRIPTION STUDY submitted by Karlee Fonteyne in partial fulfillment of the requirements of the degree of Master of Science in Nursing. Dr. Laura Struik, School of Nursing Supervisor Dr. Elizabeth Keys, School of Nursing Supervisory Committee Member Dr. Mohammad Khalad Hasan, Computer Science, Irving K. Barber Faculty of Science Supervisory Committee Member Dr. Lesley Lutes, Department of Psychology, Irving K. Barber Faculty of Arts and Social Sciences University Examiner iii Abstract Background: Vaping among youth and young adults (YYAs) has become a significant public health issue, with increasing prevalence and associated health risks. Despite awareness of these risks, many YYAs struggle to quit due to social pressures, stress, and a lack of tailored interventions. Digital tools, including augmented reality (AR), offer an opportunity to address these challenges by creating engaging, personalized support systems. Research Question: What can be learned from YYA vapers who are currently in the process of quitting to inform mobile-based AR intervention designs? Methodology: This qualitative study applied an interpretive descriptive (ID) approach to explore YYA perspectives on vaping cessation and their preferences for digital intervention features. Semi-structured interviews were conducted with participants who shared their experiences with vaping, quitting attempts, and ideas for AR-based support. Data Analysis: Reflexive thematic analysis and ID were used to code the data and identify patterns, leading to the development of themes that reflected the individualized and contextual nature of vaping cessation. Results: Findings revealed that vaping cessation is a deeply personal process influenced by internal motivations (e.g., health improvement, personal milestones) and external factors (e.g., social context). Participants identified AR as a promising tool for cessation, valuing features such as gamified rewards, health visualizations, and anonymous support. Gamification and progress tracking were seen as engaging and motivational, while health visualizations offered reinforcement of quitting benefits. However, participants emphasized the need for sensitive design to avoid negative or punitive content. Stress management and coping strategies were also highlighted as critical components of successful and sustainable cessation interventions. Discussion: This study provides actionable insights for designing YYA-centered digital health tools that leverage AR to support vaping cessation. By addressing the unique sociocultural and behavioural needs of YYAs, AR-based interventions can bridge gaps in traditional cessation strategies. These findings contribute to the development of innovative public health approaches aimed at reducing vaping prevalence in vulnerable populations. Keywords: vaping cessation, augmented reality, nicotine, youth and young adults iv Lay Summary This study explores how digital tools, including augmented reality (AR), can help young people quit vaping. Vaping is a growing concern, especially among youth, and quitting can be challenging due to stress, social pressures, and strong cravings. By listening to the experiences of young people who vape, this research identifies what features they find most helpful in a digital quitting tool. Suggestions include fun and engaging elements like games and rewards, tools to track progress, and support for managing stress and cravings. The study also highlights how AR could make quitting easier by providing interactive support, such as showing how the body improves after quitting or offering private, non-judgmental help. This work helps create practical, youth-focused solutions to reduce vaping and offers new ideas for using technology to improve health and well-being. v Preface Chapters 1, 3, and 5 are independent, original, and unpublished works by the author Karlee Fonteyne (KF). Chapter 2 is prepared as a manuscript for submission to the Journal of Medical Internet Research. KF identified the research question, conceptualized and designed the literature review, conducted screening and data extraction of all articles, and led data analysis and manuscript writing. Dr. Laura Struik (LS) assisted KF in identifying the research question, conceptualizing and designing the literature review, screening articles and data analysis, and providing critical feedback for manuscript drafts. Dr. Elizabeth Keys (EK) and Dr. Mohammad Khalad Hasan (MKH) reviewed and provided critical feedback on the manuscript drafts. Fonteyne, K., Keys, E., Hasan, M. K., & Struik, L. Digital interventions for vaping cessation: A scoping review, in preparation for submission to the Journal of Medical Internet Research, target Chapter 4 is prepared as a manuscript for submission to the Journal of Medical Internet Research. KF identified the research question, conceptualized the study design, created the data collection tools, collected all data, and led analysis and manuscript writing. LS assisted KF with identifying the research question, conceptualizing the study design, creating the data collection tools, data analysis, and manuscript writing. EK and MKH assisted KF with conceptualizing the study design, creating the data collection tools, and reviewing and providing critical feedback on the manuscript drafts. Fonteyne, K., Keys, E., Hasan, M. K., & Struik, L. Youth and young adult perspectives on augmented reality-driven vaping cessation interventions: An interpretive description study, in preparation for submission to the Journal of Medical Internet Research, target vi Generative Artificial Intelligence (AI) was not used in any aspect of this work. This study was granted ethics approval by the University of British Columbia Behavioural Ethics Board – Certificate Number: H24-00545. vii Table of Contents ABSTRACT ........................................................................................................................................ III LAY SUMMARY ............................................................................................................................... IV PREFACE ............................................................................................................................................. V TABLE OF CONTENTS .................................................................................................................. VII LIST OF TABLES ............................................................................................................................. XI LIST OF FIGURES .......................................................................................................................... XII ACKNOWLEDGEMENTS ............................................................................................................ XIII CHAPTER 1: INTRODUCTION ........................................................................................................ 1 1.1 Introduction ........................................................................................................................ 1 1.2 Background ......................................................................................................................... 2 1.2.1 The Emergence of Vaping ............................................................................................ 2 1.2.2 Health Implications of Vaping ...................................................................................... 3 1.2.3 Factors Driving the YYA Vaping Epidemic ................................................................ 5 1.2.4 A Correlation between Vaping and the YYA Mental Health Crisis ............................ 6 1.2.5 Sex and Gender-Based Differences in YYA Vaping Behaviours ................................ 7 1.2.6 Motivations and Challenges Faced by YYA in Quitting Vaping ................................. 8 1.2.7 The Vaping Cessation Landscape and Digital Interventions ........................................ 9 1.2.8 Behaviour Change Techniques in Cessation Interventions ........................................ 10 1.2.9 An Innovative and Immersive Approach to Vaping Cessation .................................. 11 1.3 Research Problem ............................................................................................................ 12 1.4 Research Question and Objectives ................................................................................. 13 1.5 Researcher Positionality and Reflexivity ....................................................................... 14 1.6 Conclusion ......................................................................................................................... 15 CHAPTER 2: A SCOPING REVIEW ON DIGITAL INTERVENTIONS FOR VAPING CESSATION ........................................................................................................................................ 17 2.1 Introduction ...................................................................................................................... 17 2.1.1 Aim and Objectives .................................................................................................... 19 2.2 Methods ............................................................................................................................. 19 viii 2.2.1 Study Design ............................................................................................................... 19 2.2.2 Search Strategy ........................................................................................................... 20 2.2.3 Inclusion and Exclusion Criteria ................................................................................ 20 2.2.4 Study Selection Process .............................................................................................. 22 2.2.5 Data Extraction and Analysis ..................................................................................... 22 2.3 Results ............................................................................................................................... 23 2.3.1 Overview of the Search Results .................................................................................. 23 Figure 1 ................................................................................................................................ 23 2.3.2 Main Characteristics of the Included Papers .............................................................. 24 Table 1 ................................................................................................................................. 24 2.3.1 Types of Digital Interventions .................................................................................... 26 2.3.1.1 Text Messaging Interventions ............................................................................. 26 2.3.1.2 Mobile App-Based Interventions ........................................................................ 27 2.3.1.3 Telehealth Delivered Contingency Management ................................................ 28 2.3.1.4 Web and Social Media-based Support ................................................................ 29 2.3.2 Common Strategies and Supports ............................................................................... 30 2.3.3 Challenges and Obstacles ........................................................................................... 32 2.4 Discussion .......................................................................................................................... 34 2.5 Strengths and Limitations of This Review ..................................................................... 36 2.6 Conclusion ......................................................................................................................... 37 CHAPTER 3: RESEARCH METHODS .......................................................................................... 39 3.1 Study Aims and Objectives ............................................................................................. 39 3.2 Study Framework............................................................................................................. 40 3.3 Methodology ..................................................................................................................... 40 3.3.1 Theoretical Underpinnings of Interpretive Description .............................................. 41 3.4 Research Design ............................................................................................................... 43 3.4.1 Diversity and Inclusion Considerations ...................................................................... 43 3.4.2 Inclusion and Exclusion Criteria ................................................................................ 44 3.4.3 Sampling Methods and Recruitment .......................................................................... 44 3.4.4 Sample Size ................................................................................................................ 45 ix 3.4.5 Data Collection ........................................................................................................... 46 3.4.5.1 Semi-Structured Interviews ................................................................................. 47 3.4.5.2 Data Management Plan ....................................................................................... 48 3.4.6 Data Analysis .............................................................................................................. 48 3.4.6.1 Reflexive Thematic Analysis and Interpretive Description ................................ 49 3.4.6.2 Gender-Based Data Analysis............................................................................... 51 3.5 Quality ............................................................................................................................... 52 3.5.1 Quality Measures ........................................................................................................ 52 3.5.2 Applied Researcher Accountability ............................................................................ 53 3.6 Ethical Considerations ..................................................................................................... 54 3.7 Integrated Knowledge Translation ................................................................................. 55 3.8 Conclusion ......................................................................................................................... 56 CHAPTER 4: STUDY MANUSCRIPT: YOUTH AND YOUNG ADULT PERSPECTIVES ON AUGMENTED REALITY-DRIVEN VAPING CESSATION INTERVENTIONS: AN INTERPRETIVE DESCRIPTION STUDY ..................................................................................... 58 4.1 Introduction ...................................................................................................................... 58 4.2 Research Aim .................................................................................................................... 59 4.3 Methods ............................................................................................................................. 59 4.3.1 Interpretive Description .............................................................................................. 59 4.3.2 Participants and Procedures ........................................................................................ 60 4.3.3 Data Collection and Analysis ..................................................................................... 60 4.3.3.1 Gender-based Analysis ........................................................................................ 62 4.3.4 Quality and Rigour ..................................................................................................... 62 4.4 Results ............................................................................................................................... 62 4.4.1 Description of the Sample .......................................................................................... 62 4.4.2 Qualitative Themes ..................................................................................................... 64 4.4.3 Theme 1: Social and Cultural Context Play a Role in YYAs’ Experiences of Cessation………………………………………………………………………….. ............ 64 4.4.4 Theme 2: Quitting Vaping is a Personal Decision That Does Not Always Mean Success ................................................................................................................................. 66 4.4.5 Theme 3: Digital Support as a Bridge Between Individual and Social Needs ........... 68 x 4.4.6 Theme 4: AR as a Catalyst for Personalized Support ................................................. 70 4.4.6.1 AR as a Conduit to Non-judgmental Real-time Feedback .................................. 70 4.4.6.2 AR as a Tool for Distraction and Motivation ...................................................... 72 4.4.6.3 AR Meets the Desire for Education and Real-time Coping Mechanisms ........... 73 4.5 Discussion .......................................................................................................................... 75 4.6 Limitations and Future Research ................................................................................... 81 4.7 Implications and Conclusion ........................................................................................... 83 CHAPTER 5: CONCLUSION ........................................................................................................... 86 5.1 Summary ........................................................................................................................... 86 5.2 Integration of Research and Current Knowledge ......................................................... 86 5.3 Conclusions on Study Goals and Contributions............................................................ 87 5.3.1 Methodological Reflection and Strengths .................................................................. 88 5.4 Reflection on Disciplinary Contributions ...................................................................... 88 5.5 Conclusion ......................................................................................................................... 90 BIBLIOGRAPHY ............................................................................................................................... 91 APPENDIX A .................................................................................................................................... 107 APPENDIX B .................................................................................................................................... 110 APPENDIX C .................................................................................................................................... 114 APPENDIX D .................................................................................................................................... 124 APPENDIX E .................................................................................................................................... 125 APPENDIX F ..................................................................................................................................... 138 APPENDIX G .................................................................................................................................... 141 APPENDIX H .................................................................................................................................... 144 APPENDIX I ...................................................................................................................................... 145 xi List of Tables Table 1: Summary of Tested Digital Interventions and Outcomes ....................................... 22 Table 1: Participant Characteristics and Vaping History ...................................................... 60 xii List of Figures Figure 1: PRISMA Flow Diagram ........................................................................................ 21 xiii Acknowledgements First and foremost, a heartfelt thank you to my thesis supervisor, Dr. Laura Struik, for her exceptional mentorship, encouragement, and unwavering guidance throughout this journey. Your invaluable insights, countless Zoom calls (regardless of the time zone I was in), and detailed feedback have shaped this project and my growth as a researcher. I feel truly blessed to have had such a strong woman, scholar, and nurse as my mentor. I extend my profound gratitude to Dr. Keys and Dr. Hasan for their expertise and support in shaping this project. Your thoughtful feedback and encouragement were instrumental in refining my ideas and bringing this work to fruition. I am deeply thankful to the Faculty of Health and Social Development at the University of British Columbia - Okanagan for their unwavering support throughout my academic journey. Your resources and encouragement have provided me with the foundation to thrive. A special thanks to the UBC Create in Immersive Technologies (CiTech) program for pushing me outside my comfort zone and instilling in me the confidence to embrace innovation in research and practice. Your program broadened my perspective on the endless possibilities of integrating emerging and immersive technologies into healthcare solutions. Thank you to the Canadian Institutes of Health Research (CIHR) for their funding support, which made this research possible and allowed me to contribute meaningfully to the fields of nursing and public health. To the participants of this study: your openness and valued insights were the cornerstone of this project. Your voices will help shape interventions that aim to make a tangible difference. I would also like to express my enduring gratitude to Dr. Tanya Park, who was a tremendous influence during my undergraduate studies and helped set me on the path I am on today. xiv Your patience, passion, and positivity inspired me to find my own voice and develop as a scholar. To my husband and family, thank you for your endless moral support and for listening to my thoughts, frustrations, and ideas throughout my many years of education (and probably more to come). Your belief in me has been my anchor. Finally, thank you to my best friend and fellow nurse Hannah Fonteyne who kept me grounded and motivated throughout our undergraduate studies together and into the programs that followed. You inspire me every day. 1 Chapter 1: Introduction 1.1 Introduction The rise of vaping or electronic cigarette (e-cigarette) use, particularly among youth and young adults (YYAs), has become a significant public health concern in recent years. This epidemic is highlighted by statistics from the 2022 Canadian Tobacco and Nicotine Survey (CTNS) indicating that 30% of Canadian adolescents aged 15 to 19 years and 47.5% of young adults aged 20 to 24 years had tried vaping at some point (Government of Canada [Gov Can], 2023). Additionally, 13.6% of adolescents and 19.7% of young adults reported vaping within the previous 30 days, with higher rates observed among male youth compared to their female counterparts. Alarmingly, this 30-day prevalence represents a nearly 120% increase compared to pre-legalization figures from 2017, when only 6% of young Canadians reported vaping within the past 30 days (East et al., 2023). Such data underscores the urgent need for effective interventions and a deeper understanding of the factors driving vaping behaviours in YYAs. Initially marketed as a safer alternative to traditional combustible cigarettes and as a smoking cessation tool, vaping has rapidly evolved into a widespread phenomenon (Askwith et al., 2024; McCausland et al., 2019). Despite regulatory measures aimed at restricting access to vaping products, vaping among YYAs continues to grow, raising alarms about its potential short- and long-term health consequences. Given the scope of the vaping epidemic and its potential to cause harm over time, there is a pressing need for effective and practical YYA-centered interventions. Traditional cessation methods, while effective for adult smokers, often fail to resonate with YYAs, who are more immersed in digital environments and motivated by peer influences (Berg et al., 2021; Sanchez et al., 2021; Struik et al., 2023b). This disconnect highlights the importance of exploring digital interventions that can engage YYAs in meaningful ways. Augmented Reality (AR) presents a promising, novel solution by integrating digital tools into the real world, allowing users to confront their behaviours in their natural environments (Vinci et al., 2020a; Vinci et al., 2020b; Yang et al., 2022). This thesis aims to address the urgent need for innovative vaping cessation strategies by investigating the potential of AR-based interventions for YYAs. By exploring YYA 2 experiences and preferences regarding mobile applications and digital health tools, this study seeks to develop practical recommendations for designing an AR-driven intervention tailored to this demographic's unique needs and challenges. In doing so, the research will contribute to the growing field of digital health and help bridge the gap between public health initiatives and the digitally immersed lifestyles of YYAs today. 1.2 Background Vaping refers to the use of electronic devices such as e-cigarettes, vape pens, or pod systems, which heat a liquid into an aerosol, commonly referred to as vapour, that is then inhaled by the user (Jonas, 2022; Traboulsi et al., 2020; Tsai et al., 2020). Unlike traditional combustible cigarettes, which rely on the burning of tobacco to produce smoke, vaping devices use a battery-powered heating element to vaporize an e-liquid (or vape juice) without combustion. This e-liquid typically contains nicotine, propylene glycol, vegetable glycerin, and various flavourings. Most vaping devices comprise a battery, an atomizer or coil to heat the liquid, and a mouthpiece through which the vapour is inhaled. 1.2.1 The Emergence of Vaping Initially, e-cigarettes were introduced in the mid-2000s as a harm-reduction tool for tobacco smokers (Hajek et al., 2019; Lindson et al., 2024; Traboulsi et al., 2020). They were designed to provide nicotine without many of the harmful chemicals associated with combustible tobacco products, making them an attractive alternative for those seeking to reduce or quit smoking. The concept driving vaping as a smoking cessation tool was that users could replicate the sensory and behavioural aspects of smoking, such as the hand-to-mouth action, while gradually lowering their nicotine intake, eventually quitting altogether. Studies such as those included in the Electronic Cigarettes for Smoking Cessation Cochrane Review (Lindson et al., 2024) have indicated that some smokers have successfully transitioned away from combustible cigarettes by using vaping devices. However, there is concern that using e-cigarettes to quit combustible cigarette use may lead to prolonged e-cigarette use or dual use (Palmer et al., 2022a). While vaping may offer benefits for smokers seeking to quit, its broad adoption by non-smokers complicates its role as a harm-reduction tool and has fueled ongoing debates about its regulation and safety (Askwith et al., 2024; Berry et al., 2019; Yang et al., 2024). 3 Regulatory gaps have contributed to high rates of YYA vaping in Canada. While there are some policies at the federal level, such as those under Canada’s Tobacco and Vaping Products Act (2024), which make it illegal to sell and market vaping products to individuals under 18, as well as additional regulations at territory and provincial levels, enforcement is inconsistent, and accessibility varies significantly, especially across online platforms and in retail settings (Coen et al., 2023; Nottage et al., 2024). This patchwork of regulations allows many underage individuals to access vaping products easily, undermining efforts to control use among underage youth (Braak et al., 2020; Crane et al., 2023). Social sources like friends and older siblings are common pathways for underage youth to obtain e-cigarettes, adding another layer of complexity in youth access to these products despite legal restrictions (Crane et al., 2023; Gov Can, 2023; McCausland et al., 2024). 1.2.2 Health Implications of Vaping Vaping is a relatively new phenomenon, with long-term health effects largely unknown; however, emerging research draws concerning parallels to traditional cigarette smoking, suggesting significant risks, particularly for young users (Banks et al., 2023; Glantz et al., 2024; Traboulsi et al., 2020). Much like tobacco use, it may take decades to fully understand the chronic impacts of vaping on public health. Nicotine dependence in non-smokers, particularly among YYAs, is a notable concern as vaping introduces them to nicotine, often for the first time (Banks et al., 2023; Berry et al., 2019). Studies indicate that YYAs who begin with e-cigarettes are more likely to transition to combustible cigarettes, with vaping serving as a gateway to traditional smoking by establishing nicotine dependence and normalizing habitual nicotine use. Interestingly, in their meta-analysis, Glantz et al. (2024) found dual use of e-cigarettes and combustible cigarettes was associated with a 20–40% increase in odds of disease (cardiovascular disease, stroke, metabolic dysfunction, asthma COPD, and oral disease) compared to exclusive cigarette smoking, suggesting a higher population health risk. Furthermore, vaping is strongly associated with alcohol, cannabis, and illicit drug use (Mehra et al., 2019). A growing body of research points to several toxicological risks associated with vaping. In their umbrella and systematic review of the global evidence on electronic cigarettes and health outcomes, Banks et al. (2023) highlight conclusive evidence of the risks 4 associated with nicotine, including the potential for nicotine toxicity or poisoning and seizures. Studies such as Muthumalage et al. (2019) have demonstrated that flavouring compounds in e-liquids can induce oxidative stress, inflammation, and DNA damage in lung cells. Moreover, device components such as heating coils and atomizers release metals, including lead and nickel, into the vapour; these elements are inhaled, leading to heavy metal poisoning and further respiratory complications (Banks et al., 2023; Traboulsi et al., 2020). Banks et al. (2023), Jonas (2022), and Traboulsi et al. (2020) highlight the risk of vaping-related lung injuries, particularly EVALI (E-cigarette or Vaping Product use-Associated Lung Injury). Initially described in 2019, EVALI is an acute or subacute respiratory illness that may become severe or life-threatening. Between August 2019 and March 2020, nearly 3,000 cases of EVALI were reported in Canada and the USA, approximately 15% of which were in youth under 18 (Krishnasamy et al., 2020). The cardiovascular impacts of vaping are similarly concerning, with evidence indicating there that e-cigarette aerosols can elevate heart rate, blood pressure, and arterial stiffness (Banks et al., 2023; Tsai et al., 2020). These physiological changes indicate that e-cigarettes may elicit similar cardiac stress responses to traditional cigarettes, potentially leading to chronic cardiovascular disease. In addition to physical health risks, mental health implications may be particularly significant among YYAs. Cambron (2022) found a strong association between e-cigarette use and increased psychological distress, including heightened rates of anxiety and depressive symptoms among adolescents. This study suggests that vaping may have correlations with mental health challenges in young people. Finally, Banks et al. (2023) highlight environmental hazards, including increased airborne particulate matter in indoor environments, ensuant ecological waste from vaping paraphernalia, and the risk of vaping devices causing fires. Notably, these vaping-related hazards pose risks not only to the individual who vapes but also to those around them. The emerging evidence thus underscores the multifaceted health risks associated with vaping. Despite initial claims of harm reduction, vaping poses notable respiratory, cardiovascular, and mental health risks, with effects mirroring some known impacts of traditional tobacco cigarettes but introducing unique challenges due to its distinct chemical profile and delivery mechanism (Glantz et al., 2024; Traboulsi et al., 2020). Addressing these risks urgently requires focused cessation efforts and enhanced public awareness to mitigate 5 YYA exposure and protect public health. 1.2.3 Factors Driving the YYA Vaping Epidemic Alarmingly, vaping has rapidly expanded beyond its initially touted purpose of a smoking cessation aid and has become increasingly popular among YYAs, many of whom have never smoked traditional cigarettes. To this point, the CTNS 2022 data shows that 68.9% of youth aged 15-19 and 61.8% of young adults aged 20-24 who vaped in the past 30 days have never tried a tobacco cigarette (Gov Can, 2023). Vaping uptake is driven by a combination of factors, beginning with the perception of vaping as low-risk and safer than smoking (Crane et al., 2023; Guerra Castillo et al., 2024; Earnscliffe Strategy Group, 2024; Gov Can, 2023; McCausland et al., 2024). Because vaping lacks the combustion process associated with traditional cigarettes, many view it as a lower-risk activity, particularly given the limited research on its long-term health effects. The range of enticing e-liquid flavours, from fruit and candy to mint and dessert, makes vaping especially appealing to young users (Donaldson et al., 2021; Gov Can, 2023; Guerra Castillo et al., 2024; McCausland et al., 2024; Struik et al., 2023b). The sleek, portable, and often disposable design of today’s vaping devices further enhances their appeal, making them easy to conceal and use without drawing attention (Askwith et al., 2024). To this point, Hammond et al. (2024) highlight that as of 2023, the sale and use of disposable products have surpassed the refillable and cartridge/pod-based systems which dominated the vaping industry in 2017, further emphasizing the rapidly shifting nature of the vaping landscape. Social norms and subcultures around vaping reinforce the trend. Studies by Coen et al. (2023), Crane et al. (2023), Earnscliffe Strategy Group (2024), McCausland et al. (2024), Skinner et al. (2024), and Struik et al. (2023b) demonstrate that YYAs are significantly influenced by peer vaping, which is linked to higher odds of personal vaping use. Peer groups often view vaping as a shared activity that strengthens social bonds and signals inclusion (Crane et al., 2023; McCausland et al., 2024). Social media and influencer culture have amplified vaping’s allure by glamorizing it as a trendy, acceptable activity, particularly for YYAs (Coen et al., 2023; Vogel et al., 2024). The presence of e-cigarette marketing across digital spaces, including social platforms, video games, and television, further fuels YYA interest (Amin et al., 2020; Askwith et al., 2024; Coen et al., 2023; Vogel et al., 2024; 6 Yang et al., 2024). Visual-heavy advertising downplays risks, often presenting vaping as an exciting and emotionally engaging experience (Yang et al., 2024). Additionally, psychological factors play a notable role, as many young people turn to vaping as a way to manage stress, anxiety, or boredom (Crane et al., 2023; Gov Can, 2023; Struik et al., 2023b). With rising levels of stress among youth, vaping has become an accessible, socially accepted coping mechanism. These combined influences have embedded vaping within YYA culture, creating a social atmosphere where vaping is both normalized and encouraged. 1.2.4 A Correlation between Vaping and the YYA Mental Health Crisis Compounding the complexities of cessation, Canadian youth are currently experiencing significant mental health challenges. According to the 2023 Canadian Health Survey on Children and Youth, approximately one in four Canadian youth reported a deterioration in their mental health between 2019 and 2023, a trend exacerbated by the COVID-19 pandemic, social disruptions, and academic pressures (Statistics Canada, 2023). These challenges are intricately linked to vaping. Evidence suggests that vaping dependence, not just frequency of use, is associated with increased depressive symptoms among Canadian youth who have never smoked, indicating that nicotine dependency itself may act as a stressor, compounding pre-existing vulnerabilities (Chaiton et al., 2024). Similarly, young e-cigarette users were found to have significantly higher odds of experiencing extreme life stress compared to non-users, even when controlling for other health and lifestyle factors (To et al., 2024). This growing body of evidence affirms that vaping may not only be used to cope with poor mental health but may also worsen it over time. Given this context, cessation programs must shift away from rigid, high-pressure models toward more compassionate, flexible, and trauma-informed approaches. Research analyzing a quit vaping community on Reddit revealed that youth and young adults strongly value self-compassion, emotional safety, and gradual reduction methods when trying to quit (Struik & Yang, 2021). Rather than prescribing strict deadlines or promoting abrupt abstinence, which may trigger anxiety and a sense of failure, a harm-reduction framework that celebrates small wins and accommodates relapse can better support youth with concurrent mental health concerns. Positive reinforcement, embedded emotional support, and 7 flexible pacing are not only more engaging to youth but also acknowledge the deeply personal and nonlinear nature of their cessation journeys. As mental health continues to decline among young people in Canada, cessation interventions that are attuned to their emotional realities will be critical to fostering long-term wellness and sustainable behaviour change. 1.2.5 Sex and Gender-Based Differences in YYA Vaping Behaviours In discussions about vaping behaviours and cessation, it is critical to distinguish between sex and gender, as these constructs, while interrelated, are often conflated in the literature and public discourse. According to Rioux et al. (2022), sex refers to biological attributes such as chromosomes, hormones, and anatomy, while gender encompasses socially constructed roles, behaviours, and identities shaped by cultural and societal expectations. While sex is often a focus in epidemiological studies to identify biological differences, gender plays a more significant role in understanding the behavioural, social, and environmental factors influencing vaping among YYAs. Gender is particularly relevant in the context of vaping because it intersects with power structures, social norms, and cultural influences, which shape how behaviours like vaping are normalized or stigmatized. For example, traditional gender norms often frame vaping as a risk-taking behaviour associated with masculinity, driven by peer influences and the perception of vaping as "cool" or rebellious (Donaldson et al., 2021; Struik et al., 2023b). Alternatively, for femininity, vaping may be socially mediated and tied to relational dynamics, such as managing stress or fitting into peer groups (Huma et al., 2022; Struik et al., 2023b). These gendered experiences are critical for understanding vaping behaviours, as they influence how YYAs perceive vaping, respond to social pressures, and engage with cessation efforts. As Rioux et al. (2022) emphasize, conflating sex and gender risks misattributing behavioural differences to biology when they may instead reflect the broader sociocultural context in which behaviours are embedded. Research consistently shows gender-based differences in vaping behaviours. For example, young men exhibit higher prevalence rates of vaping (Davidson & Al-Hamdani, 2023; Struik et al., 2023b) and frequently associate vaping with behavioural cues like video gaming and media consumption, where vaping is normalized or even glamorized (Struik et 8 al., 2023b; Vogel et al., 2024). Participants who identify as men also report experiencing greater peer pressure to vape (Davidson & Al-Hamdani, 2023). Conversely, vapers who identify as women are more likely to cite stress relief as a primary reason for vaping and are less likely to quit "cold turkey," instead preferring gradual reduction approaches and aesthetically tailored apps (Huma et al., 2022). Additionally, females often report that social media exposure plays a significant role in initiating vaping behaviours (Davidson & Al-Hamdani, 2023). The literature also highlights the vulnerability of sexual and gender minority youth to vaping. Donaldson et al. (2021) found that youth identifying as sexual and/or gender minorities were more likely to identify as vapers compared to their heterosexual and cisgender peers. These findings suggest that vaping may serve as a coping mechanism or social tool within marginalized groups, though limited research has been conducted to explore these dynamics further. These insights emphasize the importance of incorporating diverse YYA participants in vaping research to capture the nuanced gender-based differences driving initiation, use, and cessation. Understanding how vaping behaviours are shaped by gender and intersect with other demographic factors allows public health initiatives to develop inclusive and tailored interventions. Such approaches are critical for addressing the unique experiences, motivations, and barriers YYAs face, ultimately ensuring that interventions resonate across this population's diverse spectrum of identities. 1.2.6 Motivations and Challenges Faced by YYA in Quitting Vaping Despite the pervasiveness of vaping, many YYAs express a desire to quit. Cuccia et al. (2021) found that over half (54.2%) of adolescent vape users had a general intention to quit, with 15.3% planning to do so within the next 30 days. Motivations for quitting are often driven by shifting perceptions of vaping risks, health concerns, social influences, financial implications, and personal aspirations (Amato et al., 2021; Cha et al., 2024; Crane et al., 2023; Palmer et al., 2022a). Health awareness frequently emerges as a primary motivator, with many YYAs citing respiratory symptoms or concerns over long-term health risks as reasons to quit (Cha et al., 2024; Lin et al., 2024). Social influences, such as changing peer attitudes or parental disapproval, encourage some YYAs to distance themselves from vaping, though this can sometimes lead to feelings of social disconnection (Guerra Castillo et al., 9 2024; Struik & Yang, 2021). Additionally, psychological motives, including self-improvement, control over behaviour, and reducing nicotine dependency, drive cessation efforts, along with financial considerations and dissatisfaction with vaping’s effects on daily life (Cha et al., 2024; Palmer et al., 2022a). However, several distinct barriers complicate YYAs’ efforts to quit. Nicotine dependence, especially with high-nicotine e-cigarettes, intensifies withdrawal symptoms, making it challenging for users to manage cravings (Struik & Yang, 2021; Sanchez et al., 2021). Social and sensory reinforcements, such as the enjoyment of various flavours and perceived stress relief, further reinforce the habit. At the same time, the discreet and socially acceptable nature of vaping makes cessation feel less urgent compared to traditional cigarettes (Sanchez et al., 2021). Exposure to pro-vaping content on social media also glamorizes the behaviour, creating positive associations that undermine the motivation to quit (McCausland et al., 2024; Struik & Yang, 2021; Vogel et al., 2024). These intersecting motivations and barriers reveal the complex role vaping plays in YYA’s social lives, highlighting the need for comprehensive cessation strategies that address both the physical and social dimensions of vaping dependency. 1.2.7 The Vaping Cessation Landscape and Digital Interventions Data from the CTNS indicates that in 2022, 42.4% of Canadians aged 15 and older who reported daily vaping made at least one quit attempt lasting 24 hours in the past year (Gov Can, 2023). Several publications highlight the most common cessation approaches used by YYA to be "cold turkey" cessation and gradual reduction by decreasing nicotine levels or usage frequency rather than engaging in structured behavioural interventions (Al-Hamdani et al., 2023; Guerra Castillo et al., 2024; Lin et al., 2024; Struik & Yang, 2021). That said, less than one-third of ex-vapers in Al-Hamdani et al. (2023) identified cold turkey as their successful quit strategy and instead recommended support systems, including friend groups or professional counselling services (29.5 %) and tailored vaping cessation apps (17.3 %) for those looking to stop vaping. Digital interventions represent a promising new frontier in vaping cessation to meet the needs of YYAs, leveraging technology to support health outcomes through accessible, scalable tools that align with YYAs’ daily technological habits. YYAs are among the most 10 active users of digital technologies, making smartphone-based interventions particularly promising for this demographic. In 2022, smartphone use by teenagers and adults aged 15 to 24 was 96% (Asselin, 2024), with many YYAs aged 15 to 24 (46%) and 25 to 34 (33%) reporting using their smartphone as frequently as every 15 minutes. Popular apps cater to diverse interests, from social media and gaming to health and wellness, reflecting a growing trend in leveraging technology for personal growth and behaviour change (Lupton, 2021; Milne-Ives et al., 2020; Wu et al., 2024). Digital health technologies, including fitness trackers, calorie-counting apps, and mental health tools, are widely adopted by YYAs, offering accessible and often anonymous avenues for managing their health (Lupton, 2021). In their systematic review of mobile apps for health behaviour change, Milne-Ives et al. (2020) found completion rates for app-related interventions averaged nearly 83%, with participants frequently finding the apps helpful and easy to use. However, challenges such as navigating vast online health information and avoiding negative comparisons with social media influencers highlight the need for thoughtful design (Lupton, 2021; Vogel et al., 2024; Wu et al., 2024). This high level of engagement underscores the potential of app-based interventions for vaping cessation, as they can seamlessly integrate into YYAs' routines, offering personalized, accessible, and engaging support to address their unique needs. As explored in depth in Chapter 2, the current landscape of digital cessation tools highlights a critical opportunity for public health initiatives to bridge existing gaps in vaping cessation. Research indicates that YYAs prefer mobile app-based cessation support that offers flexible personalization, behaviour tracking, managed social support, and positive messaging (Huma et al., 2022). Rahman et al. (2024) found that vaping cessation interventions should be accessible to diverse groups, affordable, adaptable to user preferences, and should use appropriate language and platforms targeted toward YYAs. Ongoing research is needed to assess the effectiveness of digital interventions and optimize their relevance to YYAs’ unique motivations and challenges. 1.2.8 Behaviour Change Techniques in Cessation Interventions Behaviour Change Techniques (BCTs) are key building blocks of effective cessation interventions. BCTs refer to an intervention's specific, actionable components designed to directly influence the factors driving behaviour, such as motivation, capability, or 11 opportunity (Mitchie et al., 2011; 2013). These techniques are intended to be clearly defined, repeatable, and applicable across various settings, making them valuable tools for structuring and evaluating interventions. Recent literature highlights several BCTs that show promise in supporting cessation among YYAs. Goal-setting and social support, for example, have been identified as especially impactful, as they help individuals make concrete plans for quitting while drawing strength from peer or community encouragement (Struik et al., 2022; 2023c). On the other hand, techniques like offering tangible incentives have shown limited long-term success, suggesting that interventions should focus more on fostering internal motivation and sustained behavioural engagement rather than relying on short-term external rewards (Struik et al., 2023c). Despite the known value of a range of BCTs, vaping-related interventions have been found to fall short. For example, a study examining BCTs used in vaping prevention and harm reduction campaigns in North America found that campaigns often over-relied on communicating health risks and overlooked other promising strategies such as fostering identity change, comparing behaviours, or building supportive social networks (Struik et al., 2023c). This highlights a key opportunity to broaden and diversify the BCTs used in digital cessation tools to better engage young people and support lasting change. 1.2.9 An Innovative and Immersive Approach to Vaping Cessation Traditional cessation methods are often didactic and passive and may fail to resonate with YYAs who have grown up immersed in interactive digital environments. Immersive technologies, such as AR, present a promising approach uniquely suited to the preferences and experiences of YYAs. AR presents a unique opportunity for vaping cessation to engage YYAs through interactive, real-world applications that can seamlessly integrate with their daily environments. AR enhances real-world experiences through devices like smartphones, tablets, or AR glasses, creating an interactive and accessible platform ideal for engaging YYAs (Parekh et al., 2020). Unlike virtual reality (VR), which isolates users in an entirely virtual environment, AR overlays digital content onto the real world, allowing users to engage with virtual elements while remaining aware of their surroundings (Khan et al., 2019; Parekh et al., 2020; Vinci et al., 2020a). Popular mobile applications (apps) like Pokémon Go™ and Snapchat illustrate the broad appeal of AR, yet its use in health interventions remains relatively novel, particularly in addressing vaping cessation. 12 Evidence from substance use research shows that leveraging cue exposure therapy (CET) may effectively disrupt the link between environmental triggers and cravings by repeatedly presenting cues (such as images of vape products) without reinforcing the conditioned response (Unrod et al., 2014; Vinci et al., 2020b; Zhang et al., 2023). Combining CET with AR, Yang et al. (2022) found that a smartphone AR app for tobacco cessation helped reduce cravings through repeated exposure to smoking cues, which users found both effective and easy to use. At the follow-up, participants (57%) reported a reduction in the number of cigarettes smoked over the past week. As participants in Yang et al. (2022) were smokers with a mean age of 43 years, it merits exploring if there is interest in this type of intervention amongst a younger demographic who vapes. Beyond CET, AR could be harnessed to incorporate coping mechanisms that train users to observe and manage cravings in real-world settings. For example, YYAs might receive AR-embedded reminders to stay present and avoid impulsive vaping in high-risk situations, such as social gatherings or near vape shops. Educational features could further enhance the intervention, as in Borovanska et al. (2020), where a mobile AR app allowed young users to visualize healthy and smoker-affected lungs. A similar feature could help YYAs visualize the physical impacts of vaping, reinforcing their motivation to quit. Another avenue is gamification; in their systematic review of gamification in e-Health, Sardi et al. (2017) indicate that feedback and rewards were the most frequently used incentives in gamifying e-Health applications and games. El-Hilly et al. (2016) found that gamification enhanced user engagement and promoted positive health behaviours through key drivers such as extrinsic motivation and perceived behavioural control when applied to mobile health interventions for smoking cessation. Gamification elements, like goal setting, progress tracking, and rewards, fostered a sense of achievement and commitment among participants, supporting adherence to cessation efforts. 1.3 Research Problem Symptoms of dependence among YYA vape users are increasing, including frequency of use, frequent strong urges to vape, addiction and unsuccessful quit attempts (Hammond et al., 2022). While many YYAs express a desire to quit vaping, current cessation efforts face substantial barriers, both in terms of user motivation and available resources. 13 Studies show that while health concerns, financial strain, and social influences encourage cessation attempts, the addictive nature of nicotine, the sensory appeal of flavours, and the social acceptability of vaping create formidable challenges. Existing cessation resources are often modelled after traditional smoking cessation methods and fail to address the specific social, psychological, and behavioural needs of YYAs who vape. There exists a critical gap in cessation interventions specifically designed for YYAs. Emerging digital interventions, such as app-based tools discussed in Chapter 2, show promise in supporting cessation but often lack rigorous evaluation, making their effectiveness uncertain. Addressing this need, this research aims to inform the development of an evidence-based cessation strategy that combines behavioural, social, and digital elements to support YYAs in quitting vaping successfully. AR has demonstrated potential in smoking cessation by providing scalable, portable, and real-world applicable support (Vinci et al., 2020b). However, no studies have yet explored its application in vaping cessation, leaving a valuable opportunity for this research to contribute innovative, youth-driven solutions that address the distinct needs and behaviours of YYAs. 1.4 Research Question and Objectives The overarching aim of this study was to investigate the experiences and perspectives of YYAs engaged in vaping cessation, with a specific focus on informing the design of a YYA-driven intervention for vaping cessation. The driving research question was: What can be learned from YYA vapers who are currently in the process of quitting to inform mobile-based AR intervention designs? The objectives of this research were as follows: i. To explore YYAs’ experiences with vaping cessation, including their motivations for quitting, barriers faced, and the strategies they find most effective. ii. To examine YYAs’ preferences for mobile-based cessation interventions, including the types of applications they currently use (if any), their frequency of use, and their perceived effectiveness. iii. To investigate YYAs’ familiarity with AR technology and its potential role in vaping cessation, including their comfort levels, preferences, and feedback on possible features that could enhance their quit journey. 14 iv. To synthesize the findings into practical recommendations for developing mobile-based AR interventions targeting vaping cessation among YYAs To effectively address vaping cessation among YYAs, designing interventions that resonate with their values and experiences is essential, engaging them through interactive, tailored approaches. App-based cessation interventions should integrate the voices and perspectives of diverse YYAs, ensuring that their insights shape and enrich the co-creation of meaningful, impactful solutions (Krane et al., 2021). While qualitative studies such as Coen et al. (2023), Huma et al. (2022) and Struik and Yang (2021) have included YYA perspectives, they often stop short of fully involving them as active co-creators in the research and design process. By engaging YYAs at every stage of intervention development, from initial design to implementation, this study aims to ensure that vaping cessation strategies are evidence-based and highly relevant to the needs and preferences of YYA end-users. Additionally, exploring the application of such interventions across diverse subpopulations within the YYA demographic is vital to ensure inclusive and equitable access to practical cessation tools. 1.5 Researcher Positionality and Reflexivity Researcher positionality is a researcher's worldview underlying their ontological and epistemological position (Berger, 2015; Holmes, 2020). Some aspects of positionality are generally regarded as being fixed, such as race, gender, and nationality, whereas others are more fluid, such as socio-political stances and personal life experiences. Reflexivity is a continual and multifaced reflective exercise in which researchers apply their self-awareness and metacognition to critically consider, assess and evaluate how their internal experiences and personal context affect the qualitative research process from start to finish (Berger, 2015; Olmos-Vega et al., 2023). The goal of reflexivity is not to neutralize the subjectivity of the researcher but to instead acknowledge that the researcher’s subjective perspective is fundamentally intertwined with the qualitative research process, a key tenet of ID (Thorne, 2016) and reflexive thematic analysis (RTA) (Braun & Clarke, 2021a; 2021b;), and adds value to the generation of data (Olmos-Vega et al., 2023). This aligns with constructivist ontology because the researcher is viewed as having a particular understanding rather than an objective stance. 15 My experiences working in public health and acute care settings as a registered nurse, as well as my personal experiences witnessing vaping and the ensuant health effects amongst friends and family, have ignited my interest in pursuing equitable youth-driven interventions for vaping cessation. I acknowledge that my age, professional identity as a nurse, and never-vaped status may position me as both an insider and outsider in this research. While I share generational proximity with the participants, I occupy a position of relative authority and privilege as a researcher, which may influence participant responses. My prior work in immersive technologies, including my involvement with UBC’s Create in Immersive Technologies (CiTECH) program, reflects a professional interest in leveraging innovative tools to address public health challenges, which may have subtly shaped my focus on AR and digital solutions for vaping cessation. I conducted this research, aware that my positionality carries strengths and potential biases. My background enabled rapport-building with participants, fostering open discussions. However, I recognize the influences my professional or personal assumptions may have on interpreting the data. To ensure I was cognizant of my subjectivity as a researcher, I employed reflexive journaling throughout the research process, consistently reflecting on my positionality and its influence on data collection, analysis, and interpretation. By engaging in critical reflection and maintaining transparency, I aim to honour participants’ voices, allowing their lived experiences to drive the findings. My position as a researcher is inherently relational; I am not a neutral observer but an active participant in the research process. Through this thesis, I strived to contribute to a nuanced understanding of YYA-driven vaping cessation strategies while remaining conscious of my role, privilege, and responsibilities as a researcher and healthcare professional. 1.6 Conclusion This research addresses an urgent public health concern, as vaping prevalence continues to rise alarmingly among YYAs. Understanding this demographic's unique values, motivations, and challenges is crucial for developing interventions that genuinely resonate with their experiences. Leveraging AR technology in this study represents an innovative approach to engage and empower YYAs in their cessation journeys, offering a novel, immersive experience that aligns with their technological engagement. The findings will 16 guide the creation of YYA-driven strategies that address the specific needs of those affected by vaping, providing a foundation for targeted interventions that foster healthier futures for young individuals. This introductory chapter has provided an overview of the YYA vaping epidemic, the need for effective cessation strategies, and the potential of AR-based digital interventions to fill the gap. Next, Chapter 2 presents a comprehensive scoping review of existing literature on digital interventions for vaping cessation across age groups. Chapter 3 outlines the study’s methodology based on Interpretive Description (Thorne, 2016). Chapter 4 presents the research findings in a journal manuscript format and may include some methodological overlap with Chapter 3 due to publication requirements. Finally, Chapter 5 concludes this thesis with a discussion of the implications of these findings for future research and the advancement of innovative, youth-centred vaping cessation interventions. 17 Chapter 2: A Scoping Review on Digital Interventions for Vaping Cessation 2.1 Introduction The rise in vaping, particularly among youth and young adults (YYA), has become a pressing public health issue. Frequently marketed as a tool for smoking cessation and a safer alternative to traditional tobacco products, the use of e-cigarettes has become widely popular among non-smokers and indoctrinated a new generation into nicotine addiction (Askwith et al., 2024; McCausland et al., 2019). The myriads of flavour options, convenient and discreet device designs, misconceptions about vaping-related harms, the addictive nature of nicotine, and complex socioenvironmental influences further perpetuate vaping behaviours and complicate cessation efforts (Crane et al., 2023; Gov Can, 2023; Guerra Castillo et al., 2024; Han & Son, 2022). Despite the proliferation of vaping among YYAs, recent evidence indicates that many young e-cigarette users want to quit (Amato et al., 2021; Cha et al., 2024; Cuccia et al., 2021; Lin et al., 2024; Palmer et al., 2022a; Sanchez et al., 2021). This expressed desire to quit, coupled with the challenges associated with vaping, necessitates the urgent development of tailored, accessible and effective interventions to help individuals quit vaping. Over the years, a variety of smoking cessation interventions such as nicotine replacement therapy (NRT) (Lindson et al., 2019), pharmacotherapy (e.g., varenicline or bupropion) (Cahill et al., 2013), counselling (Lancaster & Stead, 2017), and contingency management (CM) (incentives for verified abstinence) (Secades-Villa et al., 2020), have demonstrated efficacy in aiding individuals to quit smoking. Tools have been developed to verify smoking abstinence, including measuring exhaled breath carbon monoxide (CO) and saliva cotinine (a metabolite of nicotine) (Marsot & Simon, 2016; Moore et al., 2018). More recently, digital behavioural interventions, including virtual counselling, text messaging programs, telehealth-delivered CM, and app-based modalities, have been integrated into smoking cessation support with significant evidence of their success (Kong et al., 2017; Webb et al., 2022; Whittaker al., 2019). Interventions that have been successful for tobacco cessation may provide a promising foundation for vaping cessation strategies. Sanchez et al. (2021) highlight that vaping and smoking share common barriers to quitting, such as social influences, stress reduction, and sensory gratification, as well as 18 similar reasons for quitting, including financial loss and dependence. While there are commonalities, there are also unique social and behavioural dimensions of vaping that differ significantly and should not be discounted. Key differences include the enjoyment of flavoured e-liquids, the discreetness and convenience of vaping and a lack of self-awareness among users regarding their vaping habits (Sanchez et al., 2021). Vaping devices are often perceived as trendy and less harmful than smoking, and the social environments surrounding their use, both online and offline, can make quitting difficult. Furthermore, many users engage in dual use (vaping alongside smoking) or use vaping in conjunction with other substances, such as cannabis (co-use) (Berg et al., 2021; Mehra et al., 2019). Another critical difference highlighted by Sanchez et al. (2021) is the lack of reliable information on the health risks of vaping, which leads to confusion and mistrust among users. This uncertainty, along with the distinct characteristics of vaping, emphasizes that smoking cessation tools, while useful, may not fully address the unique appeal and social nature of vaping, underscoring the importance of exploring both existing and novel interventions tailored specifically to the context of e-cigarette cessation. In response to the complexities of vaping cessation, digital interventions have emerged as promising tools for behaviour change, particularly among younger populations who are highly engaged with novel technologies. Mobile apps, text messaging, social media, and web-based support platforms have gained momentum to deliver scalable, personalized, real-time interventions (Amin et al., 2023). These tools offer distinct advantages, such as providing instant feedback and encouragement in moments of need, continuous support, and the ability to tailor content based on the user and their behaviour, goals, and preferences. Leveraging digital interventions may also have the capacity to address some of the unique barriers to vaping cessation, such as the social aspect of vaping, by offering community or peer-based support and connecting users with real-time flexible coaching. Previous research with YYAs has revealed that cessation support via digital technologies is desirable, especially mobile app-based technologies (Berg et al., 2021; Dai et al., 2023). Given the omnipresence of technology in the lives of YYAs, digital interventions offer an approach that warrants thorough exploration. 19 2.1.1 Aim and Objectives This scoping review aimed to identify and map the landscape of digital interventions designed to support vaping cessation. By synthesizing existing research, this review sought to provide insights into digital vaping cessation interventions’ effectiveness, engagement strategies, and implementation considerations. This scoping review considered the following questions: (1) What types of digital interventions have been developed and/or evaluated for vaping cessation? (2) What evidence exists regarding the effectiveness of these digital interventions in promoting vaping cessation and user engagement? (3) What key barriers and facilitators influence digital vaping cessation interventions’ adoption, adherence, and success? (4) What gaps remain in the literature, and what areas should future research prioritize to enhance the design and effectiveness of digital vaping cessation tools? By addressing these questions, this review aimed to provide a synthesis of digital vaping cessation tools, offering guidance for future research and intervention design to enhance accessibility, engagement, and long-term cessation success. 2.2 Methods 2.2.1 Study Design Scoping reviews are well-suited to projects aiming to map out a broad and evolving field where the evidence is diverse and emerging (Pollock et al., 2021). Given that vaping cessation interventions are a relatively new area of research, this method allows for the inclusion of various study designs, including randomized controlled trials (RCTs), qualitative studies, protocols, and pilot programs (Pollock et al., 2021). This is crucial for understanding the effectiveness of these interventions and the challenges and opportunities they present. Additionally, the rapid evolution of digital technology necessitates a broad and inclusive approach to ensure that the review captures the full range of available evidence. The Joanna Briggs Institute reviewer’s manual was used to guide the conduct of this scoping review (Pollock et al., 2021). The scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist (see Appendix A) (Tricco et al., 2018). A scoping review protocol was drafted internally by KF and LS. 20 2.2.2 Search Strategy The search strategy was developed in collaboration with an academic librarian to ensure comprehensive coverage of relevant literature. Preliminary searches were conducted in high-impact journals related to digital health and tobacco cessation to refine search terms. An initial set of searches in Medline was performed to analyze title and abstract keywords and the index terms used to classify relevant articles. Based on these findings, a finalized list of search terms was compiled. A systematic search of the databases CINAHL, Medline, and PsycINFO was conducted in October 2024 to identify peer-reviewed studies evaluating digital interventions for vaping cessation. Boolean operators (AND/OR) were used to refine search results, combining keywords related to vaping cessation and digital interventions, such as mobile health (mHealth), text messaging, mobile applications, telehealth, and social media. The search strategy was structured to capture quantitative, qualitative and mixed-methods studies, ensuring a broad representation of intervention types and study designs. A hand search of reference lists from included studies was conducted to identify additional relevant articles. The full search strategy, including search terms and database queries, is provided in Appendix B. 2.2.3 Inclusion and Exclusion Criteria Inclusion criteria included the English language and publication after January 2018 to capture recent changes in vaping and the vaping cessation landscape. Qualitative, quantitative and mixed-methods peer-reviewed articles were considered to ensure that the effectiveness of these interventions and the lived experiences of those attempting to quit vaping were captured. Studies that explored a range of technology driven interventions, such as those including mobile applications, text messaging programs, social media platforms, telehealth coaching, and other digital-based interventions explicitly aimed at helping individuals quit vaping, were sought. The key outcome of interest was vaping cessation itself; as such, interventions that were evaluated were sought as outcome data was needed for the analysis. In contrast, secondary outcomes like reduced vaping frequency, changes in nicotine dependence, user engagement with the intervention, participant satisfaction, retention and adherence, and intervention design were also given consideration. The review aimed to capture these digital tools' effectiveness and user experience by focusing on a wide 21 range of outcome measures. Hybrid interventions (e.g., combining digital tools with non-digital elements like brief counselling) were included if they explicitly evaluated the digital component. Protocols were also included as they capture novel strategies and intervention designs that may inform future research and intervention development, even if effectiveness data was not yet available. The inclusion of study protocols maintained the comprehensiveness of the review, ensuring it reflects the rapidly evolving work being done in vaping cessation. Age range was not used as a limiter to ensure the review captured a broad spectrum of digital interventions for vaping cessation, recognizing that vaping affects individuals across various age groups and that interventions may target different populations, from adolescents to older adults. Research focused solely on smoking cessation or other forms of tobacco use, unless it explicitly addressed e-cigarettes or vaping, was excluded. If a study addressed vaping cessation alongside smoking cessation, it was eligible only if it provided distinct data on vaping. Interventions that were not digital in nature, such as traditional face-to-face counselling or pharmacological treatments, were excluded unless used in conjunction with a digital component. Studies centred on vaping prevention, such as campaigns or interventions aimed at deterring individuals from starting to vape, were also excluded, as this review sought to understand how digital tools assist individuals already engaged in vaping to quit. Studies that focused generally on the desired format for vaping cessation interventions without an in-depth exploration of specific digital interventions were excluded as existing research and reviews already address preferences for cessation methods, particularly among YYAs (Amin et al., 20223; Berg et., 2021; Dai et al., 2023). Studies that reported only on attitudes or knowledge related to vaping without measuring actual cessation behaviours or discussing a specific intervention were also excluded, as the primary interest for this scoping review lies in understanding how digital interventions impact vaping cessation outcomes and what digital interventions are being explored. Finally, studies that did not provide empirical data, such as editorials, opinion pieces, or grey literature, were excluded to maintain the rigour and relevance of the review. By focusing on existing digital interventions, this review provides a clear, actionable synthesis of tools and strategies developed to support vaping cessation. 22 2.2.4 Study Selection Process Studies retrieved from the database searches were managed using Covidence (Veritas Health Innovation Ltd), a reference management and screening software. Any duplicates were removed by Covidence before being imported for screening. KF manually conducted a two-stage screening process following duplicate removal. During level 1 screening, the titles and abstracts of the studies were assessed against the eligibility criteria. Studies that did not meet the criteria based on their title or abstract were excluded. In level 2 screening, the full-text articles that passed level 1 screening were reviewed to confirm their eligibility for inclusion. Studies that met all inclusion criteria were selected for full data extraction, while reasons for exclusion at the full-text stage were recorded, consistent with PRISMA-ScR guidelines (Pollock et al., 2021). For any studies where there was a question of whether the criteria were satisfied, KF consulted with LS, and a decision was made through discussion and consensus. 2.2.5 Data Extraction and Analysis KF conducted data extraction manually, following a standardized extraction form designed with LS to ensure consistency and accuracy. The extracted data were organized in Microsoft Word tables (see Appendix C) and managed using Zotero reference manager software. The key data extracted included author, year, country, study design, sample size, population characteristics, intervention type, and key findings related to digital interventions for vaping cessation. A qualitative and quantitative summary of each study’s findings was also extracted, ensuring that numerical outcomes (e.g., cessation rates, engagement metrics) and thematic insights (e.g., user satisfaction, barriers, and facilitators) were captured. Following extraction, data was categorized thematically to identify recurring patterns across studies using an iterative process. Studies were grouped based on intervention type (e.g., mobile apps, text messaging, social media), and thematic analysis was employed to synthesize qualitative data, focusing on commonly used strategies and barriers and facilitators of digital intervention success. Quantitative data, such as cessation outcomes, were summarized descriptively and tabulated for comparison. This combined approach allowed for a holistic view of the current state of research on vaping cessation interventions, identifying both gaps in the literature and areas for further exploration. 23 2.3 Results 2.3.1 Overview of the Search Results A total of 794 articles were identified through database searches (CINAHL: n=172, Medline: n=451, PsycINFO: n=171). After 272 duplicate records were removed, 522 articles remained for title and abstract screening. Of these, 485 studies were excluded for not meeting the eligibility criteria, leaving 37 full-text articles for further assessment. Following a full-text review, 21 studies were excluded due to irrelevant study outcomes (n=8), ineligible intervention types (n=8), or non-qualifying study populations (n=5). Ultimately, 16 studies met all inclusion criteria and were included in the final review. Figure 1 presents the PRISMA-ScR flow diagram, outlining the study selection process (Tricco et al., 2018). Figure 1 PRISMA Flow Diagram 24 2.3.2 Main Characteristics of the Included Papers A total of 16 studies were included in this review, representing a variety of designs and digital interventions aimed at vaping cessation. These studies spanned quantitatively tested cessation interventions (e.g., RCTs, cohort studies) (Table 1) and quantitively scored content analyses of available vaping cessation mobile apps (n=9), qualitative designs (e.g., interviews, focus groups) (n=3) (Huma et al., 2022; Lyu et al., 2022a; Struik et al., 2023a), study protocols (n=2) (Lyu et al., 2022b; Sanchez et al., 2023). While RCTs play an important and complementary role in the evidence landscape for evaluating intervention efficacy, few studies in this review employed this rigorous design. Instead, many interventions relied on pilot studies, feasibility studies, or observational methods, limiting the strength of evidence regarding their effectiveness. Nonetheless, qualitative studies and study protocols provide valuable insights into user experiences, barriers, and facilitators to engagement. Participant demographics ranged from adolescents to adults, with sample sizes varying from as few as 8 participants to over 2,500. The study participants were predominately White, female, and under 30 years of age. This demographic focus underscores the need for future research to recruit more diverse populations to address health disparities in vaping cessation outcomes. While no age range was used as a limiter, the focus on YYAs reflects the population most affected by vaping. The majority of the studies were published by authors from the United States, except for four published by Canadian authors (Huma et al., 2022; Sanchez et al., 2023; Sanchez et al., 2022; Struik et al., 2023a) and one from Australian authors (McKay et al., 2024). Table 1 Summary of Tested Digital Interventions and Outcomes Study Intervention Type Participants (N) Mean Age (Years) Distribution of Sexes (F/M/Other) Cessation Rate Bilic et al. (2023) Zoom-based peer coaching 89 N/A (university students) 73% /23.6% /3.4% Reduced e-cigarette use (b = -2.1, p < 0.001) and lower use susceptibility (RR = 0.04, p = 0.05) compared with no coaching sessions. 25 Study Intervention Type Participants (N) Mean Age (Years) Distribution of Sexes (F/M/Other) Cessation Rate Graham et al. (2024) Text Messaging Program (This is Quitting) 1,503 16.4 51.4% /41.8%/ 6.8% Participants receiving the intervention were significantly more likely to report 30-day abstinence at 7 months (37.8%) compared to the control group (28%). Graham et al. (2021) Text Messaging Program (This is Quitting) 2,588 20.4 50.3% /48.4% /1% Participants receiving the intervention were significantly more likely to report 30-day abstinence at 7 months (24.1%) compared to the control group (18.6%). Krishnan et al. (2023) Text Messaging Program (Quit the Vape) ± Counselling 58 27.3 41.4% /53.5% /5.2% The intervention with counselor-delivered messages reported higher rates of 7-day abstinence (27.8%) compared to those without counselor group (11.1%) and control groups (5.9%). Marler et al. (2024) Mobile App (Pivot) 73 37.4 54%/ 45%/ 3% At 26 weeks, 45% of participants reported achieving 30-day vaping abstinence. Orfin et al. (2024) Text Messaging Program (Kick Vaping) 40 22.3 45%/ 47.5/ 7.5% At month 3, 75% of participants reported 7-day vaping abstinence. Palmer et al. (2022b) Telehealth ± Contingency Managment (CM) 27 20.3 66.7%/ 33.3% Participants in the CM group submitted 55.4% abstinent samples compared to 8% in the control group, showing preliminary support for the CM intervention. Raiff et al. (2022) Telehealth + Contingency Managment (CM) 8 19.88 63%/ 37% All eight participants quit vaping nicotine during the 2-week intervention, with 100% compliance in submitting samples and attending calls. Webb et al. (2023) Mobile App (Quit Genius- Vaping) + nicotine replacement therapy (NRT) 51 27.9 54.6%/ 45.4% At 1 month post-quit-date, 48.9% of participants reported 7-day abstinence, and 28.8% reported 30-day continuous abstinence. 26 2.3.1 Types of Digital Interventions Four categories of interventions were tested, including text messaging programs (n=4) (Graham et al., 2024; Graham et al., 2021; Krishnan et al., 2023; Orfin et al., 2024), mobile apps (n=2) (Marler et al., 2024; Webb et al., 2023), telehealth delivered CM (n=2) (Palmer et al., 2022b; Raiff et al., 2022), and web or social media-based support (n=1) (Bilic et al., 2023). McKay et al. (2024) and Sanchez et al. (2022) conducted assessments and content analyses of vaping cessation mobile apps available on the Apple and Google Play stores. The two study protocols sought to test an Instagram-based intervention (Lyu et al., 2022b) and a mobile app-based intervention, Crush the Crave (Sanchez et al., 2023). Additionally, Huma et al. (2022), Lyu et al. (2022a) and Struik et al. (2023a) qualitatively explored app-based, social media-based, and web-based cessation support, respectively. Beyond identifying the type of intervention, content and features were also considered. 2.3.1.1 Text Messaging Interventions Text messaging programs emerged as a modality for vaping cessation, demonstrating high feasibility and efficacy across diverse populations. This Is Quitting (Graham et al., 2024; 2021) is an automated, interactive text message program designed for youth vaping cessation, tailored to users’ age, quit date, and vape brand. Grounded in social cognitive theory and youth smoking cessation research, it provides skill-building, coping strategies, mental health support, and reinforcement of social norms through peer-written messages. The program delivers tailored messages before and after a quit date, focusing on the risks of vaping and the benefits of quitting, with on-demand support via keywords. When targeted toward young adults aged 18–24 years, This is Quitting program achieved a 24.1% 30-day PPA rate at 7 months, significantly outperforming the control group at 18.6% (Graham et al., 2021). Comparably, when trialled for adolescents ages 13–17 years, This is Quitting achieved 37.8% abstinence, emphasizing the role of tailored and age-specific content (Graham et al., 2024). Another intervention, Kick Vaping, built upon Decídetexto, a smoking cessation text messaging intervention for Latinos, was particularly impactful for Latino young adults, combining English or Spanish messaging to improve accessibility (Orfin et al., 2024). Kick Vaping contains 212 messages delivered across four phases: Pre-quit, Quit Day, Post-quit 27 Intensive, and Post-quit Maintenance, as well as bidirectional communication with research staff and automated responses triggered by keywords. Kick Vaping reported 75% self-reported 7-day abstinence at three months and significantly increased self-efficacy among participants. Hybrid intervention Quit the Vape integrated automated text messaging with optional live counsellor-delivered messages and interactions (Krishnan et al., 2023). The intervention with counsellor-delivered messages reported higher rates of 7-day abstinence (27.8%) compared to the without counsellor group (11.1%) and the control group (5.9%), indicating that combining automated and human elements may serve to create a more personalized cessation experience and enhance efficacy. 2.3.1.2 Mobile App-Based Interventions Mobile applications emerged as a versatile platform, leveraging a combination of behavioural tools for vaping cessation. In their qualitative descriptive study, Huma et al. (2022) found young adults aged 20-29 years preferred mobile vaping cessation tools that are accessible, personalized, and engaging. Desired features included behavioural tracking, tailored quit plans, peer support, motivational messages, and evidence-based education. Emotional support and interactive elements, such as gamification and progress milestones, were also identified as crucial for sustained engagement (Huma et al., 2022). The Pivot app, adapted from a successful digital tobacco cessation program, is a 12-month app-based intervention designed for vaping cessation (Marler et al., 2024). It integrates evidence-based methods such as motivational interviewing, CBT, self-determination theory, and acceptance and commitment therapy. Key features include educational content, progress tracking, a moderated online discussion community, and personalized quit coaching. At six months, Pivot achieved a 48% 7-day point-prevalence abstinence rate (PPA) and demonstrated significant reductions in vaping dependency among non-abstinent participants. Secondary outcomes included improved self-efficacy, motivation to quit, and reduced vaping frequency and intensity (Marler et al., 2024). The Quit Genius-Vaping app is a comparable program that combines self-guided CBT content with digital coaching and nicotine replacement therapy (NRT) to support vaping cessation (Webb et al., 2023). The app provides users with tailored quit plans, interactive educational modules, and access to professional coaching. One month after the participants' target quit date, the program achieved 48.9% 7-day PPA and 28.8% 30-day PPA. Secondary outcomes included 28 reductions in vaping frequency and improvements in user-reported confidence to quit (Webb et al., 2023). While both Pivot (Marler et al., 2024) and Quit Genius-Vaping (Webb et al., 2023) demonstrated promising results in achieving vaping cessation, their findings are limited by relatively small sample sizes, with 71 and 53 participants, respectively. These limitations highlight the need for larger studies to validate their effectiveness and generalizability. Sanchez et al.’s (2023) protocol describes one of the first-ever RCT studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among YYAs. Sanchez et al. (2023) propose testing a third vaping cessation app, Crush the Crave, among youth aged 16-18 years and young adults aged 19-29 years. An earlier version of the Crush the Crave app was used for smoking cessation. Crush the Crave offers features such as tracking vaping triggers, cravings, and habits through a geotagged diary while providing users with supportive messages, personalized visual progress, and access to evidence-based resources like quitlines (Sanchez et al., 2023). Additional features include push notifications highlighting money saved, health improvements, and milestones achieved, as well as tailored messages and digital awards to encourage users throughout their quitting process. This study will assess self-reported 30-day PPA at three months as the primary outcome (Sanchez et al., 2023). Secondary measures include the intention to quit within six months, puffs per session, daily vaping frequency, and total vape sessions in the past 30 days. 2.3.1.3 Telehealth Delivered Contingency Management Two interventions leveraging telehealth-delivered CM were examined in this review (Palmer et al., 2022b; Raiff et al., 2022). CM involves delivering an incentive, often financial, contingent on objective evidence of abstinence. Because CM relies on incentives, it is essential to frequently verify abstinence. In the examined studies, vaping abstinence was verified using saliva cotinine samples. Participants in Raiff et al. (2022) tried and evaluated two different saliva cotinine tests (NicAlert and iScreen) to verify abstinence, with financial rewards provided upon confirmation (up to $140). Participants were given information about quitting vaping (https://teen.smokefree.gov/quit-vaping/how-toquit-vaping) to help support their cessation efforts, as the telehealth calls did not focus on cessation coaching but rather the evaluation and witnessing of the cotinine tests. All eight participants in Raiff et al. (2022) achieved full vaping abstinence during a two-week trial period, with 100% compliance in 29 submitting samples and attending calls. Additionally, iScreen was consistently rated higher on all measured dimensions, including ease of use, compared to NicAlert. Palmer et al. (2022b) conducted a similar study using cotinine-verified (iScreen) vaping abstinence paired with CM (up to $200). Participants were instructed to download the DynamiCare app; every 2–3 days during the treatment period, the app prompted participants to submit videos of their saliva cotinine test collection and results. All participants were provided with information for This is Quitting to augment the CM intervention and provide skills-based resources and content during the vaping quit attempt (Graham et al., 2024; Graham et al., 2021; Palmer et al., 2022b). It is unclear whether participant experiences with This is Quitting influenced the overall cessation results. Participants in the CM group submitted 55.4% abstinent samples compared to 8% in the control group, showing preliminary support for the CM intervention (Palmer et al., 2022b). Although the CM approach has shown high feasibility and scalability, it often requires robust infrastructure and resources for implementation (Palmer et al., 2022b; Raiff et al., 2022). 2.3.1.4 Web and Social Media-based Support Struik et al. (2023a) explored the strengths and limitations of the web-based cessation program QuitNow through qualitative interviews with 36 participants who vape, smoke, or dual use. QuitNow provides personalized quit plans, sessions with trained quit coaches, a coach-moderated community forum, multiple support channels (telephone, SMS, and live chat), and resources for users and healthcare professionals. Participants appreciated its evidence-based information, credibility, and social support features, particularly forums and quit coaches. However, limitations included a text-heavy interface, insufficient youth-oriented and vaping-specific content, and a lack of personalization. Recommendations included improving the platform’s aesthetics, incorporating mobile-friendly features, and tailoring content to younger users and those seeking vaping cessation (Struik et al., 2023a). Bilic et al. (2023) expanded the scope of web-based interventions by integrating Zoom-based peer health coaching with multi-behavioural support targeting vaping cessation. This approach addressed co-occurring health behaviours, such as physical activity and stress management, within the same framework. Participants highlighted the benefits of real-time virtual interaction and the flexibility of remote delivery. Preliminary outcomes suggested 30 promising reductions in e-cigarette use and improved self-efficacy compared with no coaching. However, the study emphasized the need for larger, controlled trials to confirm these findings. Lyu et al. (2022a) identified Instagram as a suitable platform for delivering peer-based vaping cessation interventions due to its professional features, including group messaging, direct messaging, and multimedia sharing capabilities. Participants expressed comfort using their personal social media accounts for mentoring, provided clear boundaries were maintained. Building on this, Lyu et al. (2022b) detail a protocol for an Instagram-based intervention targeting young adults through private groups. The intervention includes up to three posts per weekday for 25 days, incorporating techniques such as self-liberation, stimulus control, and counterconditioning while encouraging quit dates and detailed plans. Groups are facilitated by a trained cessation counsellor with additional support from a pediatrician, and participants are educated on nicotine dependence, with encouragement to consider pharmacotherapy via healthcare providers (Lyu et al., 2022b). 2.3.2 Common Strategies and Supports Several recurring approaches emerged from the literature, highlighting the importance of social support and personalization as essential features of digital-based interventions, along with integrating behaviour change models and frameworks. Social support was a cornerstone of many vaping cessation tools, leveraging peer and community networks, quit-coaching, or professional support to enhance user engagement and motivation (Bilic et al., 2023; Krishnan et al., 2023; Lyu et al., 2022a; Marler et al., 2024; Struik et al., 2023a; Webb et al., 2023). Lyu et al. (2022a) emphasized the value of peer mentoring for adolescents, highlighting that effective mentors were those who had successfully quit vaping, were relatable and provided regular check-ins. Inclusive and safe spaces, such as LGBTQ+-friendly groups, were considered essential, along with a preference for small-group formats or one-on-one support. Similarly, Struik et al. (2023) reported that the QuitNow platform’s coach-moderated community forums and access to trained quit coaches were highly valued by participants, particularly among those who vaped or dual-used nicotine products. Programs like Pivot (Marler et al., 2024) also emphasized the role of moderated community forums, where users could share experiences and encouragement, creating a sense of 31 connection and accountability. Hybrid approaches, such as Quit the Vape (Krishnan et al., 2023), which combined automated text messages with human counsellor outreach, demonstrated the potential of combining scalable digital tools with personalized human support. These findings suggest that social support mechanisms, whether through peer mentoring, professional counselling, or online forums, are critical to fostering motivation and addressing the emotional challenges of quitting vaping. Personalization was a recurring idea, with tailored approaches enhancing user engagement and long-term success. Programs like This Is Quitting (Graham et al., 2021; 2024) customized text messages based on users' age, quit readiness, and vaping habits. These personalized messages included coping strategies, motivational content, and nicotine dependence education, which were well-received by participants. Webb et al. (2023) highlighted tailoring the pace, feedback, and digital content to the individual. Based on user data, including app utilization, program completion, motivations for quitting vaping, and quit date, personalized content was delivered in the form of personalized quizzes, skills training exercises, and personalized progress feedback. Culturally adaptive interventions, such as bilingual support in Kick Vaping, underscored how tailoring content to linguistic and cultural preferences can reduce barriers and increase engagement among underserved populations (Orfin et al., 2024). Despite much of the literature pointing to the importance of personalization, Sanchez et al. (2022) identified personalization gaps in existing apps as few tailored content to vaping-specific behaviours, such as the use of flavoured pods or device preferences. Theories and behaviour change models were incorporated to varying degrees across several of the included studies, serving as foundational frameworks to guide the design, delivery, and implementation of digital interventions. Cognitive Behavioural Therapy (CBT) emerged as a prominent framework, especially in mobile applications. CBT principles informed various intervention components, including structured content delivery, goal-setting, and coping strategies designed to address the cognitive and behavioural aspects of vaping cessation. For example, apps like Pivot (Marler et al., 2024) and Quit Genius-Vaping (Webb et al., 2023) used CBT to help users identify and challenge unhelpful thoughts, develop healthier coping mechanisms, and set achievable milestones, such as reducing daily vaping sessions or achieving abstinence. The Transtheoretical Model (TTM), referenced by 32 Lyu et al. (2022b), involved tailored support based on participants' readiness to quit and recognizing behaviour change's cyclical and non-linear nature. Key processes within the TTM, such as self-liberation (e.g., committing to quit), stimulus control (e.g., removing vaping devices from one's environment), and counterconditioning (e.g., replacing vaping with healthier behaviours), were integrated into the proposed intervention posts (Lyu et al., 2022b). The Social Cognitive Theory (SCT) was less frequently discussed but implicitly integrated into interventions emphasizing social support, self-efficacy, and observational learning. For instance, Graham et al. (2021; 2024) used messages crafted by other users and curated by staff to ensure relevance and alignment with evidence-based practices. Such features reflect SCT principles, as they leverage social influence and modelling to encourage healthier behaviours. Multiple platforms sought to foster a sense of community, reinforce perceived social norms around quitting, and boost self-efficacy through positive peer reinforcement (Bilic et al., 2023; Krishnan et al., 2023; Lyu et al., 2022a; Marler et al., 2024; Struik et al., 2023a; Webb et al., 2023). Despite these examples, not all studies explicitly justified their choice of behaviour change theories, and some interventions lacked detailed explanations of how these frameworks informed specific program features. This lack of transparency limits the ability to fully assess these interventions' effectiveness and transferability. Overall, the findings underscore the importance of explicitly integrating and justifying behaviour change models in digital vaping cessation programs, as these frameworks guide the development of evidence-based features and enhance user engagement and intervention efficacy. Greater clarity in applying these theories would help optimize program design and ensure alignment with the diverse needs of users. 2.3.3 Challenges and Obstacles Digital interventions for vaping cessation face numerous challenges, as highlighted across the reviewed studies. Low engagement and retention rates emerged as significant barriers, with many users discontinuing participation before completing the program. Adolescents and young adults, in particular, struggled to maintain motivation, especially when interventions lacked dynamic features or relied on static content. Programs like Pivot 33 (Marler et al., 2024), which incorporated personalized coaching and real-time feedback, demonstrated better user retention, whereas others, such as This Is Quitting (Graham et al., 2024), experienced a 29% participant drop-off at seven months. These findings underscore the need for digital interventions to adopt adaptive engagement strategies, including gamification features like rewards, progress tracking, quizzes, and interactive feedback. However, studies like Sanchez et al. (2022) and McKay et al. (2024) revealed that such features were underutilized, limiting the ability of interventions to sustain user interest and motivation over time. CM approaches, which rely on financial incentives tied to verified abstinence, showed promise in improving engagement and cessation rates but presented scalability challenges. Resource-intensive requirements, such as frequent abstinence verification through saliva cotinine testing and incentive distribution, limited their feasibility for large-scale implementation (Palmer et al., 2022b; Raiff et al., 2022). While these interventions achieved impressive short-term outcomes, such as 100% abstinence over two weeks in Raiff et al. (2022), their applicability in broader public health efforts remains uncertain due to the significant funding and infrastructure required. Further challenges included limitations in the quality and usability of vaping cessation apps. Sanchez et al. (2022) and McKay et al. (2024) identified critical gaps in adherence to evidence-based guidelines, such as inconsistent implementation of CBT techniques like goal-setting and self-monitoring. Both studies noted that many apps failed to address essential components of cessation, such as coping strategies for withdrawal or relapse prevention, reducing their long-term efficacy. The lack of collaboration with healthcare professionals during app development was also identified as a missed opportunity to improve app design and ensure user-centred, evidence-based features (Sanchez et al., 2022; McKay et al., 2024). Recruitment challenges further compounded engagement issues, as many studies relied on convenience sampling from predominantly homogeneous populations. This lack of diversity limited the generalizability of findings and highlighted the need for culturally tailored content. Interventions that did not address cultural and socioeconomic relevance risked disengagement among racially and economically diverse populations, perpetuating health disparities in vaping cessation outcomes (Graham et al., 2024; Krishnan et al., 2023). 34 To expand their reach and equity, digital vaping cessation tools must address these recruitment and cultural relevance barriers, ensuring that interventions are accessible and effective for all populations. 2.4 Discussion This scoping review underscores the growing potential of digital interventions for vaping cessation, highlighting their ability to address the behavioural, psychological, and social complexities of vaping, particularly among YYAs. Text messaging programs, mobile apps, telehealth-delivered CM, and web-based or social media interventions demonstrated promising outcomes, yet significant challenges persist in their design, implementation, and evaluation. Recognizing the strengths of existing interventions while addressing their limitations will be essential for enhancing their accessibility, engagement, and long-term effectiveness across diverse populations. Programs such as Kick Vaping (Orfin et al., 2024) and Quit Genius-Vaping (Webb et al., 2023) achieved significant abstinence rates by addressing users' unique psychological and contextual needs. These findings align with Shams et al. (2021), who emphasize that tailored eHealth interventions targeting substance use can enhance engagement and self-efficacy. However, as highlighted in this review, the inconsistent application and justification of theoretical frameworks across interventions limit their scalability and generalizability. Berg et al. (2021) argue that vaping cessation interventions must account for distinct behaviours and barriers, such as the perceived safety and social acceptability of e-cigarettes, which differentiate vaping from smoking cessation. Engagement and retention emerged as barriers across interventions. Graham et al. (2024) and Krishnan et al. (2023) reported relatively high attrition rates, with some participants disengaging once the novelty of the intervention faded. Gamified elements such as rewards and progress tracking, as explored in El-Hilly et al. (2016), are promising strategies for sustaining motivation and engagement but remain underutilized in vaping cessation interventions. For instance, interventions incorporating these features have improved adherence and behavioural outcomes, suggesting their potential as low-cost and scalable solutions. Struik et al. (2022a) highlight community forums as another valuable tool for sustaining user engagement. In their content analysis of web-based smoking cessation 35 support QuitNow, the authors found that individuals who had successfully quit smoking often returned to the online community to support others. This underscores the importance of establishing digital communities to foster peer support and role modelling rather than creating interventions solely focused on an individual. To this point, Congruent with the findings of this review, Struik et al. (2022a) emphasize the merit of considering how cessation interventions can become more of a social enterprise. A shared limitation among several of the studies was reliance on self-reported vaping abstinence, as such participants may over-report their cessation and introduce response bias. One way this may be addressed is through biochemical verifications such as saliva cotinine testing. Leveraging this tool, CM emerged as a promising approach for vaping cessation, rewarding financial incentives for biochemically verified abstinence. Studies in this review demonstrated its effectiveness, with participants achieving higher abstinence rates compared to controls (Palmer et al., 2022; Raiff et al., 2022). These findings align with the broader literature on substance use, where CM has shown strong efficacy for smoking cessation (Secades-Villa et al., 2020). However, the resource-intensive nature of CM, including costs for abstinence verification and incentive distribution, limits its scalability. Future research should explore hybrid models that integrate sustainable approaches to CM with other behaviour change techniques, such as CBT or social support, to enhance feasibility and long-term impact. Social support played a central role in many interventions, reflecting the principles of SCT. Programs like Quit the Vape demonstrated that combining automated messaging with live counsellor support significantly improved abstinence rates by fostering accountability and motivation (Krishnan et al., 2023). Similarly, Instagram-based peer mentoring interventions highlighted the value of emotional support and community-building in reducing the isolation often associated with quitting (Lyu et al., 2022a). These findings are consistent with Whittaker et al. (2019), who identified the combination of human interaction and automated digital tools as a key driver of success in smoking cessation interventions. However, many programs' absence of culturally tailored social support mechanisms underscores the need for more inclusive and diverse designs to address health disparities in vaping cessation outcomes. This review also identified gaps in accessibility and equity, with interventions 36 frequently targeting homogenous populations, limiting their generalizability. Sanchez et al. (2022) and McKay et al. (2024) emphasized that many mobile apps lack cultural relevance or bilingual support, which reduces their effectiveness among underserved populations. Amin et al. (2023) similarly highlighted the importance of tailoring interventions to address the diverse needs of e-cigarette users, particularly given the sociocultural influences shaping vaping behaviours. Addressing these gaps is critical to ensuring that digital tools are accessible, equitable, and effective across diverse populations. Future research must prioritize integrating innovative strategies, such as hybrid models that combine automated and human support, gamification, and biochemical feedback, to enhance engagement and retention. Additionally, incorporating robust theoretical frameworks, such as the TTM and SCT theory, can strengthen intervention design and evaluation. Longitudinal studies with representative samples are essential to validate these approaches and ensure their scalability. By addressing these challenges, digital interventions have the potential to significantly reduce vaping prevalence and mitigate its associated health risks, offering scalable, evidence-based solutions to an urgent public health issue. 2.5 Strengths and Limitations of This Review This scoping review has several strengths that contribute to its value in understanding the current landscape of digital interventions for vaping cessation. One of the primary strengths is the comprehensive and systematic approach taken to identify and synthesize evidence from diverse sources. Including various study designs, ranging from RCTs to qualitative evaluations, provides a holistic view of the effectiveness, user engagement, and barriers associated with these interventions. Furthermore, by focusing on recent literature, this review captures contemporary trends in vaping cessation and reflects the rapidly evolving nature of digital technologies. Another strength is the breadth of intervention types reviewed, including text messaging programs, mobile apps, telehealth platforms, and social media or web-based interventions. This diversity allows for a nuanced understanding of how different tools address vaping cessation’s unique behavioural, psychological, and social challenges. Additionally, the review identified quantitative and qualitative outcomes, offering insights into both effectiveness metrics (e.g., cessation rates) and user perspectives (e.g., satisfaction and perceived barriers). 37 However, this review also has notable limitations. The screening and data extraction processes were conducted by a single reviewer, which may introduce selection bias and reduce the rigour of study selection. While efforts were made to ensure consistency in applying inclusion criteria, the absence of a second reviewer could have led to the omission of relevant studies or the inclusion of less relevant ones. The relatively small number of included studies directly addressing digital interventions for vaping cessation limits the breadth of evidence available for synthesis. This may restrict the generalizability of findings, particularly as many included studies had small sample sizes and focused primarily on short-term outcomes. Additionally, while excluding grey literature and non-peer-reviewed studies was intended to maintain rigour, this approach may have overlooked valuable insights from real-world applications or emerging interventions. Publication bias represents another limitation. Studies reporting negative results or the ineffectiveness of digital interventions may be underrepresented in the literature, potentially skewing the review's findings toward positive outcomes. Finally, the lack of formal quality assessment of included studies, consistent with the scoping review methodology (Pollock et al., 2021), means that the methodological rigour of the evidence base was not evaluated. This could affect the conclusions' reliability, as lower-quality studies may contribute to the synthesis. Despite these limitations, this review provides a valuable synthesis of the current evidence on digital interventions for vaping cessation. 2.6 Conclusion The scoping review contained in this chapter highlights digital interventions as a promising approach to vaping cessation, offering accessible, scalable, and personalized solutions for individuals seeking to quit. While text messaging programs, mobile apps, telehealth-based CM, and web-based interventions have demonstrated positive outcomes, challenges related to engagement, theoretical grounding, and accessibility remain. The findings of this review suggest that hybrid intervention models integrating automated and human support, gamification, and social engagement strategies could enhance user retention and quit success. Additionally, incorporating robust theoretical frameworks, culturally tailored designs, and biochemical verification of abstinence will be critical for optimizing intervention effectiveness. Future research should prioritize longitudinal evaluations to determine the sustainability of digital vaping cessation programs and their potential for 38 widespread implementation. By addressing these challenges, digital interventions have the potential to significantly reduce vaping prevalence and contribute to improved public health outcomes. 39 Chapter 3: Research Methods 3.1 Study Aims and Objectives There remains a critical gap in vaping cessation interventions tailored specifically for youth and young adults (YYAs). While emerging digital interventions, such as mobile apps, show promise in supporting cessation, as explored in Chapter 2, many existing tools fail to fully address the social, behavioural, and technological factors that shape YYAs’ vaping experiences and quitting efforts. This research seeks to bridge this gap by exploring how augmented reality (AR) can be leveraged to enhance vaping cessation support. AR-based interventions have demonstrated potential for smoking cessation by providing scalable, portable, and contextually relevant support (Vinci et al., 2020b). However, their application in vaping cessation remains largely unexplored, presenting an opportunity to develop innovative, youth-centred solutions that align with the needs, behaviours, and technological preferences of YYAs attempting to quit. This thesis explores the experiences and perspectives of YYAs engaged in vaping cessation, with a specific focus on informing the design of an AR-based mobile intervention. The study is guided by the following research question: What can be learned from YYA vapers who are currently in the process of quitting to inform the design of a mobile-based augmented reality (AR) intervention for vaping cessation? To support the investigation of the overarching research question, this study addresses the following objectives: i. To explore YYAs’ experiences with vaping cessation, including their motivations for quitting, barriers faced, and the strategies they find most effective. ii. To examine YYAs’ preferences for mobile-based cessation interventions, including the types of applications they currently use (if any), their frequency of use, and their perceived effectiveness. iii. To investigate YYAs’ familiarity with AR technology and its potential role in vaping cessation, including their comfort levels, preferences, and feedback on possible features that could enhance their quit journey. iv. To synthesize the findings into practical recommendations for developing 40 mobile-based AR interventions targeting vaping cessation among YYAs 3.2 Study Framework Given the evolving landscape of YYA vaping behaviours and the innovative nature of AR interventions, this project ventured into relatively unexplored territory. As vaping is a novel phenomenon, there is not a substantial amount of vaping-specific literature from which to draw. Existing models were primarily developed for smoking cessation and do not fully account for the unique behavioural, social, and technological influences driving vaping among YYAs. As such, this study did not employ a pre-existing theoretical framework. Instead, it adopted an exploratory approach underpinned by interpretive description, allowing the research process to uncover emergent patterns and themes without being constrained by pre-existing models. This flexible approach enabled a nuanced understanding of participant experiences and perspectives, fostering innovation in intervention design. Rigidly adhering to a single existing analysis framework from the start risked constraining the exploration of novel insights (Latkin, 2010). Thompson Burdine et al. (2020) cautioned that researchers should not predetermine that a given theory will be appropriate to their study, stating, “Trying to fit your insights into established models can distort your argument and make it difficult to illuminate new ways of framing the phenomenon” (p. 339). Alternatively, the authors suggested that attempting to elucidate human experiences utilizing established theories and existing models as the study unfolds can offer valuable perspectives on the pertinent social contexts and the interconnected relationship between individuals and their environment (Thompson Burdine et al., 2020). With this in mind, the approach to analysis was inductive, allowing for a flexible and context-sensitive examination. 3.3 Methodology Interpretive description (ID) was developed within the nursing discipline to address the gap between theoretical knowledge and its application in practical, clinical, or real-world settings (Thorne et al., 1997; Thorne, 2016). As such, ID prioritizes generating actionable insights that resonate with the complexities of human health and behaviours and enables researchers to provide rich descriptions and interpretations of participants' experiences and perspectives (Thompson Burdine et al., 2020; Thorne, 2016). ID can be a practical approach 41 to qualitative inquiry into human experiences to develop helpful knowledge for those working in applied settings; this generation of applied knowledge made ID well-suited to answer my research question. Through exploring the qualitative experiences of YYAs regarding vaping and vaping cessation, I transformed what can be learned from this demographic into clinically relevant knowledge and recommendations for the development of a targeted app-based intervention. By posing the question of what can be learned, I moved into an active position of applying the knowledge that was shared by the YYA participants, reflecting the practical nature of ID that is both grounded in and applicable to the health science disciplines and orientated toward knowledge translation (Thorne, 2016; 2020). By prioritizing the contextual and experiential aspects of YYA vaping behaviour and cessation approaches, ID enabled a deep and nuanced understanding that extended beyond mere description, allowing for generating insights directly applicable to intervention design. 3.3.1 Theoretical Underpinnings of Interpretive Description This ID study was grounded in philosophical perspectives aligned with nursing knowledge and practice (Thorne et al., 1997; Thorne, 2016; 2020). Nursing inherently bridges the objective and subjective, requiring practitioners to discern patterns of health and illness across populations while simultaneously addressing the unique needs of individuals or communities in their care (Thorne, 2016; 2020). This dynamic interplay between the general and the specific is a defining characteristic of the discipline (Thorne et al., 1997; Thorne, 2016; 2020). As an applied discipline, nursing often prioritizes the health and well-being of others. When nurse researchers engage in theorizing, it is often with the aim of advancing clinical practice and enhancing knowledge to improve patient or client care outcomes. The discipline’s pragmatic and adaptable nature seeks actionable knowledge while acknowledging that “truth” evolves with context and ongoing knowledge development (Thorne et al., 1997; Thorne, 2020). These fundamental tenets of nursing philosophy underpin the principles of interpretive description. ID is a qualitative research methodology rooted in nursing and constructivist epistemology (Thorne, 2016). Constructivism acknowledges that experiences are socially constructed and subjective while recognizing the possibility of shared realities and multiple 42 ways of knowing as valid (Pilarska, 2021). Central to ID is the belief that knowledge is co-constructed through the interaction between researchers and participants (Thorne, 2016). This epistemological stance recognizes that participants' perspectives are shaped by their unique social, cultural, and personal contexts. Simultaneously, the researcher’s interpretive lens, shaped by their own experiences and positionality, plays a critical role in analyzing and presenting findings (Thorne, 2016). This mutual influence underscores the dynamic and iterative nature of knowledge generation in ID. By asking what can be learned from YYAs regarding their vaping behaviours and their cessation journeys, the co-constructed data was interpreted and orientated toward clinical relevance. This interpretive, constructivist philosophy underlies ID’s central tenets. By focusing on the lived experiences and contextual realities of YYA vapers, this study employs ID to bridge the gap between theoretical understanding and practical implementation. The central principles of ID guided this study’s design and implementation. These principles emphasize that: (a) research is carried out in participants’ natural environments, prioritizing ethical considerations and participant well-being; (b) participant experiences are central to applied practice knowledge; (c) both shared and unique participant experiences of the phenomenon are explored and utilized; (d) researchers must recognize that certain issues transcend specific times and contexts while attending to the temporal and situational nuances of human experiences; (e) the subjective experiences of participants and the shared essence of those experiences are integrated; (f) multiple ways of knowing and experiencing reality are acknowledged, including the presence of contradictions; and (g) researchers and participants are inherently connected, with mutual influences shaping the research process (Thorne, 2016). These guiding principles ensured the study remained flexible, context-sensitive, and rooted in the lived experiences of YYAs, ultimately generating insights that are theoretically meaningful and practically applicable for vaping cessation. ID encourages researchers to be adaptive and to purposefully integrate diverse design methods, including elements from other methodologies and data collection approaches, in a rationalized and transparent manner (Thompson Burdine et al., 2020; Thorne, 2016; 2020). Unlike phenomenology, which seeks to uncover universal essences of lived experience, or grounded theory, which aims to generate new theoretical constructs, ID is uniquely positioned to address applied clinical questions by bridging disciplinary knowledge and 43 empirical findings with practical implementation (Thorne, 2016; 2020). It prioritizes flexibility and responsiveness to emerging insights while maintaining systematic rigour in data collection, analysis, and interpretation (Thorne, 2016). This adaptability was particularly advantageous for examining the under-researched phenomenon of vaping cessation among YYAs using AR interventions. ID provided an ideal methodology for exploring the nuanced and dynamic interplay between YYAs’ behaviours, perceptions, and preferences in this context. The approach enabled the generation of rich, detailed narratives that informed the design of mobile-based AR interventions tailored to this demographic’s needs and experiences. By centring on the lived realities of YYA participants, this study highlights the potential of ID to advance clinically relevant knowledge and foster innovative solutions in nursing practice. 3.4 Research Design This study employed a qualitative research design, using online semi-structured interviews to explore the experiences and perspectives of YYAs engaged in vaping cessation. Guided by ID, this approach allowed for an in-depth examination of the behavioural, social, and technological factors influencing quitting efforts. Participants discussed their motivations for quitting, barriers faced, and the role of digital tools, specifically mobile apps and AR, in supporting cessation. To further engage participants in the co-design process, an interactive Zoom whiteboard activity was conducted, where they ranked proposed AR-based features and provided feedback on their preferences. Reflexive TA was used to analyze the data, ensuring that both shared and unique perspectives were captured to inform the development of youth-centred digital cessation interventions. 3.4.1 Diversity and Inclusion Considerations This project was committed to fostering inclusivity at every stage of the research process to ensure a broad representation of YYA perspectives on vaping cessation. Recruitment strategies were designed to reach diverse participants by framing the study advertisement in inclusive, non-stigmatizing language and disseminating them through trusted networks. Study advertisements were shared with colleagues who are teachers, allowing access to a broad range of students and young adults, as well as with past research participants, who were encouraged to share the opportunity within their networks. This 44 approach helped broaden representation and ensure the study captured diverse vaping experiences across different identities and backgrounds. The data collection process prioritized participant comfort, privacy, and autonomy, allowing for flexible scheduling and remote participation. Researchers were fully committed to respecting participants' chosen names and pronouns, fostering an affirming and inclusive environment during interviews. Analysis was conducted reflexively, recognizing how vaping behaviours and cessation challenges are shaped by individual and structural factors and ensuring that shared and unique experiences were acknowledged. Finally, knowledge translation efforts emphasize inclusive, accessible dissemination to ensure that findings inform equitable, relevant, and youth-centred vaping cessation interventions. 3.4.2 Inclusion and Exclusion Criteria Inclusion criteria for this study were as follows: (1) between 16 and 24 years of age; (2) currently vaping; (3) motivated to quit vaping; (4) able to communicate in written and spoken English; (5) living in Canada; and (6) access to a stable high-speed internet connection. The inclusion criteria for this study ensured the relevance and feasibility of the research. Participants aged 16 to 24 were selected because this age range represents a critical developmental period where vaping behaviours are often initiated, and cessation efforts are particularly impactful. Additionally, this demographic represents Canada's largest population of vape users (Gov Can, 2023). Requiring participants to be current vapers motivated to quit aligned with the study’s focus on understanding vaping cessation. Criteria related to language proficiency and stable internet access ensured effective communication and participation, particularly given virtual data collection methods. Participants were excluded if they did not reside in Canada or were outside the target age range. 3.4.3 Sampling Methods and Recruitment In line with ID research, I used purposive sampling based on the inclusion criteria and snowball sampling (Throne, 2016). When using ID methodology, researchers discern the appropriate individuals to include in the study, ensuring that the findings provide a deeper comprehension of the phenomenon under investigation (Ahmad & Wilkins, 2024; Thorne, 2016). In other words, purposive sampling aims to align the sample with the research's specific aims and objectives by selecting respondents most likely to yield information 45 pertinent to answering the research question posed (Ahmad & Wilkins, 2024). The deliberate selection afforded by purposive sampling contributed to heightened study rigour and enhanced the trustworthiness of the collected data and resultant findings. I achieved purposive sampling by using the recruitment strategies listed below. In addition to purposive sampling, I utilized snowball sampling, whereby one participant referred another to the study (Leighton et al., 2021). I asked study participants if they knew anyone else who may be interested in participating in the study and encouraged them to share the Qualtrics link with these individuals. I leveraged my connections with teachers, public health nurses, and the network of my supervisor, Dr. Struik, for recruitment purposes. I shared inclusive recruitment materials in the form of a digital poster advertisement (see Appendix D) and/or email, both of which contained a link to the Qualtrics form. Many participants were recruited from a list of previous research participants in Dr. Struik's lab who agreed to be contacted for future research. Past participants were contacted via email and invited to complete a Qualtrics survey encompassing a screener, study information, consent form, and demographics survey (see Appendices E and F). Combining these items into one Qualtrics survey served to streamline the process and prevent attrition. YYAs were provided with an email to contact a researcher in case of additional questions or to receive more information about the study. Researchers emailed interested participants who successfully completed the Qualtrics to schedule a Zoom interview. Additionally, participants were offered honoraria ($50 e-gift card) for their time and contributions. 3.4.4 Sample Size For ID, there is no preset quota for an appropriate sample size, as the focus is on generating rich, applicable insights rather than achieving statistical representation (Thorne, 2016). Rather than relying on data saturation, which assumes a finite set of themes that will eventually be exhausted, this study adopted the principle of information power (Malterud et al., 2016). Information power suggests that the more relevant and rich the data, the fewer participants are required, with sample size influenced by study aim, sample specificity, theoretical application, quality of dialogue, and analytical approach. This study aimed to explore the experiences and perspectives of YYAs engaged in vaping cessation, with a 46 specific focus on informing the design of youth-driven AR interventions. The focused nature of this aim, combined with a highly specific sample selected based on clear inclusion criteria, supported the feasibility of a smaller yet information-rich sample. Additionally, within the scope of a Master’s thesis, a manageable sample size allowed for deep, inductive analysis, ensuring that findings were meaningful rather than overly broad. Given the understudied nature of vaping cessation among YYAs, an initial estimate of 15–20 participants was made. However, this number remained flexible, contingent on recruitment feasibility, participant interest, retention, and the evolving richness of the data. Interviews were conducted in a focused, engaging manner, prioritizing depth over breadth to enhance data richness. My background as a nurse and my proximity in age to participants facilitated the development of rapport and trust, which strengthened the quality of interview dialogue. Applying reflexive TA (Braun & Clarke, 2021a; 2021c; see Section 3.3.4), the study engaged in iterative, interpretative coding, ensuring that analysis remained open to nuance, complexity, and contradiction rather than being constrained by a search for "saturation." This approach further supported the sufficiency of a smaller sample size, as meaning was co-constructed through analysis rather than simply extracted from data (Braun & Clarke, 2021c). After ten interviews, no substantively new insights were emerging in relation to the research question. To ensure analytical rigour and confirm sufficiency, two additional interviews were conducted, reinforcing the determination that sufficient information power had been achieved. At this stage, further data collection was unlikely to yield significantly new perspectives while still maintaining feasibility within the study scope. By aligning with the principles of ID, information power, and reflexive thematic analysis (RTA), this approach ensured that the selected sample size struck an optimal balance between data richness, methodological rigour, and practical constraints while allowing for a deep and meaningful exploration of YYA vaping cessation experiences. 3.4.5 Data Collection Before each individual interview session, participants completed a Qualtrics Survey to screen for eligibility and collect data on demographic characteristics, vaping history and behaviour, dependence, motivation to quit vaping, app use, and familiarity with immersive technologies. The intake questionnaire (see Appendix E) and a semi-structured guide (see 47 Appendix G) for the interviews were designed, piloted, and refined with a YYA co-researcher to ensure they captured the necessary information and were appropriate for this demographic. Recognizing that many individuals are unfamiliar with AR or confuse it with other immersive technologies, like virtual reality, participants were sent an email briefly explaining the technology (See Appendix H). They were encouraged to install and use a free mobile-based AR application (e.g. Pokémon GO™) before attending the interview to familiarize themselves with the general principles, capabilities, and limitations of AR. 3.4.5.1 Semi-Structured Interviews In ID, data is viewed as constructed rather than collected, highlighting the interpretive paradigm by reflecting the researcher’s active role in choosing what counts as data and is subsequently analyzed as such (Thorne, 2016). As per previous ID studies, I collected and analyzed data concurrently to enrich data collection and analysis through this iterative process (Thompson Burdine et al., 2020; Thorne, 2016). Semi-structured interviews were the primary data source to explore the vaping and vaping cessation experiences of YYAs. Interviewing is a process whereby a researcher asks a participant questions to elicit information or co-create a participant’s experience of a phenomenon (Adeoye‐Olatunde & Olenik, 2021). Semi-structured interviews apply a flexible interview guide and allow for more responsivity to the participants, thus aligning with ID studies (Thorne, 2016). This approach facilitated in-depth conversations and encouraged participants to elaborate on their thoughts, creating rich, nuanced data. The iterative process allowed preliminary insights from earlier interviews to inform subsequent ones, ensuring that the emerging understanding remained grounded in participant perspectives while aligning with the study’s aims. This iterative and reflexive approach underscored the co-constructive nature of ID and contributed to the depth and relevance of the findings. All interviews were conducted virtually using the University of British Columbia’s (UBC) approved videoconference platform (Zoom) and audio-recorded. Zoom sessions offered a convenient and accessible platform for engaging with geographically dispersed participants across Canada. The whiteboard function within the Zoom platform was leveraged during the semi-structured interviews. Toward the end of each session, participants were shown a virtual whiteboard (see Appendix I) depicting four potential AR-based features, with a short explanation of each concept and a supporting photo. The proposed features were determined 48 in collaboration with interdisciplinary team member and computer scientist MKH. The goal of the whiteboard activity was to add clarity to the ideas and increase the interactivity of the interview (Dewitz, 2023). To that point, Dewitz (2023) highlights the potential for visual participatory approaches in enhancing interview settings and leading to gathering rich data. Participants were asked to rank the four features (1 = strongest idea to 4 = weakest idea), and a screenshot of their choices was retained at the end of the interview. 3.4.5.2 Data Management Plan The study implemented a comprehensive data management plan to ensure the secure handling, storage, and organization of research data. All data collected, including audio recordings, transcripts, survey responses, and reflexive memos, was stored on password-protected UBC servers in Canada and accessible only to the research team. During the data collection, audio recordings from interviews were securely uploaded to a cloud-based storage system compliant with UBC institutional data security policies. These recordings were transcribed verbatim, with all personally identifiable information removed to maintain participant confidentiality. Participants were assigned a participant ID# (including gender and age), and only this anonymized identifier was included in the transcription, data files, and interview notes. Transcripts and associated metadata were organized and stored within NVivo 14 qualitative data analysis software, which provides secure data coding and retrieval tools. After the study concludes, data will be retained for five years in accordance with ethical guidelines, after which all files will be securely deleted. Participants were informed of these measures during the consent process to ensure transparency. Any data shared in publications or presentations will be fully anonymized to protect participants’ privacy. Participants were able to withdraw until data analysis had been completed; no participants elected to withdraw from the study; if they had withdrawn, all associated data collected would have been immediately destroyed. This data management plan reflects the study's commitment to upholding high standards of data integrity, security, and ethical research practices. 3.4.6 Data Analysis The semi-structured interviews were audio-recorded in Zoom and then transcribed using Otter.ai software. The transcriptions were reviewed and corrected as needed to ensure 49 accuracy and that I was adequately familiar with the data, as Braun and Clarke (2021a) and Thorne (2016) recommended. The files were uploaded onto NVivo 14 qualitative data management software to support the coding and organization of the data. 3.4.6.1 Reflexive Thematic Analysis and Interpretive Description The data were analyzed using RTA, a qualitative analytical method well-suited to the exploratory nature of this project. While ID provides a strong methodological foundation for generating applied health knowledge, it does not prescribe a specific step-by-step analytical approach (Thorne, 2016). RTA was particularly appropriate as it enabled the construction of themes reflecting the depth and complexity of participants’ experiences, which are central to ID’s focus on capturing shared and individual perspectives. The compatibility between RTA and ID lies in their shared emphasis on the researcher’s positionality and the need for deep engagement with data to move beyond surface-level observations toward higher levels of abstraction (Braun & Clarke, 2021a; 2021b; Thorne, 2016). Given that this study explores the lived experiences of YYAs in vaping cessation, RTA’s flexibility, reflexive approach, and iterative process allowed for a rich, contextually grounded interpretation of the data. By integrating RTA with ID, this study benefitted from both the applied focus of ID and RTA's structured yet adaptable analytic process, ensuring that the findings were theoretically informed, reflexive, and practically meaningful. I conducted the analysis from a constructionist perspective (Braun & Clarke, 2021b), seeking to understand what could be learned from YYAs about their vaping behaviours and cessation experiences. To guide this process, I followed Braun and Clarke’s (2021b) six-phase framework for RTA: (1) familiarization with the dataset, (2) data coding, (3) initial theme generation, (4) theme development and review, (5) theme refinement, definition, and naming, and (6) writing up. While these six phases provided a general structure, they were applied flexibly to allow responsiveness to emerging insights and maintain alignment with the principles of ID (Thorne, 2016). Familiarization was done both throughout and after data collection. Audio recordings were transcribed verbatim; I ensured accuracy by cross-referencing transcripts with audio files. During interview sessions and while re-listening to recordings and reading the transcripts, I took detailed notes on participants’ tone, emphasis, and moments of heightened 50 emotional expression to capture the nuances of the discussions. These initial reflections were documented in a reflexive journal, allowing me to engage critically with the data from the outset. This phase also involved repeated readings of transcripts to immerse myself in the dataset and identify potential patterns. All coding and interpretation were completed manually without the assistance of any artificial intelligence (AI) software. Despite the potential timesaving benefits, relying on AI coding has been shown to be insufficient for RTA in that the product is more descriptive than interpretive. It is not an appropriate substitution for “higher-level decision by a subjective analyst” (Morgan, 2023, p. 6). As Braun and Clarke (2020; 2021b) described, the researcher's subjectivity is a crucial tenant of RTA. As such, the coding process was conducted manually to ensure an in-depth engagement with the data. I applied a constructionist perspective (Braun & Clarke, 2021b), focusing on how participants’ narratives reflected broader social and contextual influences on their vaping behaviours and cessation efforts. I systematically coded each transcript line by line, creating detailed code labels that captured single meanings or concepts relevant to the research objectives (Braun & Clarke, 2020). Codes were kept flexible and inclusive to capture the diversity of participants’ experiences. Reflexive memos were maintained to document emerging thoughts, connections between codes, and potential biases. These memos also included reflections on my positionality as a researcher with a nursing background and age proximity to participants, which shaped my interpretations. Using the codes, I began clustering them into initial themes that reflected recurring ideas, relationships, and patterns within the data. This step emphasized the interpretive nature of ID, where themes moved beyond descriptive categories to provide a deeper understanding of participants’ experiences (Thorne, 2016). For example, early themes such as “emotional triggers for vaping” and “perceptions of AR technology” emerged as significant areas of focus. The initial themes were reviewed against the dataset to ensure they were grounded in the data and represented participants’ voices authentically. I iteratively refined the themes by revisiting the transcripts and my reflexive memos. Regular discussions with my supervisor (LS) and thesis committee members (EK and MKH) served as a critical tool for confirmation, providing me with an opportunity to challenge my interpretations and refine the thematic structure. This phase also involved assessing the coherence and distinctiveness of themes, ensuring each theme captured a unique and relevant 51 aspect of the data (Braun & Clarke, 2021b). The naming process was informed by participants’ language and expressions, ensuring that the themes resonated with the dataset’s context. For example, a theme initially called “barriers to vaping cessation” was redefined as “Social and Cultural Context Play a Role in YYAs’ Experiences of Cessation,” reflecting the complex interplay between individual motivations and social influences. The final phase involved integrating the themes into a coherent narrative that addressed the research objectives and highlighted the nuanced realities of participants’ experiences (Braun & Clarke, 2021b). Excerpts from the transcripts were used to illustrate each theme, ensuring that participants’ voices remained central to the analysis. This phase also involved reflecting on how the themes could inform the design of YYA-driven AR interventions, aligning with the applied focus of ID. The iterative nature of RTA allowed me to refine themes progressively, ensuring that they captured the richness of participants’ narratives (Thompson Burdine et al., 2020; Thorne, 2016). High-quality dialogue during interviews, facilitated by my background in community health nursing and age proximity to participants, contributed to the depth and relevance of the data. Furthermore, I reviewed, discussed, and refined themes during data analysis meetings with my supervisor. This deep engagement enabled me to construct themes that reflected the nuanced realities of YYAs’ experiences with vaping cessation. Ultimately, RTA complemented the interpretive approach of ID by providing a systematic yet adaptable framework for analyzing complex, participant-driven data. 3.4.6.2 Gender-Based Data Analysis Given the documented gender-based differences in vaping behaviours (Davidson & Al-Hamdani, 2023; Donaldson et al., 2021; Huma et al., 2022; Struik et al., 2023b), I included a disaggregated analysis by gender to explore potential trends, such as variations in motivations for cessation or preferences for AR features. Reflexive memos were maintained to document preliminary observations, which were revisited during the theme refinement process to ensure gendered patterns were thoroughly considered. Despite these efforts, the small sample size limited the ability to perform a robust gender-based analysis, and no distinct trends emerged. However, this absence of observable trends does not preclude the existence of gender differences in preferences for AR-based vaping cessation interventions. Instead, it highlights the need for future research with larger, more diverse samples to explore 52 these nuances systematically. Incorporating gender as a disaggregating construct emphasizes its importance in developing a comprehensive understanding of vaping cessation. Future studies could adopt mixed-methods approaches or larger sample sizes to capture gender-specific influences on behaviours, motivations, and intervention preferences. Such work would strengthen the foundation for tailoring interventions to meet the unique needs of different genders, ensuring greater inclusivity and effectiveness. While this study provides preliminary insights, it underscores the critical need for further investigation into the role of gender in vaping cessation interventions. 3.5 Quality 3.5.1 Quality Measures I used the quality measures put forth by Thorne (2016) throughout this project: (a) epistemological integrity, (b) representative clarity, (c) analytic logic, and (d) interpretive authority. Firstly, epistemological integrity refers to the researcher being consistent with and transparent about their epistemological stance, including how truth is constructed within the study’s design (Thorne, 2016). I demonstrated this by explicitly articulating my constructivist epistemology and aligning it with my theoretical underpinnings, methodology and results. Representative credibility emphasizes coherence between the study’s methods and findings (Thorne, 2016). I achieved this through strategies such as triangulation of findings between the interview transcripts, whiteboard interactions, and questionnaire responses, and sustained engagement with my supervisor and supervisory committee throughout the research process. Analytic logic ensures that the inductive reasoning used in the study is transparent and verifiable by the reader (Thorne, 2016). This was accomplished by maintaining a detailed audit trail of analytical decisions and discussing preliminary themes with my supervisor to refine interpretations and ensure logical coherence. Thick descriptions and verbatim quotes from participants lend additional context. Finally, interpretive authority refers to the researcher’s trustworthiness in data analysis, which includes accounting for positionality and subjectivity through reflexivity (Thorne, 2016). To uphold this, I wrote reflexive memos after each data collection session to document my impressions. Additionally, I disclosed my positionality within the research report to ensure transparency. These measures collectively 53 ensured the quality, rigour and credibility of my research, aligning with the principles of ID and supporting the validity of my findings. 3.5.2 Applied Researcher Accountability Due to the applied purpose of ID studies, Thorne (2016) highlights that the applied researcher must ensure that high-quality, ethical studies are conducted. Findings from such studies may be used in clinical practice or influence the development of interventions, creating potential positive or negative impacts supplementary to theory generation. This places an ethical responsibility on researchers to minimize harm, ensure trustworthiness, and produce meaningful findings. I applied the additional quality measures outlined by Thorne (2016) to address the broader ethical implications of this work: moral defensibility, disciplinary relevance, pragmatic obligation, contextual awareness, and probable truth. Moral defensibility refers to the justification of why one is engaging with participants and how the findings may benefit the clinical population to which they are applicable. This study addressed a critical gap in understanding vaping cessation experiences among YYAs, a vulnerable population at risk of long-term health consequences. The findings can inform the development of effective, tailored interventions to improve vaping cessation outcomes. Next, disciplinary relevance ensures that the research aligns with the values and priorities of the nursing discipline. By exploring a public health issue through the lens of applied nursing research, this study contributes actionable knowledge that aligns with nursing’s focus on holistic, patient-centred care. Pragmatic obligation emphasizes that findings must be presented in a way that can be meaningfully applied in practice. I achieved this by ensuring the study’s conclusions were grounded in participants’ experiences and values while offering practical insights that can inform the development of future interventions. Contextual awareness requires the researcher to consider the broader sociocultural, political, and economic contexts in which the research is situated. This study was conducted within the Canadian context, where vaping among YYAs has emerged as a pressing health concern. I acknowledged these contextual factors when interpreting findings and discussing their implications for practice. Finally, probable truth reflects that the findings should be trustworthy and resonate as plausible within the study’s scope. I ensured the findings were credible and defensible by following 54 methodological and analytic processes, maintaining reflexivity, consulting my supervisory committee every 3-5 months, and engaging in sustained dialogue with my supervisor every 1-3 weeks. That said, I acknowledge that even compelling findings may turn out to be untrue or less true for some contexts and people. Ultimately, these ethical quality measures ensured that my research was conducted with integrity, transparency, and a strong commitment to producing meaningful, trustworthy, and clinically relevant findings. 3.6 Ethical Considerations Ethics approval was granted by UBC’s Research Ethics Board (ID #H24-00545). I ensured that I obtained consent from all participants, which was informed, voluntary, and revisited throughout the research process. Participants were provided with information pertaining to the study and a consent form embedded within the Qualtrics intake questionnaire (see Appendices E and F). Participants were also provided with an email they could contact for additional information or clarification. On Zoom, before the interview and audio recording began, I outlined key points regarding the study, voluntary participation and information sharing with the participants. I confirmed their verbal understanding and consent, as well as a written copy of a signed consent form. I emphasized the voluntary nature of the project and that participants could stop participating for any reason; no participants stopped the interview or withdrew from the study. I asked participants if they had any questions about the consent form and research process. Two participants had questions about the honoraria, and one requested information about confidentiality, specifically pertaining to how the data was to be anonymized and whether what they shared could be traced back to them. The de-identification process of the data and assignment of a participant ID# denoting an assigned number, as well as self-identified gender and age, was explained to the participant; their consent was again verified, and we proceeded with the interview. If there had been any questions that I could not address independently, I would have contacted my Principal Investigator to ensure the participants' questions could be adequately answered before commencing an interview. If a participant had any concerns or complaints about their rights as a research participant or experiences while participating in the study, I would have directed them to the Research Participant Complain Line in the UBC Office of 55 Research Services or the UBCO Okanagan Research Services Office. Contact numbers for these resources were also provided to participants on the consent form. The research was anticipated to pose a low physical, emotional, and social risk, and there were no direct benefits to participating in the research past the honoraria. The probability and magnitude of potential harm from participating in this research were not greater than what was encountered by YYAs in their everyday life. That said, vaping may have mental health connotations; as such, participants were provided mental health support resources, including helplines and online counselling services, should the discussions evoke emotional distress. 3.7 Integrated Knowledge Translation Integrated knowledge translation (IKT) is a collaborative research approach wherein researchers partner with knowledge users who can use or implement the research recommendations and findings (Boland et al., 2020; Canadian Institutes of Health Research [CIHR], 2012). As defined by the CIHR (2012), IKT involves meaningful collaboration with knowledge users throughout the research process, from conceptualization of the study (e.g., defining the research question) to the application and dissemination of the findings (e.g., publication). This approach signifies a paradigm shift from traditional scientist-driven research to collaborative problem-solving, where researchers and knowledge users work together to address complex and pertinent real-world challenges (Boland et al., 2020). This project benefited from the existing infrastructure of Dr. Laura Struik’s lab, the Youth Health Promotion and Cancer Prevention Lab and included a multidisciplinary research team with various areas of expertise (e.g., youth, nursing, health sciences, computer science). Furthermore, the research received feedback and support from YYAs. Specifically, a YYA co-researcher with Dr. Struik’s lab and a group of young researchers comprised of individuals of diverse identities across gender, age, and educational contexts were consulted in developing the semi-structured interview guide and recruitment materials. The involvement of YYAs as both researchers and participants was crucial to the success of this project as they are the primary end-users. IKT efforts have been structured along a dissemination timeline to reach scholarly and community audiences. The insights garnered from this project will be disseminated by 56 publishing research findings in a respected peer-reviewed journal. The research abstract has been submitted for presentation at the 2024 Canadian Association of Psychosocial Oncology (CAPO) and the 2024 Canadian Public Health Association (CPHA) conferences, with additional plans to submit to the 2026 International Society for Research on Nicotine and Tobacco (SRNT) conference. Lay summaries will be disseminated via youth-friendly channels, such as Discord. Discord provides a platform for like-minded individuals to connect, communicate, and collaborate on various topics of interest. A dedicated Discord community will serve as a hub for ongoing collaboration, where findings will be shared in accessible formats such as infographics, interactive posts, and moderated discussions. Q&A sessions, discussion threads, and polls will allow participants to share their experiences with vaping cessation interventions, helping to refine and adapt digital support tools. Additionally, the community will serve as a think tank for co-creating content, where users can suggest new research priorities and participate in digital health advocacy initiatives. The outcomes of this study will serve as the cornerstone for shaping the design of a mobile-based AR intervention and plans for future testing via a randomized control trial to determine its efficacy. In alignment with the research objectives, findings have been synthesized into practical recommendations for developing mobile-based AR interventions targeting vaping cessation among YYAs, considering their unique needs and preferences. 3.8 Conclusion This chapter discussed ID and RTA as approaches that align well with the study's objectives. ID was particularly well-suited for this research, as it allows for the generation of applied health knowledge that bridges theoretical insights with real-world practice. Its emphasis on capturing shared and individual experiences enabled a nuanced exploration of YYAs' vaping cessation journeys, ensuring that the findings remain contextually grounded while offering transferable insights for intervention development. RTA complemented this approach by providing a structured yet flexible framework for analyzing complex, experience-driven data. By prioritizing researcher reflexivity and acknowledging the co-constructed nature of knowledge, RTA ensured that themes were developed in a way that honoured the lived realities of participants while allowing space for multiple interpretations. Together, these ID and RTA provided a rich foundation for understanding the behavioural, social, and emotional factors influencing vaping cessation, ultimately informing the 57 development of innovative, youth-centred interventions. The following chapter presents study findings and is formatted as a manuscript for publication in a peer-reviewed journal. 58 Chapter 4: Study Manuscript: Youth and Young Adult Perspectives on Augmented Reality-Driven Vaping Cessation Interventions: An Interpretive Description Study 4.1 Introduction Vaping, particularly among youth and young adults (YYAs), represents a growing epidemic with concerning health and societal implications. In Canada, the prevalence of vaping has risen sharply in the last decade, with 30% of adolescents aged 15–19 years and 48% of young adults aged 20–24 years reporting having ever tried vaping, and 13% and 18%, respectively, reporting vaping within the past 30 days (Government of Canada [Gov Can], 2023). These rates reflect a nearly 120% increase compared to pre-legalization figures in 2017, underscoring the urgency of effective cessation interventions (East et al., 2023) Initially marketed as a harm-reduction tool for adult smokers, vaping has gained traction among non-smoking YYAs due to its perceived safety, appealing flavours, and sleek, portable devices (Crane et al., 2023; Struik et al., 2023b). Social media, peer influences, and cultural norms further exacerbate the problem by glamorizing vaping as a socially acceptable behaviour (Skinner et al., 2024; Vogel et al., 2024). Emerging evidence highlights significant health risks associated with vaping, including nicotine dependence and respiratory and cardiovascular complications (Traboulsi et al., 2020; Glantz et al., 2024). At the same time, YYAs are navigating a broader mental health crisis, and many turn to vaping as a coping mechanism for stress and anxiety despite emerging evidence linking e-cigarette use to worsening psychological distress (Cambron, 2022; Chaiton et al., 2024). Despite increasing motivation to quit, many YYAs face unique barriers to cessation, including nicotine dependence, social reinforcement, and a lack of appealing support tools. Traditional cessation methods, which are often adapted from adult-focused smoking programs, tend to be rigid, abstinence-oriented, and disconnected from the lived realities of YYAs. These approaches frequently neglect the digital and social contexts that shape youth behaviour, and fail to resonate with their preferences for non-judgmental, flexible, and emotionally supportive tools (Struik & Yang, 2021; Guerra Castillo et al., 2024). Given this mismatch, there is a pressing need for novel, youth-driven solutions that prioritize harm reduction, self-compassion, and gradual behaviour change. 59 Augmented reality (AR) represents a novel opportunity to meet these preferences. AR technology overlays digital elements onto real-world environments through smartphones or tablets, creating immersive and interactive experiences that can disrupt habitual behaviours and support real-time decision-making (Yang et al., 2022; Vinci et al., 2020a; 2020b). For example, AR has demonstrated success in smoking cessation interventions by utilizing cue exposure therapy (CET) to break the association between environmental triggers and cravings (Zhang et al., 2023). CET represents just one of the many ways in which AR may be leveraged for health interventions. AR features may be especially valuable for YYAs, who are highly engaged with mobile technology and often prefer dynamic, real-world interventions over static educational resources. To date, little research has explored the potential of AR for vaping cessation, particularly among YYAs. This study addresses this critical gap by investigating YYA perspectives, preferences, and experiences with vaping cessation to inform the development of AR-based mobile interventions. By centering on the voices of YYAs, this research aims to advance the design of innovative, practical, and youth-driven digital tools to support vaping cessation. 4.2 Research Aim This study aimed to explore the experiences and perspectives of YYAs engaged in vaping cessation to inform the development of AR-driven mobile interventions. By focusing on this demographic’s unique needs, motivations, and challenges, the research sought to generate practical insights to guide the design of innovative and engaging cessation tools. The overarching goal was to identify key features and design considerations that would optimize the effectiveness and relevance of AR-based interventions for YYAs. 4.3 Methods 4.3.1 Interpretive Description This study employed Interpretive Description (ID), a qualitative methodology designed to generate clinically relevant insights for applied health research (Thorne, 2016). ID is grounded in constructivist epistemology, which acknowledges that knowledge is co-constructed through interactions between researchers and participants. Unlike other qualitative methodologies that adhere to rigid theoretical frameworks, ID emphasizes 60 flexibility, allowing researchers to explore both shared and individual experiences to develop actionable findings (Thorne et al., 1997; Thorne, 2016). ID was particularly suited to this study’s focus on vaping cessation among YYAs, as it enabled a nuanced understanding of their experiences and preferences within broader social and technological contexts. 4.3.2 Participants and Procedures Participants were purposively recruited to ensure alignment with the study’s aims. Inclusion criteria were: (1) aged 16–24, (2) currently vaping, (3) motivated to quit vaping, (4) proficient in English, and (5) residing in Canada. Recruitment was conducted via professional networks, outreach to teachers and public health professionals, and email invitations to past research participants. Inclusive recruitment materials, such as a digital poster advertisement, were shared on social media platforms and through email lists (see Appendix D). Interested participants completed a Qualtrics survey to screen for eligibility and collect data on demographic characteristics, vaping history and behaviour, dependence, motivation to quit vaping, app use, and familiarity with immersive technologies (see Appendix E). Combining these items into one Qualtrics survey served to streamline the process and prevent attrition. The consent form (see Appendix F) emphasized voluntary participation, the purpose of the study, potential risks, and the right to withdraw at any point without consequences. Participants were also informed about the potential emotional impact of discussing their vaping experiences, and support resources were shared. YYAs were provided with an email to contact a researcher in case of additional questions or to receive more information about the study. Researchers emailed interested participants who successfully completed the Qualtrics to schedule a Zoom interview. All participants were offered honoraria ($50 e-gift card) for their time and contributions. 4.3.3 Data Collection and Analysis Data were collected through semi-structured interviews conducted via Zoom, ensuring flexibility and accessibility for geographically dispersed participants across Canada. Semi-structured interviews followed a carefully designed interview guide developed in collaboration with an interdisciplinary team and a youth co-researcher (see Appendix G). The guide explored topics like participants’ vaping behaviours, motivations for quitting, 61 experiences with existing cessation resources, and perspectives on the integration of AR technology into vaping cessation interventions. To facilitate meaningful engagement and ensure informed discussions, participants were introduced to AR technology prior to the interviews and encouraged to interact with a free AR app, such as Pokémon Go™, to provide a point of reference for the technology’s capabilities and potential applications. All interviews were conducted by KF, each lasting approximately 45–60 minutes. With participants’ informed consent, interviews were audio-recorded to ensure accurate and comprehensive capture of participants' narratives. All data were de-identified to protect confidentiality, and audio recordings were transcribed verbatim using Otter.ai. Transcripts were manually reviewed and corrected by KF to ensure accuracy and to achieve a high degree of familiarization with the data (Braun & Clarke, 2020; Braun & Clarke, 2020b; Thorne, 2016). The data were analyzed using reflexive thematic analysis (RTA), a qualitative method that aligns with ID by facilitating the exploration of complex and nuanced participant experiences (Thorne, 2016; Braun & Clarke, 2020). RTA’s flexibility and iterative nature allowed themes to emerge organically, capturing the depth of participants’ narratives while addressing the study’s objectives. Braun and Clarke’s (2021b) six-phase framework guided the analysis process. First, familiarization with the data involved transcription and repeated readings of focus group and interview transcripts, during which initial impressions were documented in a reflexive journal. Coding was conducted manually to enable a deeper engagement with the data, while NVivo 14 software was used to organize and manage codes. The coding process focused on identifying meaningful patterns and relationships relevant to the research questions. Initial codes were grouped into candidate themes, which were iteratively refined through reviews of transcripts and reflexive memos. Discussions between LS and KF further supported the refinement process, ensuring that the themes reflected participant perspectives and broader social and cultural contexts. Themes were then defined and named to capture their essence, integrating participant language where possible to maintain authenticity. The final themes were presented as a coherent narrative supported by illustrative participant quotes. The analytical approach emphasized rigour, reflexivity, and alignment with the principles of ID, ensuring that the findings offer actionable insights for designing YYA-driven AR interventions for vaping cessation. 62 4.3.3.1 Gender-based Analysis Given documented gender-based differences in vaping behaviours, this study included an analysis disaggregated by gender to explore potential trends, such as variations in motivations for cessation or preferences for AR features. Gender was self-reported during demographic data collection, with all females identifying as women and all males identifying as men. Reflexive memos documented gender-related observations, which were revisited during theme refinement to ensure gendered patterns were considered. 4.3.4 Quality and Rigour To ensure methodological rigour, the study adhered to Thorne’s (2016) quality criteria for ID research. Epistemological integrity was maintained by aligning the constructivist foundation with the study design and analysis. Representative credibility was achieved through purposive sampling and rich, thick descriptions of participant narratives, and triangulation between the interview transcripts, whiteboard interactions, and questionnaire responses. Analytic logic was demonstrated through an audit trail of decisions made during data collection and analysis. Finally, reflexivity was prioritized throughout the research process, with KF journaling reflections and acknowledging their positionality as a nurse researcher with a professional interest in vaping cessation. 4.4 Results 4.4.1 Description of the Sample The findings presented in Table 1 provide a detailed profile of the participants’ vaping histories, cessation strategies, and primary motivations, offering valuable insights into the diversity of experiences within the study cohort. A total of 19 individuals completed the Qualtrics survey; however, 7 participants were lost to attrition due to either not responding to the emails to schedule an interview or not attending their scheduled session. Participants (N=12, mean age = 21.4 years) included a mix of genders (7 men, 5 women). The small sample size limited the capacity for a robust gender-based analysis, and no distinct trends were identified. This does not imply that gender differences are absent but highlights the need for future research with larger, more diverse samples to investigate these nuances systematically. Participants indicated varying durations of vaping, ranging from 1-3 years to over 3 years. The frequency of vaping also varied significantly, from occasional use (once 63 per week or less) to several times per day. Cessation attempts were common, with most participants reporting 1-4 attempts, although a few indicated more frequent efforts (5-10 attempts). The strategies employed were similarly varied, encompassing gradual reduction, cold turkey, cessation apps, nicotine replacement therapy (NRT), and professional counselling. Motivations for cessation spanned personal health concerns, financial pressures, social influences, and shifts in perceptions about vaping’s appeal. Table 1 Participant Characteristics and Vaping History, N = 12. ID # Gender Age (years) Years Vaping Frequency of Vaping Cessation Attempts Cessation Strategies Primary Motivation 1 M 19 > 3 years Several times per day 1-4 attempts Gradual reduction, cold turkey, NRT Financial 2 M 21 1-3 years About once per day - - Health 3 W 24 1-3 years Several times per day 1-4 attempts Gradual reduction, cessation apps, NRT Health 4 W 23 > 3 years Several times per day 1-4 attempts Cold turkey, cessation apps, NRT Social pressures 5 M 22 > 3 years Once per week or less 1-4 attempts Gradual reduction, NRT, professional counselling Health 6 W 21 > 3 years Several times per day 1-4 attempts Gradual reduction, cold turkey, cessation apps, NRT Health 7 M 22 > 3 years A few times per week 5-10 attempts Gradual reduction, cold turkey, tolerance breaks Health 8 M 21 1-3 years Several times per day 1-4 attempts Gradual reduction Health 9 W 21 1-3 years Several times per day 1-4 attempts Gradual reduction, tolerance breaks Health 10 M 18 1-3 years Several times per day 1-4 attempts Gradual reduction, tolerance breaks Shift in perception: ‘it's not cool’ 64 ID # Gender Age (years) Years Vaping Frequency of Vaping Cessation Attempts Cessation Strategies Primary Motivation 11 M 21 1-3 years About once per day 1-4 attempts Gradual reduction, tolerance breaks, cessation apps Shift in perception: ‘it's not cool’ 12 W 24 > 3 years Several times per day 5-10 attempts Cold turkey, cessation apps, NRT Financial 4.4.2 Qualitative Themes The findings collectively yielded four major themes: (1) Social and Cultural Context Play a Role in YYAs’ Experiences of Cessation, (2) Quitting Vaping is an Individual Endeavour That Does Not Always Mean Success, (3) Digital Support as a Bridge Between Individual and Social Needs, (4) AR as a Catalyst for Personalized Support. These themes address the motivations, challenges, and opportunities identified by participants in their cessation journeys and their perspectives on integrating AR technology as a supportive tool. To illustrate these themes, participant quotes support the results, which provide a nuanced understanding of their lived experiences and preferences. By grounding the findings in participants’ voices, this section highlights critical insights to inform the design of engaging, practical, and YYA-driven AR interventions for vaping cessation. 4.4.3 Theme 1: Social and Cultural Context Play a Role in YYAs’ Experiences of Cessation Participants described vaping as a normalized and pervasive behaviour within their social environments, shaping both their initiation into the habit and their cessation attempts. Most YYAs indicated that they started vaping in social settings due to exposure, often viewing it as an expected part of social interactions. Vaping was frequently portrayed as an accepted and routine activity in many environments, creating a sense of normalcy that reinforced its persistence. When asked about their quitting journeys, many participants highlighted how their social environment and peers acted as barriers to cessation. “It's almost like there's like, a push not to quit [...] it's not that they're like, constantly telling me you shouldn't quit, but it's like, they'll offer me vapes constantly or something like that. So, it makes it harder, it's still doable, like you can always just say no, but it does make it much harder” (#5, M, 22). 65 The normalization of vaping has created significant barriers to quitting, as participants often felt that ceasing to vape could isolate them socially or disrupt their sense of belonging. One participant expressed concerns about being excluded by colleagues at work, highlighting how social contexts can reinforce vaping behaviours and make quitting more difficult: “I feel like vaping is just a very normalized thing amongst young people [...] in my work, there's actually like a designated smoke space for people outside, they would go to smoke, and they would go to vape [...] I feel like stopping would make me kind of like a social outcast.” (#1, M, 19) In many cases, participants deliberately distanced themselves from environments, social settings, or relationships that normalized or encouraged vaping. For some, this involved avoiding social gatherings or workspaces where vaping was prevalent, while for others, it meant disengaging from friendships with peers who vaped regularly. Although these measures were often helpful, they came with personal sacrifices, “My peer group has been negative. They haven't been helping. So, I've tried to cut some of them off” (#10, W, 18). Such accounts underscore the relational complexities participants navigated in their efforts to quit. Another participant captured the nuanced interplay between family, peers, and environment, explaining: “It's a mixed support because my family are supporting me to quit vaping, and when I'm with them, the urge to vape is reduced, but when I go out and around my peers, I have the urge to vape. So, it depends on my location and the people around me.” (#9, W, 21) Beyond social normalization, vaping also emerged as a coping mechanism for many YYAs, particularly as a way to manage stress or emotional challenges. Participants described how stress from work, school, or personal relationships often drove them to vape, framing it as an accessible and socially acceptable method of self-soothing. One participant shared, “The moment I feel stressed, the only thing that comes to my mind is to go and vape” (#9, W, 21). While another echoed this, stating, “Most times, when I'm sad, when I'm frustrated, the only thing that helps keep me calm is when I vape” (#8, W, 21). This dual role of vaping as both a normalized social behaviour and a tool for coping further entrenched its presence in participants’ lives, making quitting especially challenging without alternative coping strategies. Online platforms also played a dual role in participants’ vaping experiences. Social 66 media, particularly TikTok and Reddit, served as both a source of inspiration and a site of conflicting messages. For some, seeing influencers share their quitting journeys provided motivation: “There’s a big wave on TikTok of influencers quitting vaping […] that’s helped me a lot” (#4, W, 23). However, others noted that the glamorization of vaping on social media often undermined their efforts to quit. 4.4.4 Theme 2: Quitting Vaping is a Personal Decision That Does Not Always Mean Success Participants consistently emphasized the deeply personal nature of quitting vaping, highlighting how individual motivations, readiness, and self-efficacy shaped their cessation journeys. While external factors, such as social or familial pressures, sometimes influenced participants’ decisions to quit, these were often secondary to internal drivers like health concerns or personal goals. Illustrating how the physical effects of vaping served as a powerful motivator, one participant described that: “My lung health in particular, I definitely have damaged lungs at this point. It's very hard to breathe [...] I'm out of breath when I go up the stairs, or if I'm walking at a faster pace, I definitely notice now it's harder to actually breathe and take deeper breaths than it was beforehand.” (#6, W, 21) Others framed their attempts to quit as milestones in personal growth, with one describing it as a personal goal: “I wanted to quit since the beginning of the year […] I saw it as a personal goal type of thing” (#5, M, 22). Despite recognizing the importance of quitting, many participants acknowledged their success hinged on their confidence and readiness to commit to the process. One participant reflected, “It’s really hard because it always comes down to me and me making up my mind” underscoring the centrality of self-efficacy in navigating cessation; they go on to add, “I feel like it has to be really my decision, and I’m not there yet” (#3, W, 24), highlighting how personal readiness can act as both a catalyst and a barrier. External pressures, such as social disapproval or encouragement from family and peers, were recognized but rarely decisive. Participants stressed the importance of making their own decisions, emphasizing the individualized nature of quitting. One participant encapsulated this sentiment: “It has to be your decision. There is no one else who can do it for you” (#4, W, 23). Participants expressed a desire for recognition of small milestones in their vaping 67 cessation journeys, emphasizing the importance of celebrating progress rather than focusing on setbacks. The pressure to succeed often felt overwhelming, particularly when relapses erased their “vape-free streak,” which some described as belittling their overall efforts. This highlights the need for supportive approaches that frame quitting as a nonlinear process, allowing room for growth and resilience. While intrinsic motivation played a key role in initiating quit attempts, participants expressed that external reinforcement would be helpful to sustain their efforts over time; encouragement from peers, digital tracking of progress, and structured incentives were seen as important in maintaining motivation, particularly during periods of heightened stress or vulnerability. Participants frequently employed redirection strategies to manage cravings and navigate the challenges of quitting vaping. These approaches involved substituting behaviours, avoiding triggers, and restructuring their routines to reduce opportunities for vaping. Redirection was often seen as a practical and immediate method of coping, especially during moments of heightened cravings or emotional stress. A commonly reported technique was behavioural substitution, where participants replaced vaping with alternative activities or products. Simple actions such as chewing gum, using mints, or staying physically active were described as effective distractions during craving episodes; “How I cope is either a coping mechanism, like nicotine gum, mints, or distracting myself in some way” (#12, W, 24). These substitutions served as manageable, low-barrier interventions that provided participants with tangible alternatives during moments of temptation. However, while these strategies were useful for immediate craving management, participants noted that without external reinforcement, it was difficult to sustain momentum over time, reinforcing the need for structured ongoing support. Reliance on self-discipline and willpower alone was frequently associated with challenges and relapses. Participants who attempted unassisted cessation methods, such as quitting “cold turkey,” often found the process unsustainable. While some expressed a desire to take control of their behaviour independently, they acknowledged the difficulty of doing so without external support or tools, “Cold turkey takes a lot of willpower […] It’s not something you can just wake up one morning and do” (#1, M, 19). These perspectives exemplify the limitations of self-reliance, particularly when facing strong nicotine cravings or deeply ingrained habits. As such, many participants expressed a desire for digital 68 interventions that not only supported self-directed quitting but also provided extrinsic motivators, such as virtual rewards, positive reinforcement, and social accountability, to sustain long-term cessation efforts. 4.4.5 Theme 3: Digital Support as a Bridge Between Individual and Social Needs Participants highlighted the potential of digital tools to address the dual needs of individual autonomy and social connection in their vaping cessation journeys. Digital interventions, such as mobile apps, were seen as capable of personalizing the quitting process while offering supportive, non-judgmental spaces for connection with others. Many participants appreciated the adaptability of these tools, emphasizing the importance of features that cater to their individual progress and goals. That said, most participants disclosed little experience engaging with currently available mobile-based vaping cessation apps. When questioned why they did not use apps in their quit journeys or about their opinions generally on cessation apps, YYAs shared a lack of knowledge of existing apps, a lack of confidence in the effectiveness of vaping cessation apps, and a lack of sustained engagement with apps they had tried. This lack of confidence stemmed in part from perceptions that existing tools were outdated, impersonal, or not tailored to the realities of current vaping products or YYA experiences. One participant shared their previous experience with an app, stating: “I think the technology wasn't there for it. I just think it wasn't as up to date as it should have been [...] it was more catered to, like older style vapes and less like the newer disposable kind” (#4, W, 22). Building confidence in AR-based interventions will require addressing these gaps by ensuring relevance, personalization, and innovation. Participants indicated that future tools must feel current and responsive in terms of technology and content and include features that reflect the modern vaping landscape, such as support for disposable vape cessation, real-time feedback, and interactive engagement. Additionally, establishing credibility through trusted partnerships, transparent design, and co-creation with YYAs may help foster greater trust and perceived efficacy. That said, several positive attributes of potential app-based interventions were discussed. For participants who valued anonymity, digital platforms offered an intriguing means of connecting with peers facing similar struggles without fear of judgment. Features like anonymous forums for peer support within apps were especially appealing, as they allowed 69 participants to feel less isolated in their journeys. One participant explained, “[It] doesn't have to be like something like super, super social, but, you know, just reading other people's experiences, maybe talking about your experience, that kind of stuff. I think that that's important” (#5, M, 22). Many YYAs highlighted the desire for a balance between social connection and privacy; this blend of community and privacy was seen as a critical strength of digital tools, particularly for YYAs navigating the stigma around vaping. While traditional peer interactions in person could reinforce vaping behaviours, structured, judgment-free digital communities were seen as a way to foster motivation and reduce feelings of isolation. This blend of community and discretion was identified as a crucial strength of digital interventions, particularly for YYAs navigating the stigma surrounding vaping and the complexities of quitting within their social environments. Participants were particularly interested in the potential of incentives to enhance their vaping cessation efforts, viewing rewards as motivating and affirming their progress. Many appreciated the idea of earning in-app currency that could be used for virtual rewards or gamified features, fostering a sense of achievement and making the quitting process more engaging. Tangible incentives, such as e-gift cards, were seen as especially appealing, providing practical and immediate benefits and reinforcing their commitment to staying vape-free. A participant highlighted this interest, stating: “When I heard virtual rewards and incentive, I got so hyped up [...] one thing I think would be effective was, if you go a certain amount of days without vaping your virtual reward could be an entry for an even bigger prize [...] I think that having contests and having, you know, things of that nature will be beneficial. I think that also providing gift cards and, you know, coupons and discounts and all of those things, they will definitely help” (#1, M, 19). Participants emphasized that incentives could create a positive reinforcement loop, celebrating progress while encouraging continued effort. YYAs were open to abstinence verification with methods like saliva cotinine testing, thus highlighting an interest in app-based contingency management (CM). Digital tools were also recognized as a platform for reflection and growth. Features such as journaling, self-reflection prompts, and progress visualization to understand their behaviours better and celebrate milestones; “kind of reflect on, oh, I've made it this far, you know, like I could keep going and use that as a motivator” (#6, W, 21). Several participants 70 emphasized the need for positively framed content. App-based tools were ultimately viewed as an opportunity to bridge the gap between self-directed quitting and the need for external encouragement, creating a holistic support system. 4.4.6 Theme 4: AR as a Catalyst for Personalized Support Participants endorsed AR as a unique and innovative tool for enhancing their vaping cessation journeys by offering support and distraction during moments of vulnerability. AR’s immersive and interactive nature has the potential to allow participants to engage with interventions in ways that feel dynamic, responsive, and motivating. Participants ranked proposed AR-based features through a Zoom whiteboard activity, emphasizing their preferences for tools that combine motivation, engagement, and practical support. The rankings reflected strong enthusiasm for gamification and virtual rewards as the most desirable features, highlighting the appeal of progress tracking and achievement-based incentives. This is followed by health effects visualization, interactive quitting support, and trigger identification and management, reflecting a desire for educational reinforcement and real-time coping mechanisms. These findings underscore AR’s potential to provide a holistic, engaging, and youth-centred approach to vaping cessation by making support accessible and immersive, particularly during the most vulnerable moments of the quitting process. 4.4.6.1 AR as a Conduit to Non-judgmental Real-time Feedback The potential for AR to provide non-judgmental, anonymous support resonated with participants. Interactive elements, such as AI-powered avatars or real-time feedback, were viewed as desirable for those seeking guidance without fear of stigma. “I might find myself in a situation where I have nobody to talk to about this, where I'm too embarrassed to talk about this, you know what I mean, like, and then if I have [...] AI or a real human who is qualified to talk about this, I do think that would be a helpful thing.” (#7, M, 22). For some, AI-based interactions were preferable to human-led support, as they offered privacy, autonomy, and an escape from social judgment. Others, however, valued the "human-like" presence an AR avatar could simulate during moments of need, appreciating the blend of technological convenience with empathetic support. Not all participants trusted AI, with some expressing a preference for human-led interactions, such as counsellors, due to human conversations’ nuances, emotional depth, and authenticity. To foster trust in future 71 AR applications that incorporate AI, participants emphasized the importance of transparency in how AI functions, the ability to customize or opt into human support, and ensuring that AI interactions feel empathetic rather than robotic. Hybrid models, where users can choose between AI-driven guidance and human-led support, may offer the flexibility and emotional safety needed to meet diverse preferences and increase user trust and sustained engagement. Participants emphasized the importance of tailored content and motivational messaging in maintaining engagement and supporting long-term cessation. Personalized, positively framed reminders and notifications were seen as essential tools for reinforcing motivation without inducing guilt or shame. Rather than punitive or negatively framed alerts, participants preferred encouraging messages that acknowledged progress and reinforced their reasons for quitting. One participant suggested: “A feature that could give motivational affirmations for the day, like you don't have to wait today, like some of motivation that comes up pops up every day on my app to keep me motivated not to go back to vaping or stuff like that” (#9, W, 21). Features such as customizable reminders, goal setting, milestone celebrations, and daily motivational messages were viewed as ways to sustain engagement while making the quitting process feel supportive rather than restrictive. AR’s ability to deliver real-time, interactive reinforcement, such as visual progress tracking or immersive encouragement from an AI avatar, positions it as an ideal tool for keeping users motivated and engaged in a way that feels personalized, empowering, and non-judgmental. One participant underscored the importance of personalization in making the intervention feel meaningful, “I think that personalization is definitely going to be the core of this app [...] I think that that should be kind of the leading principle of the app, I think you should have the right to choose” (#1, M, 19). Another participant highlighted the importance of individualized goal setting, reinforcing the need for an intervention that adapts to the diverse experiences of users: “Everybody has their own, like, goals, right? Everybody has their own little path that they're on. And if, for me, not vaping for two weeks is a big goal, it might not be for somebody else who's hasn't been vaping for like, three years, you know what I mean?” (#7, M, 22). These findings emphasize that offering multiple support formats, ranging from AI-driven assistance to human-led interactions, is crucial to accommodating diverse user preferences. While some participants prioritized privacy and anonymity, others sought real- 72 world human connection, reinforcing the need for flexibility and choice in digital cessation interventions. By fostering a personalized, stigma-free, and engaging support system, AR has the potential to transform vaping cessation into a more interactive, accessible, and user-driven experience. 4.4.6.2 AR as a Tool for Distraction and Motivation Participants saw AR’s gamification capabilities as a compelling way to support their cessation efforts by keeping them both distracted from vaping and motivated in their journeys. AR was uniquely positioned to provide structured engagement during cravings, transforming vulnerable moments into opportunities for reinforcement. Interactive games or immersive environments could serve as a constructive alternative to vaping, helping participants navigate stress and temptation. One participant captured this sentiment by explaining how AR could serve as an immediate, accessible distraction: “If you feel a craving, you open the app, and you have somewhere to go and something to do” (#12, W, 24) another shared a similar thought saying, “an app like this [would] come in handy in case of situations where I would be tempted to vape” (#9, W, 21). These elements aligned closely with participants’ broader use of behavioural redirection strategies, offering a structured and engaging way to manage cravings. Many participants described the need for interactive and rewarding elements that could transform quitting from a rigid, pressure-driven task into an engaging and reinforcing experience. One participant highlighted this point, sharing that “the gamification and like the rewards and that kind of stuff that can be something that would make me stay more [consistent]” (#5, M, 22). Gamification through features such as progress tracking, interactive challenges, and virtual rewards were particularly appealing for their ability to reinforce positive quitting behaviours while making the process feel more like a game than a struggle. Participants envisioned gamification in a way that blended competition, community, and engagement, drawing inspiration from popular mobile games. One participant described how AR-based features could create a social yet anonymous competitive element, likening it to games such as Hay Day or Farmville, where users can build progress over time and engage in friendly competition: 73 “I love that idea. It kind of like, in my mind, the way that I like think about it is, like AR Hayday or Farmville [...] there's like, a social aspect to that where, like, you compete with people and you grow your farm or whatever [...] you can kind of, like, make it a competition with your friends or whatever, and grow a community that way, but also have that anonymous, like, just that random person across Canada that you could just battle it out with for most days that you're not vaping, which I think is really cool.” (#4, W, 23) By integrating leaderboards, virtual rewards, and community-driven challenges, AR could provide both an emotional incentive and a distraction during cravings, reinforcing progress in an engaging and interactive way. However, participants emphasized that gamified elements should be designed thoughtfully and sensitively to avoid discouragement. One key concern was handling setbacks, as overly punitive design choices, such as resetting progress entirely after a relapse, could undermine confidence and motivation. One participant stressed the importance of maintaining momentum even after a lapse: “If I do all of a sudden vape, I'm not going to obviously continue earning points, but I don't lose all of them, or, like, I just don't lose my progress, is what I'm saying. I just don't want to lose all progress just because I made a mistake and just because I did what I did.” (#7, M, 22). These findings highlight the delicate balance needed in designing gamified interventions for vaping cessation. AR-based tools must provide engagement, distraction, and reinforcement without introducing discouraging setbacks that might deter continued efforts. A well-designed system that celebrates progress, fosters competition and community, and offers flexible, forgiving incentives has the potential to make quitting feel like an achievable and rewarding challenge rather than an isolating struggle. 4.4.6.3 AR Meets the Desire for Education and Real-time Coping Mechanisms Another valued feature of AR was its potential to provide health visualizations, offering users a dynamic way to track the benefits of quitting. Unlike static educational content, AR has the ability to immerse users in a personalized, real-time experience, reinforcing the tangible progress of cessation in a visually engaging manner. Participants expressed interest in seeing how their lungs and body could heal over time, believing this could serve as a motivational tool to sustain their quit attempts. One participant emphasized the power of real-time feedback, explaining, “I think having that visualized in AR would be also beneficial, so that people could kind of see their progress on their own body in kind of 74 real time as it were.” (#12, W, 24). Another participant appreciated the positive framing of such a feature, remarking, “I like the idea of it, like showing the effects of quitting, because then it's not just like, Oh, you're doomed, you know?” (#5, M, 22). However, some participants noted the need for balance, cautioning against overly graphic or negative imagery that could provoke fear or denial. This highlights the importance of creating visualizations that are both impactful and user-sensitive. Participants also indicated that an AR visualization feature on its own may not be enough to sustain user engagement but would be a useful educational feature integrated into a more holistic app. CET was introduced as a potential feature to help desensitize users to vaping triggers, but participants expressed strong skepticism about its effectiveness in the context of vaping cessation. Many feared that deliberately exposing themselves to cues such as virtual vaping devices or smoking scenarios could be counterproductive, intensifying cravings rather than reducing them. One participant described their discomfort with being reminded of vaping, stating: “I can't even look at a vape because it just immediately, like, reminds me of it, and then I start thinking about it [...]. I just start, like, hyper fixating on it [...] it makes the cravings worse [...] I personally wouldn't open that feature and like try to see a cue, just because I know that it would just make me think about it, and it would just make everything worse.” (#6, W, 21) Another participant echoed this sentiment saying, “[its] going to make me more agitated for vaping somehow [...] even seeing vapes on phone is just going to, like trigger me more to go to what I'm trying to quit” (#11, M, 21). This skepticism reflects a broader hesitation around strategies that may feel emotionally taxing without clear evidence of their effectiveness in the context of vaping cessation. Despite concerns around CET, participants expressed strong interest in educational tools that help them identify personal triggers and develop actionable strategies for managing them. Rather than confronting triggers head-on, participants preferred interventions that provided personalized coping mechanisms. One participant shared the importance of practical alternatives, sharing a desire for learning “different actual things you can do in the moment [...] techniques [like] you can just grab a water bottle with a straw or some like something like that” (#4, W, 22) while another participant indicated a desire to learn more about their personal triggers, “something that helps me is to become aware of, like, I guess, 75 my triggers” (#5, M, 22). Participants valued the idea of combining personalized insights with practical suggestions for overcoming challenges, which could enhance their understanding of their vaping behaviours and empower them to develop healthier coping mechanisms. These findings suggest that AR could play a critical role in trigger management, not just through direct cue exposure but by integrating real-time insights and behavioural guidance. For instance, AR could help users log their triggers, recognize patterns over time, and receive tailored coping suggestions in response to their cravings. By combining personalized insights with practical, interactive solutions, AR has the potential to empower users to understand their vaping behaviours, build self-efficacy, and develop healthier coping mechanisms that support long-term cessation success. 4.5 Discussion This study explored the perspectives of YYAs on vaping cessation, emphasizing the potential role of digital interventions, including AR, in supporting their cessation journeys. Using ID, the findings highlight the multifaceted influences shaping cessation behaviours, including technological, relational, and individual factors. Four themes were co-constructed: (1) Social and Cultural Context Play a Role in YYAs’ Experiences of Cessation, (2) Quitting Vaping is an Individual Endeavour that Does Not Always Mean Success, (3) Digital Support as a Bridge Between Individual and Social Needs, and (4) AR as a Catalyst for Personalized Support. These findings underscore the complexities of vaping cessation and the opportunities for innovative, YYA-centred interventions that align with young people’s digital habits, motivations, and support needs. Stepping back from the individual themes, this study makes a broader contribution to the literature by proactively ensuring that YYA needs and preferences are embedded into intervention designs from the outset, ultimately protecting future cessation efforts from failure. Many existing vaping cessation interventions are developed without meaningful engagement from young people, leading to low uptake and limited effectiveness. By employing ID, a methodology that prioritizes applied health research, this study was able to generate practical, actionable recommendations that align with YYAs’ lived experiences, digital habits, and cessation challenges. This approach ensures that future interventions are 76 not only evidence-based but also user-centred, increasing their potential for engagement, relevance, and long-term success. In doing so, this research reinforces the importance of integrating YYA perspectives into digital health design, providing a foundation for effective, sustainable, and scalable vaping cessation solutions. The first theme emphasized the pervasiveness and normalization of vaping within YYAs’ social environments, reinforcing both initiation and continued use. Many participants started vaping in social settings, where it was framed as an expected part of social interactions, making cessation particularly challenging. The normalization of vaping was not only a driver of use but also a barrier to quitting, as participants reported experiencing peer influence, social expectations, and fear of social exclusion if they stopped vaping. These findings align with prior research showing that peer reinforcement plays a critical role in YYA vaping behaviours (Amin et al., 2020; Crane et al., 2023; Skinner et al., 2024; Struik et al., 2023a). Similar to Rahman et al. (2024), many participants attempted to distance themselves from social settings where vaping was prevalent, but this often resulted in social disconnection, reinforcing the need for cessation interventions that provide alternative forms of social support without requiring them to disengage from their social lives entirely. As explored in the second theme, quitting vaping was described as a deeply personal and nonlinear process driven primarily by intrinsic motivations such as improving health, achieving personal milestones, or addressing financial concerns. This aligns with Self-Determination Theory (Ryan & Deci, 2024), which highlights the role of autonomy and intrinsic motivation in sustained behaviour change. While external pressures, such as encouragement from family or disapproval from peers, played a role in some participants’ decisions to quit, self-efficacy and personal readiness emerged as the most critical factors for success in theme two. Many participants described the push-pull nature of cessation, where they oscillated between the desire to quit and difficulties maintaining abstinence, often cycling between quit attempts and relapse. This reinforces the need for cessation interventions that are flexible and adaptable, allowing users to engage at different stages of readiness without being penalized for setbacks. While intrinsic motivation initiated the quitting process, participants emphasized that sustaining long-term abstinence required external reinforcement, such as celebrating small wins and receiving positive social support. These findings suggest that effective cessation tools should cultivate self-determined quitting 77 efforts and integrate structured external reinforcements, such as peer accountability, personalized encouragement, and digital incentives, to help individuals remain engaged and resilient throughout their quit journey. Importantly, the findings also point to the limitations of hard deadlines or rigid abstinence expectations in this population. Participants described traditional cessation models as often misaligned with their lived experiences, especially given the mental health challenges many YYAs face. This aligns with recent research analyzing Reddit posts about quitting vaping, where young adults emphasized the importance of self-love, self-grace, and a harm-reduction mindset over perfectionism (Struik & Yang, 2021). Rather than promoting immediate abstinence, participants preferred compassionate, flexible approaches that framed quitting as a gradual process. Digital cessation tools that offer positive reinforcement, celebrate small steps, and normalize non-linear progress may be especially effective for supporting young people navigating emotional, social, and behavioural complexities in their quit journeys. Aligned with both themes two and three, participants expressed a desire for progress tracking and milestone recognition, reinforcing research on positive reinforcement and gain-framed messaging in behaviour change interventions (Cornacchione & Smith, 2012; Huma et al., 2022; Orji et al., 2023; Struik et al., 2019). These findings underscore the importance of integrating and balancing intrinsic and extrinsic motivation in digital cessation tools, ensuring that interventions celebrate progress rather than focusing solely on quitting as an all-or-nothing goal. Intrinsically motivated participants found personalized goal setting, self-reflection tools, and progress visualization to be meaningful motivators, reinforcing their sense of autonomy and self-efficacy. Others were more extrinsically motivated, responding positively to incentives, social reinforcement, and gamification elements, highlighting the importance of offering diverse engagement strategies within cessation interventions. By integrating multiple forms of motivation, digital cessation tools can increase engagement, enhance long-term commitment, and better support the diverse needs of YYAs navigating their quit journey. Findings from the third theme indicate that digital tools were viewed as a potential bridge between individual autonomy and social connection, providing customizable, non-judgmental, and interactive support. Participants reported limited engagement with existing 78 vaping cessation apps, citing a lack of awareness, skepticism about effectiveness, and difficulties maintaining engagement. This aligns with prior research indicating that many available app-based vaping cessation tools lack user-centred design and may fail to address many of the essential components of cessation, such as coping strategies for withdrawal or relapse prevention, reducing their long-term efficacy (McKay et al., 2024; Sanchez et al., 2022). Despite this, participants still viewed digital platforms as promising tools for personalized support, particularly peer-driven support networks, where they could connect with others anonymously and without stigma. This aligns with findings from Huma et al. (2022) and Rahman et al. (2024), who emphasized the importance of socially connected, non-judgmental spaces in digital cessation interventions. Within theme four, participants were divided in their preferences for AI-driven versus human-led support, highlighting the need for flexibility in AR-based interventions. Some valued AI-driven interactions, such as chatbots or virtual avatars, for their immediacy, privacy, and non-judgmental nature, seeing them as useful for on-demand support during cravings. Others preferred human-led interactions, emphasizing the emotional depth and relatability of counsellors or peer mentors. These mixed preferences reinforce the potential of AR as a personalized cessation tool, offering both AI-powered guidance and human connection to support diverse user needs. Underlying themes three and four, many participants emphasized privacy as paramount to ensure users feel safe and supported while engaging with these tools. As such, transparency in data collection and usage practices would be essential to building trust and encouraging sustained engagement among YYAs. The final theme positioned AR as a uniquely valuable tool for vaping cessation; unlike traditional cessation approaches, which often rely on rigid goal setting and self-discipline, AR can facilitate adaptive, personalized support, integrating features such as gamification, behavioural tracking, and AI-powered coaching. AR can also provide distraction, a key facilitator to quitting identified by Al-Hamdani et al. (2023), Rahman et al. (2024) and Struik & Yang (2021), giving YYAs somewhere to go during times of heightened cravings. Participants expressed enthusiasm for gamified features, such as progress tracking, virtual rewards, and interactive challenges, which have been highlighted as ways to improve user experience and enhance engagement with digital health interventions (Cheng et al., 2020; El-Hilly et al., 2016; Floryan et al., 2020; Sardi et al., 2017). 79 The findings are aligned with existing cessation literature, which consistently identifies goal setting, self-monitoring, and social support as among the most effective behaviour change techniques (BCTs) for promoting quitting success. BCTs refer to an intervention's specific, active components that aim to influence behaviour by targeting psychological or contextual mechanisms of change (Mitchie et al., 2011; 2013). The Behaviour Change Technique Taxonomy version 1 (BCTTv1) offers a standardized list of 93 BCTs grouped into 16 categories that address key drivers of behaviour, namely, capability, opportunity, and motivation, providing a comprehensive toolkit for designing effective health interventions. The strong emphasis participants placed on personalized goal setting and progress tracking reflects BCTs such as “goal setting (behaviour)” and “self-monitoring of behaviour,” both of which have been widely implemented in successful smoking cessation interventions and are shown to significantly enhance user engagement and quit outcomes (Struik et al., 2022b). Similarly, the desire for positive social reinforcement and community-based encouragement resonates with BCTs categorized under “social support,” which were not only present across all Canadian smoking cessation websites analyzed by Struik et al. (2023c) but were also associated with greater user satisfaction and perseverance through quit attempts. Within the third theme, participants expressed an interest in incentive-CM, where verified abstinence is rewarded with tangible or virtual incentives. CM has demonstrated preliminary efficacy in vaping cessation (Palmer et al., 2020; Raiff et al., 2018), with Raiff et al. (2022) finding that all eight participants in their trial achieved full vaping abstinence over two weeks using a CM-based intervention. CM is often limited by its resource-intensive requirements; however, using non-financial incentives, such as in-app rewards, badges, progress milestones, or vouchers, could make it more scalable and accessible. This approach has shown preliminary success by Raiff et al. (2018) using videogame-based incentives contingent on objective evidence of abstinence for smoking cessation. These strategies align with several BCTs, particularly those related to "reward (outcome)" and "material incentive (behaviour)" which aim to reinforce desired behaviours through contingent positive feedback (Mitchie et al., 2011; 2013). While such extrinsic motivators can be effective in the short term, they are most impactful when paired with techniques that foster intrinsic motivation and self-regulation, such as goal setting and self-monitoring, to support sustained behaviour 80 change. Bridging this concept with theme four and AR’s immersive and interactive nature, integrating CM within an AR-based vaping cessation app could enhance these effects even further by making rewards feel more tangible and tied to user behaviour. For example, virtual rewards could be visually displayed within an AR environment, allowing users to physically interact with their progress or "level up" within a gamified cessation journey. The ability to merge behavioural reinforcement with real-time, immersive feedback in AR could create a stronger sense of achievement and motivation, potentially leading to greater adherence and long-term success than traditional CM approaches. By incorporating extrinsic and intrinsic motivators, many of which are formalized in the BCT taxonomy (Mitchie et al., 2011; 2013), AR interventions could provide a holistic approach to vaping cessation, addressing the psychological, social, and behavioural factors that contribute to sustained quitting efforts. For instance, an app could initially reward users with badges and unlockable content for reaching milestones (extrinsic) but gradually transition to emphasizing health progress tracking, mindfulness coaching, and self-directed goal setting (intrinsic). Participants highlighted the importance of education and real-time coping strategies, viewing AR as a useful tool for health visualization, as discussed in the fourth theme. Many expressed an interest in tracking their lung recovery over time, seeing improvements as a motivational reinforcement for staying vape-free. However, participants cautioned against overly graphic or fear-based messaging, favouring positively framed reinforcement. When CET was introduced as a potential feature, participants expressed strong hesitancy, fearing that intentional exposure to vaping cues would intensify cravings rather than reduce them. Instead, participants preferred AR-based tools that help identify personal triggers and provide real-time coping strategies, reinforcing the need for interventions that offer behavioural guidance alongside educational components. Overall, this study is the first to explore YYA perspectives on AR for vaping cessation, offering valuable insights into the challenges, barriers, and opportunities this population faces. The findings suggest that AR-based tools have the potential to transform vaping cessation interventions by offering a dynamic, interactive, and user-driven experience. By aligning with YYAs’ digital behaviours and preferences, AR-based tools can bridge the gap between self-directed quitting and structured support, ultimately making 81 vaping cessation more engaging, accessible, and sustainable. Unlike traditional cessation programs, which often emphasize abstinence and willpower, AR-based interventions can offer adaptive, personalized support, positioning them as an innovative and effective tool in the evolving landscape of YYA vaping cessation. 4.6 Limitations and Future Research This study provides valuable insights into YYA perspectives on vaping cessation and the potential role of AR-based interventions, but several limitations should be acknowledged. The sample size was appropriate for the study’s exploratory and qualitative nature, as ID prioritizes depth and applicability over broad generalizability. While the findings provide valuable insights into YYA vaping cessation experiences, they reflect a specific group of participants, so they may not encompass the full spectrum of cessation behaviours across diverse populations. While diverse in gender and vaping experiences, the findings may not fully capture the perspectives of harder-to-reach populations, such as individuals who have never attempted cessation, those from lower socioeconomic backgrounds, or those with limited access to digital technologies. Future research should explore barriers to engagement with digital cessation tools among underrepresented groups to ensure interventions are inclusive and accessible. The small, exploratory sample held limited information power, particularly regarding gender-based differences. As Donaldson et al. (2021) noted, gender and sexual minority groups are at higher risk for vaping but remain underrepresented in cessation research. By incorporating gender as a disaggregating construct, this study emphasized its importance in understanding vaping cessation. Future research using mixed-methods approaches or larger samples could better capture gender-specific influences, ensuring interventions are inclusive and responsive to diverse needs. Including a wider range of demographics and vaping histories in future studies could further refine and expand the applicability of these findings, ensuring that intervention recommendations are responsive to the varied needs and contexts of those attempting to quit vaping. Second, the study relied on self-reported experiences, which may be subject to recall bias or social desirability effects. While qualitative methods provide rich, in-depth insights, future studies could incorporate longitudinal designs to track how YYAs' experiences and cessation strategies evolve over time, particularly in response to real-world engagement with 82 AR-based interventions. Additionally, experimental or mixed-method approaches could complement qualitative findings by quantifying the effectiveness of specific AR features, such as gamification and AI-driven support. Third, a key limitation of this study is the theoretical nature of AR discussions, which inherently limits the study’s alignment with ID. ID is intended to generate applied health knowledge that informs real-world practice; however, this study’s exploration of AR as a cessation tool was largely hypothetical, as participants did not interact with a tangible AR-based vaping intervention. Without direct engagement, participants’ perspectives were based on speculation rather than lived experience, limiting the extent to which findings can be directly translated into applied interventions. This limitation was mitigated by encouraging participants to interact with popular AR-based apps (e.g., PokemonGo™) prior to the sessions to help foster a preliminary understanding of AR technology and its possible applications. Future research should prioritize pilot testing AR-based vaping cessation tools, allowing for direct user interaction and real-world evaluation of features such as gamification, behavioural tracking, and AI-driven support. AR interventions should be designed to foster both intrinsic and extrinsic motivation, leveraging personalized and adaptive mechanics to enhance user experience and adherence. Conducting studies where participants actively engage with AR-based cessation apps would enhance the credibility and transferability of findings within an ID framework by grounding insights in actual user experience rather than hypothetical feedback. Further exploration of advanced features, such as AI-driven personalization could enhance the adaptability of interventions by tailoring support based on users’ behaviours, progress, and engagement patterns. AI could provide immediate feedback and personalized cessation plans, reinforcing motivation and commitment while reducing the burden on healthcare professionals (Nadarzynski et al., 2019). Additionally, given the increasing prevalence of dual substance use, future interventions should address the co-occurrence of vaping and cannabis use, recognizing that these behaviours often intersect and present unique cessation challenges (Mehra et al., 2019). Lastly, while this study focused on YYA perspectives, future research should explore collaboration between end-users, healthcare providers, digital health developers, and public health stakeholders to ensure that AR-based vaping cessation tools are evidence-based, 83 youth-friendly, and effectively integrated into existing cessation frameworks. By incorporating behavioural science principles, gamification strategies, and contingency management approaches, digital cessation interventions can become a viable and engaging alternative to traditional, often underutilized, cessation resources. 4.7 Implications and Conclusion The findings of this study have important implications for the development of YYA-centred vaping cessation interventions, particularly in the digital and AR space. Participants' experiences highlight the need for personalized, engaging, and flexible cessation tools that accommodate the nonlinear nature of quitting, provide real-time support, and bridge individual and social dimensions of cessation. The study’s findings also provide a foundation for developing AR-based interventions integrating health effects visualization, progress tracking, and gamified rewards to enhance user engagement and motivation. These features align with YYAs’ digital habits and preferences, making cessation support more interactive and accessible. Integrating AR-based interventions offers a promising approach by leveraging immersive technology to sustain motivation, provide distraction, and reinforce progress in ways that traditional cessation tools may not. By offering dynamic, immersive experiences, AR has the potential to shift traditional vaping cessation strategies from passive educational approaches to active, engaging, and personalized interventions (Vinci et al, 2020; Yang et al., 2022). Digital health developers can use these findings to design interventions that combine motivation, distraction, and personalized support to create sustainable behaviour change. A key implication is the importance of customization and choice in digital cessation interventions. Participants had diverse preferences for AI-driven versus human-led support, emphasizing the need for flexible intervention designs that allow users to tailor their experience. AR-based tools could accommodate this by offering interactive AI support for those who prefer anonymity while also providing pathways to peer or counsellor-led support for those seeking human interaction. Ensuring this hybrid approach can improve engagement and maximize the intervention’s reach. Additionally, this study underscores the potential for gamification and incentive-based models, such as CM, to enhance engagement and adherence. The integration of non-financial rewards, such as in-app achievements or AR- 84 driven progress visualizations, offers a scalable alternative to traditional CM programs, reinforcing positive behaviour change without the financial and logistical barriers of traditional incentive-based models. This approach has already demonstrated early success in digital health interventions (Raiff et al., 2018), and AR could further amplify its effectiveness by making rewards more interactive and immersive. Beyond personalization and engagement, resilience-building and long-term support must be central to intervention design. Regular check-ins through apps or chatbots can provide ongoing support, ensuring users remain connected to their cessation goals even after initial success. By combining co-designed elements, tailored features, and evidence-based strategies, digital interventions can empower YYAs to not only quit vaping but also sustain long-term behaviour change and improve overall well-being. The findings of this study also offer actionable insights for public health and healthcare practice. Insights from participants can inform targeted public health campaigns that not only highlight the risks of vaping but also emphasize the benefits of cessation in a way that resonates with YYAs. Public health campaigns can be made more impactful by aligning educational messaging with YYAs’ lived experiences, such as coping with stress, managing social influences, and overcoming cravings. Healthcare providers, particularly nurses, are well-positioned to integrate digital cessation tools into clinical practice, extending the reach of traditional cessation counselling with technology-driven interventions that meet YYAs where they are, both physically and digitally (Marcolino et al., 2018). AR-based interventions could be implemented as adjuncts to existing cessation programs, allowing healthcare providers to refer YYAs to interactive, evidence-based digital tools that provide on-demand behavioural support. The ability to customize intervention strategies, integrate AI-driven coaching, and offer CM incentives aligns with nursing’s holistic and patient-centred approach. Additionally, the flexibility of AI-driven and human-led support within AR interventions presents an opportunity for nurses to provide hybrid cessation models, where patients can access digital self-guided tools while maintaining a connection to professional support. This integration could improve accessibility and adherence while reinforcing the importance of quitting vaping within clinical settings. Given that social normalization and peer reinforcement play a significant role in vaping behaviours, health promotion efforts 85 should integrate digital platforms that YYAs frequently engage with, such as social media, gamified health applications, and peer-driven virtual communities, can enhance reach and engagement while reinforcing cessation behaviours in familiar digital environments (Berg et al., 2021; Huma et al., 2022; Lyu et al., 2022a; Struik & Yang, 2021; Struik et al., 2022a; Wu et al., 2024). In conclusion, this study is the first to explore YYA perspectives on AR for vaping cessation, offering new insights into how digital interventions can be designed to meet the evolving needs of young people. As vaping remains a pressing public health issue, particularly among youth and young adults, there is an urgent need for innovative, evidence-based interventions that move beyond traditional cessation approaches. By leveraging personalization, interactivity, and immersive technology, AR-based tools have the potential to redefine vaping cessation support, making it more engaging, accessible, and effective. Future research should focus on pilot-testing AR interventions, evaluating real-world engagement and effectiveness, and ensuring that YYA-driven, digital cessation strategies are integrated into broader public health efforts to reduce vaping prevalence among YYAs. 86 Chapter 5: Conclusion 5.1 Summary This thesis explored the issue of youth and young adult (YYA) vaping cessation, addressing the sociocultural, behavioural, and technological dimensions influencing cessation efforts. Through an Interpretive Description (ID) approach, the study investigated how an augmented reality (AR)-based intervention could support YYAs in their quit journeys. By centring participants’ perspectives, the research provided valuable insights into the barriers, motivations, and support mechanisms needed for effective vaping cessation interventions. Findings emphasized the importance of social and cultural influences on vaping, the individualized nature of quitting, the role of digital interventions as bridges between individual and social needs, and the potential for AR to offer personalized, engaging support. These results contribute to the growing field of digital health interventions and highlight the relevance of nursing’s role in integrating technology-driven solutions into public health and clinical practice. Chapter 1 introduced the topic of the YYA vaping epidemic and vaping cessation, thus providing the context for this thesis. Chapter 2 contained a scoping review (prepped for publication) showcasing the current landscape of digital vaping cessation interventions and identifying key gaps. A thorough overview of the methodological approach used was provided in Chapter 3. Chapter 4 was the study manuscript prepared for publication; it encompassed the study results and a discussion of the findings, including the limitations, implications, and directions for future research. In this final chapter, I will synthesize the key findings of this research, position the study within the broader nursing discipline, reflect on the methodological approach and its contributions, discuss the study’s implications for healthcare and public health practice, and outline directions for future research in the field of vaping cessation and digital health interventions. 5.2 Integration of Research and Current Knowledge This study successfully achieved its primary aim of investigating YYA preferences and experiences in vaping cessation to inform the design of AR-based interventions. Through ID, the study generated actionable recommendations for mobile-based solutions that integrate gamification, real-time feedback, and behaviour change techniques. Findings revealed that 87 vaping cessation is a deeply individualized yet socially embedded experience, underscoring the need for personalized and flexible interventions that adapt to users' shifting motivations, social pressures, and cessation goals. This research builds on current literature that identifies YYAs as a population particularly vulnerable to vaping initiation and nicotine dependence while also recognizing their digital literacy and engagement with mobile technologies (Amin et al., 2023; Berg et al., 2021; Huma et al., 2022; Lupton et al., 2021). Existing studies have indicated that traditional cessation interventions are often inadequate for YYA vaping cessation, as they do not fully account for social normalization, peer influence, or the evolving digital landscape in which young people interact with health information and support (Berg et al., 2021; Dai et al., 2023; Rahman et al., 2024; Sanchez et al., 2021). The findings of this study reinforce the importance of adaptable and personalized, technology-driven solutions, particularly those that integrate goal setting, gamification and real-time feedback to enhance motivation and engagement (Huma et al., 2022; El-Hilly et al., 2016; Floryan et al., 2020; Raiff et al., 2022; Rahman et al., 2024). While prior research has explored digital vaping cessation apps (Sanchez et al., 2022; Marler et al., 2024; McKay et al., 2024; Webb et al., 2023), there has been no examination of AR’s potential role in vaping cessation, positioning this study as an important contribution to the intersection of public health, nursing, and digital health innovation. 5.3 Conclusions on Study Goals and Contributions A key contribution of this research is its theoretical and methodological integration of ID and Reflexive Thematic Analysis (RTA) to explore how digital interventions, particularly AR, can enhance cessation efforts. By grounding its findings in the lived experiences of YYAs, the study offers practical, real-world applications that extend beyond academic discourse. The participatory nature of the research ensures that the interventions proposed are aligned with user needs, making them more likely to be engaging, effective, and widely adopted. The study findings provide a foundation for future digital health strategies by offering a roadmap for designing user-driven health interventions that leverage the immersive and interactive potential of AR. By emphasizing the importance of tailoring interventions to YYA needs, this research contributes to ongoing efforts in public health to 88 reduce vaping prevalence through evidence-based, technologically integrated strategies. The study also highlights the value of interdisciplinary collaboration, demonstrating how insights from behavioural science, technology, and nursing practice can inform the development of innovative, scalable, and sustainable interventions. 5.3.1 Methodological Reflection and Strengths The study employed ID (Thorne, 2016; 2020) to capture the nuanced and multidimensional experiences of YYAs in vaping cessation. This methodological approach allowed the research to move beyond surface-level descriptions, uncovering actionable insights addressing vaping cessation's sociocultural and behavioural complexities. The flexibility of ID guided by the use of RTA (Braun & Clarke, 2021b) allowed for a deep exploration of experiences and preferences of YYA for vaping cessation. The study illuminated vaping cessation as a deeply individualized yet relational phenomenon by embedding participants' narratives within their social and cultural contexts. This perspective is critical to designing meaningful and contextually relevant intervention recommendations. A commitment to reflexivity further strengthened the study's methodological rigour. The researcher's role in shaping the data interpretation was critically acknowledged, ensuring that findings remained grounded in participants' perspectives. This reflexive approach reduced the potential for bias and enhanced the trustworthiness of the insights, maintaining alignment with the core principles of qualitative research. The continuous involvement of YYA throughout the study was a key strength, as it actively centred participants' voices in the research process. Incorporating their insights ensured that proposed interventions were aligned with real-world needs and preferences, enhancing the practical applicability of the findings. This participatory approach also resonated with broader trends in public health that emphasize co-design and user-driven solutions (Rahman et al., 2024). Additionally, the study’s exploration of both individual and social aspects of cessation provided a comprehensive understanding of the multifaceted challenges YYAs face, reinforcing the need for multi-dimensional interventions that do not isolate individuals from their social networks. 5.4 Reflection on Disciplinary Contributions This thesis embodies the practical and solution-driven ethos of the nursing discipline, 89 contributing to nursing’s long-standing commitment to developing evidence-based interventions that address pressing public health concerns. As a profession that emphasizes holistic, patient-centred care, nursing is well-positioned to bridge scientific inquiry with practical, real-world applications. This study represents a nurse-led effort to explore and advance digital health solutions, ensuring that interventions for vaping cessation are not only technologically relevant but also aligned with the lived experience and needs of YYAs. By using ID, a nursing methodology that prioritizes applied knowledge development, this thesis advances nursing’s role in designing interventions that have the potential for meaningful impacts for YYA vaping cessation. This research is particularly significant for nurses working in public health, primary care, and health promotion, as these professionals may face struggles in engaging and supporting YYAs in their cessation journeys. Many traditional cessation programs are not tailored to younger populations or vaping specific, leaving nurses without effective, evidenced-based tools from which to draw from in practice. This thesis represents an effort towards filling that gap, demonstrating how nurses can take an active role in the development of age-appropriate technology-driven interventions that align with the preferences and behaviours of younger demographics. As a part of this initiative, this research highlights nursing’s capacity to respond to contemporary public health challenges, particularly in addressing complex health behaviours that require innovative interdisciplinary interventions. This thesis also represents nurses at the forefront of digital health intervention, reflecting the discipline’s growing presence in non-traditional, technology driven spaces. As digital health technologies continue to evolve, it is vital for nurses to remain active in shaping these developments, ensuring that interventions are patient-centred and grounded in ethical principles. This study’s exploration of AR as a vaping cessation tool demonstrates how nurses can be trailblazers in emerging digital health fields, advocating for technologies that enhance accessibility, effectiveness, and engagement in public health interventions. Further, this work reinforces that nurses are not only implementers of health technology but also innovators and leaders in development, advancing nursing’s role in behavioural health intervention design. Finally, this thesis underscores the interdisciplinary nature of public health research and intervention development, advocating for greater collaboration between nurses, digital 90 health developers, behaviour scientists, and public policy experts. Addressing complex public health challenges like vaping requires intersectoral cooperation and collaboration; this study highlights nurses’ ability to contribute meaningfully to interdisciplinary efforts that bride healthcare, technology and policy development. This research reinforces the importance of nursing in shaping evidence-based responses to pressing public health concerns. As vaping and nicotine use continue to evolve, nurses must be active participants in shaping not only clinical and community-based interventions but also digital and policy interventions that extend beyond traditional healthcare settings. In summary, this thesis advances nursing’s role in digital public health intervention design, demonstrating how nurse-led research can influence interdisciplinary collaboration, technology-driven health solutions, and the development of innovative strategies for YYA vaping cessation. By engaging with emerging and immersive technologies and advocating for youth-centred applied research, this work positions nursing as a key discipline in driving forward meaningful, evidence-based health solutions in an increasingly digital world. 5.5 Conclusion This study is the first to explore YYA perspectives on AR-based vaping cessation interventions, providing critical insights into the digital preferences, behavioural motivations, and social challenges that shape quitting experiences. By leveraging AR’s capacity for gamification, real-time feedback, and interactive support, this research highlights the potential for digital interventions to redefine youth vaping cessation. The findings reinforce the relevance of nursing in digital health innovation, positioning nurses as key players in developing digital health solutions. 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BMC Psychiatry, 23(1), 951. https://doi.org/10.1186/s12888-023-05426-z 107 Appendix A Scoping Review Checklist SECTION ITEM PRISMA-ScR CHECKLIST ITEM REPORTED ON PAGE # TITLE Title 1 Identify the report as a scoping review. 15 ABSTRACT Structured summary 2 Provide a structured summary that includes (as applicable): background, objectives, eligibility criteria, sources of evidence, charting methods, results, and conclusions that relate to the review questions and objectives. Not included for the purposes of this document INTRODUCTION Rationale 3 Describe the rationale for the review in the context of what is already known. Explain why the review questions/objectives lend themselves to a scoping review approach. 15-17 Objectives 4 Provide an explicit statement of the questions and objectives being addressed with reference to their key elements (e.g., population or participants, concepts, and context) or other relevant key elements used to conceptualize the review questions and/or objectives. 17 METHODS Protocol and registration 5 Indicate whether a review protocol exists; state if and where it can be accessed (e.g., a Web address); and if available, provide registration information, including the registration number. NA Eligibility criteria 6 Specify characteristics of the sources of evidence used as eligibility criteria (e.g., years considered, language, and publication status), and provide a rationale. 18-19 Information sources* 7 Describe all information sources in the search (e.g., databases with dates of coverage and contact with authors to identify additional sources), as well as the date the most recent search was executed. 18, 20 Search 8 Present the full electronic search strategy for at least 1 database, including any limits used, such that it could be repeated. See Appendix B Selection of sources of evidence† 9 State the process for selecting sources of evidence (i.e., screening and eligibility) included in the scoping review. 19-20 Data charting process‡ 10 Describe the methods of charting data from the included sources of evidence (e.g., calibrated forms or forms that have been tested by the team before their use, and whether data charting was done independently or in duplicate) and any processes for obtaining and confirming data from investigators. 20 Data items 11 List and define all variables for which data were sought and any assumptions and simplifications made. 20-21 108 Critical appraisal of individual sources of evidence§ 12 If done, provide a rationale for conducting a critical appraisal of included sources of evidence; describe the methods used and how this information was used in any data synthesis (if appropriate). NA Synthesis of results 13 Describe the methods of handling and summarizing the data that were charted. 20 RESULTS Selection of sources of evidence 14 Give numbers of sources of evidence screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally using a flow diagram. 20-21, see PRISMA (figure 1) Characteristics of sources of evidence 15 For each source of evidence, present characteristics for which data were charted and provide the citations. 21-22 Critical appraisal within sources of evidence 16 If done, present data on critical appraisal of included sources of evidence (see item 12). NA Results of individual sources of evidence 17 For each included source of evidence, present the relevant data that were charted that relate to the review questions and objectives. 22-31 Synthesis of results 18 Summarize and/or present the charting results as they relate to the review questions and objectives. 21- 22, see Table 1 DISCUSSION Summary of evidence 19 Summarize the main results (including an overview of concepts, themes, and types of evidence available), link to the review questions and objectives, and consider the relevance to key groups. 31-34 Limitations 20 Discuss the limitations of the scoping review process. 34-35 Conclusions 21 Provide a general interpretation of the results with respect to the review questions and objectives, as well as potential implications and/or next steps. 35 FUNDING Funding 22 Describe sources of funding for the included sources of evidence, as well as sources of funding for the scoping review. Describe the role of the funders of the scoping review. NA JBI = Joanna Briggs Institute; PRISMA-ScR = Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. * Where sources of evidence (see second footnote) are compiled from, such as bibliographic databases, social media platforms, and Web sites. † A more inclusive/heterogeneous term used to account for the different types of evidence or data sources (e.g., quantitative and/or qualitative research, expert opinion, and policy documents) that may be eligible in a scoping review as opposed to only studies. This is not to be confused with information sources (see first footnote). ‡ The frameworks by Arksey and O’Malley (6) and Levac and colleagues (7) and the JBI guidance (4, 5) refer to the process of data extraction in a scoping review as data charting. 109 § The process of systematically examining research evidence to assess its validity, results, and relevance before using it to inform a decision. This term is used for items 12 and 19 instead of "risk of bias" (which is more applicable to systematic reviews of interventions) to include and acknowledge the various sources of evidence that may be used in a scoping review (e.g., quantitative and/or qualitative research, expert opinion, and policy document). From: Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMAScR): Checklist and Explanation. Ann Intern Med. 2018;169:467–473. doi: 10.7326/M18-0850. 110 Appendix B Literature Search Strategy Database Concepts MeSH or Equivalent terms Search Strategy Number of Articles Identified CINAHL EBSCO Concept 1: vaping (MH "Electronic Cigarettes") OR (MH "Vaping") S1: (MH "Electronic Cigarettes") OR (MH "Vaping") 4,037 Keywords: vaping or vape or e-cigarette or electronic cigarette or electronic nicotine delivery system S2: Vaping OR Vape OR E-cig* OR “Electronic nicotine delivery system*” 6,914 Concept 2: digital technology (MH "Digital Technology+") OR (MH "Augmented Reality") OR (MH "Virtual Reality+") OR (MH "Virtual Reality Exposure Therapy") OR (MH "Telehealth+") OR (MH "Mobile Applications") OR (MH "Smartphone") OR (MH "Text Messaging+") OR (MH "Social Media+") S3: (MH "Digital Technology+") OR (MH "Augmented Reality") OR (MH "Virtual Reality+") OR (MH "Virtual Reality Exposure Therapy") OR (MH "Telehealth+") OR (MH "Mobile Applications") OR (MH "Smartphone") OR (MH "Text Messaging+") OR (MH "Social Media+") 95,147 Keywords: text messaging, mobile applications, smartphone, augmented reality, virtual reality, immersive technologies, telehealth, e-health, digital interventions, social media S4: (“Text messag*” OR "SMS" OR "short message service” OR “Mobile app*” OR “Smartphone app*” OR “Augmented reality” OR "AR" OR “Virtual reality” OR "VR" OR “E-health” OR "mHealth" OR "mobile health" OR "digital health" OR "Telehealth" OR "Telemedicine" OR "Social media" OR "Facebook" OR "Twitter" OR "Instagram" OR “Reddit” "YouTube" OR “Immersive tech*” OR “digital tech*” OR "Wearable tech*" OR "fitness tracker*" OR "smartwatch*") 122,512 Concept 3: cessation Keywords: cessation, quit, quitting, stop, stopping, reduction, intervention S5: (cessation OR quit* OR reduc* OR stop* OR intervention) 1,255,347 Vaping MH OR Keywords S6: S1 OR S2 7,837 111 Digital Technolgy+ MH OR Keywords S7: S3 OR S4 134,429 Vaping AND Digital Technology AND Cessation S8: S5 AND S6 AND S7 Publication Date: 20180101-; English Language 172 MEDLINE EBSCO Concept 1: vaping (MH "Vaping") OR (MH "Electronic Nicotine Delivery Systems") S1: (MH "Vaping") OR (MH "Electronic Nicotine Delivery Systems") 9,788 Keywords: vaping or vape or e-cigarette or electronic cigarette or electronic nicotine delivery system S2: Vaping OR Vape OR E-cig* OR “Electronic nicotine delivery system*” 13,544 Concept 2: digital technology (MH "Digital Technology") OR (MH "Digital Health") OR (MH "Augmented Reality") OR (MH "Virtual Reality+") OR (MH "Virtual Reality Exposure Therapy") OR (MH "Telemedicine+") OR (MH "Mobile Applications") OR (MH "Smartphone") OR (MH "Text Messaging") OR (MH "Social Media") S3: (MH "Digital Technology") OR (MH "Digital Health") OR (MH "Augmented Reality") OR (MH "Virtual Reality+") OR (MH "Virtual Reality Exposure Therapy") OR (MH "Telemedicine+") OR (MH "Mobile Applications") OR (MH "Smartphone") OR (MH "Text Messaging") OR (MH "Social Media") 97,933 Keywords: text messaging, mobile applications, smartphone, augmented reality, virtual reality, immersive technologies, telehealth, e-health, digital interventions, social media S4: (“Text messag*” OR "SMS" OR "short message service” OR “Mobile app*” OR “Smartphone app*” OR “Augmented reality” OR "AR" OR “Virtual reality” OR "VR" OR “E-health” OR "mHealth" OR "mobile health" OR "digital health" OR "Telehealth" OR "Telemedicine" OR "Social media" OR "Facebook" OR "Twitter" OR "Instagram" OR “Reddit” "YouTube" OR “Immersive tech*” OR “digital tech*” OR "Wearable tech*" OR "fitness tracker*" OR "smartwatch*") 604,843 Concept 3: cessation Keywords: cessation, quit, quitting, stop, stopping, reduction, intervention S5: (cessation OR quit* OR reduc* OR stop* OR intervention) 6,054,960 Vaping MH OR Keywords S6: S1 OR S2 13,544 Digital Technolgy+ MH OR Keywords S7: S3 OR S4 614,836 112 Vaping AND Digital Technology AND Cessation S8: S5 AND S6 AND S7 Publication Date: 20180101-; English Language 451 PsycINFO EBSCO Concept 1: vaping DE "Vaping" OR DE "Electronic Cigarettes" S1: DE "Vaping" OR DE "Electronic Cigarettes" 3,712 Keywords: vaping or vape or e-cigarette or electronic cigarette or electronic nicotine delivery system S2: Vaping OR Vape OR E-cig* OR “Electronic nicotine delivery system*” 4,441 Concept 2: digital technology DE "Digital Technology" OR DE "Electronic Health Services" OR DE "Mobile Health" OR DE "Mobile Health Applications" OR DE "Mobile Phones" OR DE "Mobile Technology" OR DE "Virtual Reality" OR DE "Virtual Reality Exposure Therapy" OR DE "Augmented Reality" OR DE "Social Media" OR DE "Text Messaging" OR DE "Telemedicine" S3: DE "Digital Technology" OR DE "Electronic Health Services" OR DE "Mobile Health" OR DE "Mobile Health Applications" OR DE "Mobile Phones" OR DE "Mobile Technology" OR DE "Virtual Reality" OR DE "Virtual Reality Exposure Therapy" OR DE "Augmented Reality" OR DE "Social Media" OR DE "Text Messaging" OR DE "Telemedicine" 57,722 Keywords: text messaging, mobile applications, smartphone, augmented reality, virtual reality, immersive technologies, telehealth, e-health, digital interventions, social media S4: (“Text messag*” OR "SMS" OR "short message service” OR “Mobile app*” OR “Smartphone app*” OR “Augmented reality” OR "AR" OR “Virtual reality” OR "VR" OR “E-health” OR "mHealth" OR "mobile health" OR "digital health" OR "Telehealth" OR "Telemedicine" OR "Social media" OR "Facebook" OR "Twitter" OR "Instagram" OR “Reddit” "YouTube" OR “Immersive tech*” OR “digital tech*” OR "Wearable tech*" OR "fitness tracker*" OR "smartwatch*") 99,471 Concept 3: cessation Keywords: cessation, quit, quitting, stop, stopping, reduction, intervention S5: (cessation OR quit* OR reduc* OR stop* OR intervention) 1,079,725 Vaping MH OR Keywords S6: S1 OR S2 4,655 Digital Technolgy+ MH OR Keywords S7: S3 OR S4 103,569 Vaping AND Digital S8: S5 AND S6 AND S7 171 113 Technology AND Cessation Publication Date: 20180101-; English Language Inclusion and Exclusion Criteria INCLUSION EXCLUSION Studies focusing on individuals of all ages Grey literature Published after January 2018, to capture to rise of digital interventions and the shift in the vaping landscape Articles not related to vaping or focused on traditional tobacco cigarette cessation Language: English Articles that only describe the development of technology or interventions without any testing or application for vaping cessation. Empirical journal articles (qualitative, quantitative, and mixed-methods research) and reviews 114 Appendix C Data Extraction Table Publication Country Aim/Purpose Design and Data Collection Sampling and Recruitment Key Findings Limitations Bilic, A., Burns, R. D., Bai, Y., Brusseau, T. A., Lucero, J. E., & King Jensen, J. L. (2023). Preliminary efficacy of a multi-behavioral Zoom-based peer health coaching intervention in young adults: A stepped wedge randomized controlled trial. Cyberpsychology, Behavior, and Social Networking, 26(9), 698-705. https://doi.org/10.1089/cyber.2022.0365 United States To test the preliminary efficacy of a Zoom-based peer coaching intervention on health and risk behaviours in young adults. Stepped Wedge Randomized Control Trial Data was collected via self-reported surveys at baseline, after one coaching session, and after two sessions using standardized questionnaires Convenience sample of students recruited from one U.S. university (N=89) After two 1-hour Zoom based peer coaching sessions using the motivational interviewing approach, participants exhibited reduced e-cigarette use (b = -2.1, p < 0.001) and lower use susceptibility (RR = 0.04, p = 0.05) compared with no coaching sessions. Participants also indicated enhanced use of stress reduction techniques and an increase in vigorous physical activity. Self-reported data may introduce response bias, as all behaviors were measured via questionnaires. Small sample size and lack of power analysis may limit the ability to detect all significant differences. Convenience sampling and inclusion of only one university limits generalizability. Differences in the demographic composition between groups (e.g., sex, race) could potentially bias the results despite randomization efforts. Graham, A. L., Cha, S., Jacobs, M. A., Amato, M. S., Funsten, A. L., Edwards, G., & Papandonatos, G. D. (2024). A vaping cessation text message program for adolescent e-cigarette users: A randomized clinical trial. JAMA, 332(9), 713-721. doi:10.1001/jama.2024.11057 United States To compare to effectiveness of a text message program for nicotine vaping cessation among adolescents Randomized Clinical Trial (RCT)- Double-blinded parallel, 2-group individually randomized. Data was collected through self-reported surveys over 7 months. The primary outcome was self-reported 30-day Convenience sampling of adolescents recruited via Snapchat, Facebook and Twitter ads. (N= 1,503; mean age= 16.4 years) At 7 months, 37.8% of participants in the intervention group reported 30-day vaping abstinence compared to 28.0% in the control group. Repeated abstinence rates were significantly higher in the intervention group (17.3%) compared to the control group (8.2%). The intervention demonstrated effectiveness across different levels of nicotine Self-reported abstinence was not biochemically verified, potentially leading to reporting bias. The intervention group may have been subject to social desirability bias due to more program touchpoints. The study's findings are generalizable only to adolescents interested in quitting, limiting applicability to other groups. Additionally, analyses of 115 vaping abstinence. dependence, mental health, and psychosocial adversity, making it a promising, scalable method for promoting vaping cessation among adolescents. mediators and changes in cannabis and alcohol use were not included, which could provide further insights into behavior changes. Graham, A. L., Amato, M. S., Cha, S., Jacobs, M. A., Bottcher, M. M., & Papandonatos, G. D. (2021). Effectiveness of a vaping cessation text message program among young adult e-cigarette users: A randomized clinical trial. JAMA Internal Medicine, 181(7), 923-930. doi:10.1001/jamainternmed.2021.1793 United States To determine the effectiveness of a text-message program for e-cigarette cessation among young adults (YAs). Randomized Clinical Trial (RCT)- Double-blinded parallel, 2-group individually randomized. Data was collected at baseline and after 7 months via self-reported surveys. The primary outcome was self-reported 30-day vaping abstinence. Convenience sampling of YAs recruited via Facebook and Twitter ads. (N= 2,588; mean age = 20.4 years) Participants receiving the intervention were significantly more likely to report 30-day abstinence at 7 months (24.1%) compared to the control group (18.6%). The intervention was effective across demographic variables, including nicotine dependence. These findings establish a benchmark for vaping cessation interventions, demonstrating that text messaging can be a scalable and cost-efficient tool for promoting vaping cessation. No biochemical verification of abstinence, rather self-reported data, which may introduce bias. The study did not include teenagers, the group with the highest rates of e-cigarette use, limiting the generalizability of findings to younger age groups. The use of incentives for participation may have introduced some level of assessment reactivity, potentially influencing the outcomes. Huma, Z. E., Struik, L., Bottorff, J. L., & Hasan, M. K. (2022). Preferences for mobile-supported e-cigarette cessation interventions among young adults: Qualitative descriptive study. JMIR Formative Research, 6(4), e33640. https://doi.org/10.2196/33640 Canada To develop an understanding of young adults’ (YAs) preferences and perceptions on app-based e-cigarette cessation interventions. Qualitative descriptive approach. Data was collected via semi-structured interviews Purposive sampling of current YA e-cigarette users looking to quit via Kijiji, Castanet, and university web posting. (N= 12; mean age= 25.2 years) YAs value mobile vaping cessation tools with features like personalized quit plans, behavioral tracking, peer support, motivational messaging, and evidence-based education. Emotional support and gamification were key to maintaining engagement, while concerns about data Small sample size with limited cultural and socioeconomic diversity, reducing the applicability of findings to broader populations with varied needs and experiences. 116 privacy and usability highlighted the need for user-friendly, inclusive designs. Participants emphasized the importance of tools that are accessible, culturally sensitive, and adaptable to diverse needs to enhance effectiveness and long-term success. Krishnan, N., Berg, C. J., Le, D., Ahluwalia, J., Graham, A. L., & Abroms, L. C. (2023). A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation. Tobacco prevention & cessation, 9. Doi: 10.18332/tpc/157598 United States To examine the acceptability and preliminary efficacy of the Quit the Vape (QTV), an automated text messaging program for vaping cessation, delivered with and without live text counseling. Pilot Randomized Control Trial (RCT) Data was collected via self-reported surveys at 4-weeks, measuring vaping cessation, quit attempts, and satisfaction with the program. Stratified random sampling from a pre-existing cohort of participants recruited via social media from 6 metropolitan areas in the U.S. (N = 58; mean age = 27.3 years) The QTV with counselor-delivered messages (QTV-C) group reported higher rates of 7-day abstinence (27.8%) compared to the QTV (11.1%) and control groups (5.9%). Quit attempts and program satisfaction were also higher in the QTV-C group. Both intervention groups reported high engagement and satisfaction, suggesting that live text counseling enhances the effectiveness of automated cessation programs. The study was not statistically powered to detect significant differences between groups, limiting its generalizability. Self-reported data without biochemical verification may introduce bias. Participants were not required to be motivated to quit, which may affect the intervention's overall efficacy in a more targeted population. The short 4-week follow-up period also limited the assessment of long-term cessation outcomes. Lyu, J. C., Afolabi, A., White, J. S., & Ling, P. M. (2022a). Perceptions and aspirations toward peer mentoring in social media–based electronic cigarette cessation interventions for adolescents and young adults: Focus group United States To understand from mentee and mentor perspectives the needs, expectations, and concerns of adolescents and young adults (AYAs) regarding peer mentoring to inform the Qualitative Data was collected via 7 focus groups sessions including four mentee groups and three potential mentor groups. Purposive sampling with participants recruited from the "Quit the Hit" (QTH) program, an Instagram-based e-cigarette cessation intervention active in California, South AYAs valued peer mentoring in social media-based vaping cessation programs, preferring mentors of similar age who had successfully quit vaping. Participants favored small-group and one-on-one mentoring on platforms like Instagram. Limitations include a small, demographically narrow sample recruited from the "Quit the Hit" program, which may not generalize to broader populations. Participants’ familiarity with Instagram potentially biased platform preferences. The self-selection of motivated 117 study. JMIR Formative Research, 6(12), e42538. https://doi.org/10.2196/42538 development of social media–based peer mentoring interventions for e-cigarette cessation. Carolina, and Minnesota. (N= 26; mean age = 19.4 years) Key mentor traits included emotional intelligence, communication skills, and inclusivity. Challenges included setting boundaries and maintaining professionalism, while incentives like certificates and monetary compensation were motivating. Peer mentoring was seen as a promising strategy to enhance engagement and retention in digital interventions. individuals interested in mentoring limited insights from less engaged groups. Additionally, the study focused on perceptions rather than real-world implementation or efficacy of peer mentoring. Lyu, J. C., Olson, S. S., Ramo, D. E., & Ling, P. M. (2022b). Delivering vaping cessation interventions to adolescents and young adults on Instagram: Protocol for a randomized controlled trial. BMC Public Health, 22(1), 2311. https://doi.org/10.1186/s12889-022-14606-7 United States To describe the protocol for a randomized controlled trial (RCT) testing the efficacy of an Instagram-based vaping cessation intervention for adolescents and young adults. Study protocol for an RCT Will utilize purposive sampling leveraging social media (Facebook) and community outreach Estimated need of approximately N=500 participants based on power analysis and estimation of attrition rates The intervention involves participants receiving a structured, Instagram-based vaping cessation program. This includes tailored, interactive content such as motivational posts, educational materials, and prompts encouraging engagement with the program. Peer mentors also provide support through direct messages and group discussions. Participants in the control condition will be directed to kickitca.org, a website offering links to chatline and texting cessation services. 7-day point prevalence abstinence will be assessed immediately, 3 months, and Reliance on self-reported outcomes could impact accuracy. Additionally, focusing solely on Instagram may limit generalizability to youth and young adults who use other platforms or have less social media access. The lack of long-term follow-up may restrict insights into sustained vaping cessation outcomes. 118 6 months after the treatment. Marler, J. D., Fujii, C. A., Utley, M. T., Balbierz, D. J., Galanko, J. A., & Utley, D. S. (2024). Outcomes of a comprehensive mobile vaping cessation program in adults Who vape daily: Cohort study. JMIR formative research. doi: 10.2196/57376 United States To evaluate the Pivot mobile vaping cessation program among adult daily vapers, assessing participant engagement, retention, changes in vaping attitudes and behavior, and participant feedback. Open-label, single-arm cohort study conducted remotely. Participants engaged with the Pivot app over 26 weeks. Data was self-reported via app and web-based questionnaires at baseline, every two weeks for 12 weeks, and at the 26-week follow-up. Non-proportional quota sampling with recruitment through web media (Facebook, Google Ads, Reddit, Craigslist) (N = 73; mean age = 37.4 years) The study found that 45% of participants achieved 30-day vaping abstinence at 26 weeks, and 30% maintained continuous abstinence from week 12 through week 26. Participants reported increased confidence to quit and reduced dependence on e-cigarettes. Most participants (88%) made at least one quit attempt, and engagement with the app remained high, particularly with messaging the coach and using the online community. The study lacked a control group, limiting conclusions about the effectiveness of the intervention. Recruitment challenges resulted in under-representation of certain demographics, including people who had never smoked and non-White participants. Additionally, reliance on self-reported data and compensating participants may have introduced bias. The findings are preliminary, and further research is needed to establish effectiveness. McKay, F., Chan, L., Cerio, R., Rickards, S., Hastings, P., Reakes, K., O’Brien, T., & Dunn, M. (2024). Assessing the quality and behavior change potential of vaping cessation apps: Systematic search and assessment. JMIR mHealth and uHealth, 12, e55177–e55177. https://doi.org/10.2196/55177 Australia To evaluate the quality, usability, and behavior change potential of smartphone apps designed to support vaping cessation. Systematic search and assessment (content analysis) 6 vaping cessation apps available on the Australian Apple iTunes and Google Play stores were assessed. Most vaping cessation apps scored poorly on quality and behavior change potential, with limited adherence to evidence-based guidelines. While some apps included features like goal-setting and progress tracking, these were inconsistently applied. User engagement tools, such as gamification and peer support, showed potential but were underutilized. Significant gaps in app design and content were identified, The study relied on app store descriptions, which may not reflect actual app functionality. The study did not assess user experiences or long-term effectiveness of the apps, limiting real-world applicability. Additionally, the evaluation excluded apps not available in English, potentially overlooking region-specific tools. The rapidly changing nature of app content also poses challenges in maintaining relevance and accuracy of the findings. 119 highlighting the need for improved integration of evidence-based strategies and collaboration with healthcare professionals. Orfin, R. H., Ramos Santiago, J. W., Decena Soriano, R., Romero Acosta, E., Bermudez, D., Rodriguez, Y. L., ... & Cartujano-Barrera, F. (2024). Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults. Journal of Ethnicity in Substance Abuse, 1-13. https://doi.org/10.1080/15332640.2024.2397422 United States (including Puerto Rico) To assess the feasibility, acceptability and preliminary impact of Kick Vaping among Latino young adults. Single-arm pilot study. Participants received 212 text messages in four phases over three months. Data was collected via self-reported surveys at baseline and at Month 3 to evaluate vaping cessation, self-efficacy, and satisfaction with the program. Convenience sampling via community outreach (e.g., malls, community-based organizations), radio interviews, and social media. (N = 40; mean age = 22.3 years) At month 3, 75% of participants reported 7-day vaping abstinence. Self-efficacy scores significantly improved from 30.65 at baseline to 50.11 at follow-up. Additionally, 88.9% of participants reported high satisfaction with the program. The intervention was found to be feasible and acceptable, showing promise in helping young Latinos quit vaping. The study lacked a control group, relied on self-reported data without biochemical verification, and had a small sample size. These factors limit the generalizability of the findings. The study was also limited to young adults, so the results may not apply to other age groups. Social desirability bias may have influenced participants’ responses. Palmer, A. M., Tomko, R. L., Squeglia, L. M., Gray, K. M., Carpenter, M. J., Smith, T. T., ... & McClure, E. A. (2022). A pilot feasibility study of a behavioral intervention for nicotine vaping cessation among young adults delivered via telehealth. Drug and alcohol dependence, 232(109311), 1-7. https://doi.org/10.1016/j.drugalcdep.2022.109311 United States To conduct a feasibility and acceptability trail of contingency management (CM) delivered via telehealth for youth and young adult (YYA) nicotine vaping cessation. Pilot feasibility trial using a randomized controlled trail design. The intervention was delivered remotely via the DynamiCare Health app over 28 days, with financial incentives provided based on abstinence, verified through saliva cotinine tests. Data was collected through app-based submissions of Convenience sampling of YYA via Facebook, Instagram, and Craigslist. (N = 27; mean age = 20.3 years) The study found high feasibility and acceptability, with 93% of participants completing the 28-day intervention and 89% completing the 1-month follow-up. Participants in the CM group submitted 55.4% abstinent samples compared to 8% in the control group, showing preliminary support for the CM intervention. Usability ratings for the app were favorable, particularly among the CM group. The study was limited by a small sample size and imbalanced randomization (22 CM, 5 Monitoring). The study was underpowered to detect significant differences in long-term cessation outcomes. Additionally, the resource-heavy nature of contingency management presents scalability challenges. 120 saliva samples and self-reported quit attempts, along with usability ratings and follow-up assessments at one month. While abstinence rates were not significantly different between groups at the end of treatment, the intervention showed potential for promoting short-term vaping cessation. Raiff, B. R., Newman, S. T., Upton, C. R., & Burrows, C. A. (2022). The feasibility, acceptability, and initial efficacy of a remotely delivered, financial-incentive intervention to initiate vaping abstinence in young adults. Experimental and clinical psychopharmacology, 30(5), 632-641. https://doi.org/10.1037/pha0000468 United States To evaluate the feasibility, acceptability, and preliminary efficacy of a remotely delivered contingency management (CM) intervention for vaping abstinence among young adults and to compare NicAlert and iScreen for remote verification. Pilot study using single-case multiple-baseline design. Participants provided saliva samples during video calls to verify vaping abstinence using NicAlert and iScreen cotinine tests. Financial incentives were provided based on negative cotinine results. Data was collected over a 2-weeks, with participants completing follow-up questionnaires. Convenience sampling with recruitment done via university administered email and word of mouth. (N = 8, mean age =19.88 years) All eight participants quit vaping nicotine during the 2-week intervention, with 100% compliance in submitting samples and attending calls. iScreen cotinine tests were rated more favorably by participants compared to NicAlert in terms of ease of use and accuracy. The intervention was rated as highly acceptable, with participants expressing satisfaction with the financial incentives and video support. The study demonstrated the feasibility of remotely delivered, incentive-based vaping cessation programs. The study had a small sample size and lacked a control group, which limits the generalizability and ability to draw strong conclusions about the intervention's efficacy. The study also relied on self-reported data and short-term outcomes (2 weeks), without long-term follow-up to assess sustained abstinence. Additionally, potential demand characteristics may have influenced outcomes, as social support was provided through video sessions. Sanchez, S., Deck, A., Baskerville, N. B., & Chaiton, M. (2023). Supporting youth vaping cessation with the Crush the Crave smartphone app: Protocol for a Canada To determine the effectiveness of the Crush the Crave app in supporting vaping cessation in comparison with an Study protocol for a 2-arm, single-blind, parallel randomized control trial (RCT). Qualitative interviews (n=25) Will utilize purposive sampling to recruit participants via the Vaping Dependence Cohort—an existing panel of youth The primary outcome variable will be self-reported 30-day point prevalence abstinence at 3 months, operationalized as not having vaped, even a puff, in the last 30 days. The study was designed to include an assessment-only control group. As the app is publicly available, there is the risk of cross-contamination. Cross-contamination measures will 121 randomized controlled trial. JMIR Research Protocols, 12(1), e42956. doi: 10.2196/42956 assessment-only control group. will be conducted with participants in the intervention arm to gain insight on the usability and acceptability of the app. enrolled in a prospective cohort study at the University of Toronto. Study invitations will be sent to 600 youth and young adult e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The secondary measures will include the intention to quit smoking in the next 6 months (yes or no), number of puffs per vaping session, number of vape sessions per day, and number of sessions in the past 30 days. be put in place to assess awareness of and engagement with the Crush the Crave app among control group participants. Focuses on nicotine vaping, findings may not be generalizable to cannabis vaping which is on the rise. Sanchez, S., Kundu, A., Limanto, E., Selby, P., Baskerville, N. B., & Chaiton, M. (2022). Smartphone apps for vaping cessation: Quality assessment and content analysis. JMIR mHealth and uHealth, 10(3), e31309. https://doi.org/10.2196/31309 Canada To examine the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Systematic search and assessment (content analysis) 8 apps available on the Canadian Apple and Google Play stores were included: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. Most apps scored low in quality, particularly in engagement, functionality, and adherence to evidence-based guidelines. Critical features like coping mechanisms for withdrawal and relapse prevention were often absent, and behavior change techniques, such as goal-setting and motivational messaging, were inconsistently applied. While apps with gamification and social support features showed higher engagement potential, these were rarely implemented. The study emphasized the need for The study relied on publicly available app store data, which may not fully represent app functionality or content. It did not assess user experiences or long-term app effectiveness, limiting real-world applicability. The analysis excluded non-English apps, potentially missing culturally relevant tools. Additionally, the rapidly evolving app market may render findings outdated, highlighting challenges in maintaining the study's relevance over time. 122 evidence-based, user-focused app design to improve effectiveness. Struik, L., Christianson, K., Khan, S., & Sharma, R. H. (2023). Strengths and limitations of web-based cessation support for individuals who smoke, dual use, or vape: Qualitative interview study. JMIR Formative Research, 7, e43096. doi:10.2196/43096 Canada To understand the strengths and limitations of web-based cessation support offered through QuitNow. Qualitative descriptive design. Data was collected via semi-structured interviews and analyzed with conventional content analysis. Convenience sampling with recruitment via Facebook and Instagram. (N = 36, aged 17-58 years) Participants identified several strengths of QuitNow, such as the breadth of information, nonjudgmental atmosphere, and professional appearance of the website. They valued the social support and quit coach access features. However, participants also noted limitations, including too much text, the need to create an account, and a lack of youth-specific content. Individuals who vape requested more information on vaping-specific health risks and quit strategies, while participants who dual-use or smoke desired more personalized support. The study's limitations include a lack of gender diversity, as the sample only included men and women, with no nonbinary or gender-nonconforming participants. Additionally, most participants were non-QuitNow users, limiting their familiarity with the program. The study was limited to participants from British Columbia, which may affect the generalizability of the findings to other regions. A reliance on self-reported data and limited time spent reviewing the website may have influenced participants’ perceptions of the program. Webb, J., Lin, Y. T., Ang, A., Michero, D., Majeed, A., Eisingerich, A., & Glasner, S. (2023). Feasibility and preliminary outcomes of a mobile intervention combining cognitive behavioral therapy, virtual coaching, and nicotine replacement therapy for nicotine United States To examine the feasibility and preliminary outcomes of an mHealth vaping cessation intervention. Single arm pilot design. The intervention was delivered via the Quit Genius-Vaping (QG-V) app over a 6-week period. Data were collected through online questionnaires at baseline and 1 Convenience sampling via Facebook. (N = 51, mean age = 27.9 years) At 1 month post-quit-date, 48.9% of participants reported 7-day abstinence, and 28.8% reported 30-day continuous abstinence. There was a significant reduction in vaping frequency, duration, and nicotine dependence. Participants highly rated the intervention's helpfulness, with 87% The study lacked a control group, limiting the ability to assess the intervention's effectiveness compared to other cessation methods. Self-reported data without biochemical verification may introduce bias. The short 1-month follow-up does not provide insights into long-term cessation outcomes. Additionally, the 123 vaping cessation. Telemedicine Reports, 4(1), 48-52. https://doi.org/10.1089/tmr.2023.0009 month post-quit-date, measuring self-reported 7-day and 30-day abstinence, nicotine dependence, and user satisfaction. reporting that the QG-V app met their needs. The intervention was considered feasible and effective for supporting vaping cessation. study's small sample size restricts the generalizability of findings. 124 Appendix D Recruitment Materials - Digital Poster Advertisement 125 Appendix E Qualtrics Intake Survey YYA Vaping Cessation Start of Block: Feature Awareness Introduction Thank you for your interest in participating in our study! Our goal is to learn more about what youth and young adults like/do not like in vaping cessation apps and how we can incorporate immersive technology, like augmented reality, into these apps to support better young people who vape in their quitting journey. Participants who complete the full study will receive a $50 e-gift card (ex, Amazon, Lululemon, Apple, BestBuy, Starbucks) for their time! Please answer the following questions to see if you qualify: Q1 Are you between 16 to 24 years old? o Yes (1) o No (2) Skip To: Q3 If Q1 = No Q33 Do you live in Canada? o Yes (1) o No (2) 126 Q2 Are you proficient in written and spoken English? o Yes (1) o No (2) Skip To: End of Block If Q2 = No Q31 Do you have access to a stable high-speed internet connection? o Yes (1) o No (2) Skip To: End of Block If Q31 = No Q6 Do you vape? o Yes (1) o No (2) Skip To: End of Block If Q6 = No Q7 Are you motivated to quit vaping? o Yes (1) o No (2) Skip To: End of Block If Q7 = No 127 Q3 If you answered No to any of the above questions, we thank you for your time and interest in our project. If you answered Yes to all of the questions, please continue forward to learn more! Page Break Info You have met the inclusion criteria for participation in our study! Emerging research shows that many young Canadians who vape are now seeking support to quit vaping, and we want to help! Who are we? A group of researchers at the University of British Columbia Okanagan Campuses led by Dr. Laura Struik and Masters of Nursing student Karlee Fonteyne. What are we doing? Our study aims to collaborate with youth and young adults interested in quitting vaping to identify the strengths and limitations of existing vaping cessation smartphone applications and explore the potential for incorporating an augmented reality (AR) feature. If you choose to be part of this study, you will be invited to participate in an online interview or focus group session at a time that best suits you. The online interviews will be held via UBC-licensed Zoom from servers in Canada, and the recordings will be done directly on the researcher’s device. The interviews will take between 50-60 minutes. To give you an idea of the types of questions that will be asked, two examples are provided: Have you used a vaping cessation app before, and what features did you like the most? Would this augmented reality feature help you in your cessation journey? You will also be asked to fill out a questionnaire with some demographic and general questions about your vaping experiences. You will receive a $50 e-gift card to thank you for contributing to this study. Vendors include Amazon, Starbucks, Tim Hortons, PC Optimum, Walmart, Lululemon, and EB Games. If you are still interested, please continue forward to learn more and sign the consent form! End of Block: Study Information Start of Block: Consent Form 128 Consent Form Information & Consent Q35 Your consent statement means: • You understand the nature of this study. • You consent to participate in this study. • You consent to have your participation audio recorded. If you agree, please type your full name and sign. ________________________________________________________________ Q34 Signature: Q39 Please indicate the email you wish to be contacted at: ________________________________________________________________ End of Block: Consent Form Start of Block: Demographics Survey Q9 Almost done... this last part is to help us learn more about you and the trends in youth and young adult vaping. Please answer honestly! All of your responses will be kept confidential. Q10 What sex/gender do you identify as? o Male/man o Female/woman o Non-binary / third gender o Prefer not to say o Other (please specify):_________________________________ 129 Q11 What age are you in years? ________________________________________________________________ Q12 Which of the following best describes you? (select all that apply) ▢ Indigenous ▢ White/European ▢ Black ▢ Asian ▢ Hispanic ▢ Native Hawaiian or Pacific Islander ▢ Do not know ▢ Other (please specify):_______________________________ ▢ Prefer not to answer Display this question: If Q12 = Indigenous 130 Q13 Indigenous Identity (select all that apply): ▢ First Nations ▢ Metis ▢ Inuit ▢ Prefer to self-describe (please specify):_______________________ ▢ Prefer not to answer Q37 Are you a member of the LGBTQIA2S+ community? o Yes o No o Prefer not to say Q14 What province or territory do you reside in? o British Columbia o Alberta o Saskatchewan o Manitoba o Ontario o Quebec o Newfoundland and Labrador o New Brunswick o Nova Scotia 131 o Prince Edward Island o Yukon o Northwest Territories o Nunavut Q16 What is your highest level of education? (This includes what you may currently be enrolled in) o Less than high school o High school graduate o Trade o 2 year degree o 4 year degree o Professional degree o Doctorate Page Break Q17 The next two questions ask about belonging to these categories because our individual experiences may shape our thoughts and experiences about accessibility and support. 132 Q18 Do you identify with having any of the following (select all that apply): ▢ Anxiety ▢ Attention-Deficit/Hyperactivity Disorder (ADHD) ▢ Autism ▢ Eating disorder ▢ Mood disorder ▢ Obsessive-Compulsive Disorder (OCD) ▢ Post-Traumatic Stress Disorder (PTSD) ▢ Other (please specify):___________________________________ ▢ Prefer not to answer Page Break Q20 How long have you been vaping? o Less than a month o Between 1-6 months o Between 6 months to a year o Greater than a year o Greater than 3 years 133 Q25 How often do you vape? o Several times per day o About once per day o A few times per week o Once per week or less Q26 How many times have you tried to quit vaping? o I have not tried to quit before o 1-4 times o 5-10 times o More than 10 times Q27 What is your primary motivation for quitting vaping? o Health concerns o The financial costs of vaping o Pressure to quit vaping from family, significant other, or friends o Change in perception about vaping; it is ‘not cool’ o Tolerance break o Other (please specify):_________________________________ Q28 What strategies have you used to help quit vaping (select all that apply)? ▢ Gradual reduction ▢ Cold turkey 134 ▢ Tolerance breaks ▢ Nicotine Replacement Therapy (NRT) (ex: nicotine patches, gum, lozenges, or inhalers) ▢ Pharmacotherapy (ex: bupropion (Zyban) or varenicline ((Chantix)) ▢ Vaping cessation smartphone applications ▢ Text-messaging based intervention ▢ Social support groups (in-person or virtual) ▢ Professional counselling ▢ Alternative Therapies (ex: acupuncture, hypnotherapy, or mindfulness-based techniques) ▢ Other (please specify):_____________________________________ Display this question: If Q28 = Vaping cessation smartphone applications Q29 What vaping cessation app(s) did you/do you currently use? (Select all that apply) ▢ Kwit ▢ Quash ▢ Stop Vaping Challenge ▢ Crush the Crave - Vape Edition ▢ Quit Vaping 135 ▢ Quit Vaping for Good ▢ Quit Vaping Addiction Calendar ▢ Aeris ▢ Escape the Vape ▢ Quit Genius ▢ No Vape ▢ Smoke Watchers ▢ Smokler ▢ Other (please specify):________________________________ Q21 Do you also use any of the following substances? (Select all that apply) ▢ Cannabis products ▢ Combustible tobacco cigarettes or cigars ▢ Chewing tobacco (ex: snus) ▢ Other nicotine-based products (ex: nicotine spray, nicotine pouches- Zyn, Velo, etc.) (4) ▢ Recreational drugs ▢ Other (please specify):__________________________________ ▢ I do not use anything else 136 ▢ Prefer not to answer Q30 How long did you use/have you been using vaping cessation app(s)? o Less than 1 month o 1-3 months o 3-6 months o Over 6 months Page Break Q22 Are you familiar with augmented reality (AR) technology? o I have no idea what this is o I know a little bit about AR and how it can be used o I have a firm grasp of immersive technologies, including AR End of Block: Demographics Survey Start of Block: Block 4 Q38 Would you rather be a part of an online focus group session (2-5 people) or participate in an online individual interview with the researcher? o Focus group o Individual interview End of Block: Block 4 137 138 Appendix F Consent Form (Embedded in Qualtrics Survey) Project Title: Youth and Young Adult-Driven Augmented Reality for Vaping Cessation Project Leads: This study is being directed by Dr. Laura Struik (UBC Okanagan - School of Nursing, Assistant Professor), Karlee Fonteyne (UBC Okanagan – School of Nursing, Masters Student), Dr. Elizabeth Keys (UBC Okanagan - School of Nursing, Assistant Professor) and Dr. Mohammad Khalad Hasan (UBC Okanagan – Computer Science, Assistant Professor). What is the study about? We want to understand the perceptions of Canadian youth and young adults (YYA) who are currently interested in quitting vaping or have previously tried to quit vaping. We want to know how vaping cessation app usage has impacted cessation journeys. We are especially interested YYA opinions on incorporating augmented reality (AR) features into an app to help quit vaping. We are looking for youth who are 16-24 years old. Why is this important? Learning from the real-world experiences of YYA who want to quit vaping will help guide researchers and clinicians to develop tools, such as apps, designed for young people. Why have you been invited to participate? Emerging research shows that many young Canadians who vape are now seeking support to quit vaping, and we want to help. We are looking for Canadians between the ages of 16-24 who are motivated to quit vaping. The following pages explain the study so that you can decide whether you want to participate. Do you have to be in the study? It is up to you if you want to be in this study. Your participation is voluntary. You have the right to refuse to participate in this study. If you decide to participate, you may still choose to withdraw from the study at any time without any negative consequences. Note that due to the conversational nature of the recorded focus group sessions, it may not be possible to redact 139 your contributions to the discussion if you choose to withdraw. Please take time to read the information in this consent form carefully before you decide. If you want to participate in this study, you will be asked to provide informed consent. The researchers will only enroll you in the study if you agree. What will happen to you in this study? If you choose to be part of this study, you will be invited to participate in an online interview or focus group session at a time that best suits you. The online interviews will be held via UBC-licensed Zoom from servers in Canada, and the recordings will be done directly on the researcher’s device. The interviews will take between 50-60 minutes. To give you an idea of the types of questions that will be asked, two examples are provided: • Have you used a vaping cessation app before, and what features did you like the most? • Would this augmented reality feature help you in your cessation journey? You will also be asked to fill out a questionnaire with some demographic questions and general questions about your usage of a vaping cessation app and those involved in your social network. You will receive a $50 e-gift card to thank you for contributing to this study. Vendors include Amazon, Starbucks, Tim Hortons, PC Optimum, Walmart, Lululemon, and EB Games. How will the study findings be shared? The results of this study will be published in scientific journals, presented at conferences, and shared with the public through community events and online/social media outlets. Please let the researchers know if you want a copy of the results. Can anything bad happen? If you participate in this study, there are no risks greater than what you would experience in your daily life. Are there benefits to participating? There are no known direct benefits to your participation. However, the information you provide will improve understanding of vaping cessation YYA Canadians. This information will help direct further research on vaping cessation and the development of resources that will better assist young people who want to quit vaping. Who will know you are in this study? Our research team will hold any information we obtain from you strictly confidential. No information that discloses who you are will be released or published unless required by law or the ethics board. The information and computer files will be password-protected and 140 stored in an encrypted device and/or file folder. This information will only be accessible to the research team. A code number will be used to identify you. You will not be identified in any reports of this research. All documents (including electronic files, audio tapes and transcriptions) will be retained for at least five years after publication and provided a secure storage location on UBC's Okanagan campus. After this period, they will be destroyed. Please note that due to the group nature of the focus group sessions, there are limits to ensuring the confidentiality of participation and the contents of what was shared. Who do you contact if you have any questions or concerns about your rights as a participant? If you have any concerns or complaints about your rights as a research participant and/or your experiences while participating in this study, contact the Research Participant Complaint Line in the UBC Office of Research Ethics toll-free at 1-877-822-8598 or the UBC Okanagan Research Services Office at 250-807-8832. Contacting the Research Complaint Line by email (RSIL@ors.ubc.ca) is also possible. When calling, please reference the study number (H24-00545) so the Complaint Line staff can better assist you. What if you want more information on the study? If you have any questions or want further information, you may contact Dr. Laura Struik by phone at 250-807-9972 (cell: 250-864-7879) or email at laura.struik@ubc.ca or Karlee Fonteyne by email at karpod@mail.ubc.ca. CONSENT TO PARTICIPATE You may provide consent to participate in this study in one of a few ways: 1. By typing your full name and signing in the Qualtrics Survey. 2. By emailing karpod@mail.ubc.ca with the following statement: “I *insert your full name* am providing consent to participate in the Youth and Young Adult-Driven Augmented Reality for Vaping Cessation Project led by Dr. Laura Struik at the University of British Columbia and have my participation audio recorded by this affirmative response.” 3. By stating your consent during an audio-recorded call with a research team member via Zoom. Your consent statement means: • You understand the nature of this study. • You consent to participate in this study. • You consent to have your participation audio recorded. 141 Appendix G Semi-Structured Interview Guide Project Title: Youth and Young Adult-Driven Augmented Reality for Vaping Cessation Purpose: Invite young Canadians to share their experiences and preferences for designing a vaping cessation app incorporating an AR feature in an individual interview (~50-60 minutes). Preparation (using Zoom for interviews) 1. AV check 2. Recording ready 3. Materials for sharing uploaded 4. Facilitator notes 5. Ensure the Qualtrics survey has been complete by the participants before starting 6. Ensure consent has been received from the participants Welcome/Instructions for Facilitators (5 minutes) Participant will be welcomed to the Zoom call and the interviewer will introduce themselves. Participant will be reminded of the purpose of the study and that participation is voluntary. Identity and permission to record will be confirmed. Participants will be asked if they have any questions before the recording begins and will be encouraged to have their cameras on. Interview questions (~45 minutes) **Start recording here** Interview Focus Questions: Rapport/ Contextualization 1. Have you tried to cut back or quit vaping? What approaches have you tried? What has been more effective for you? 2. What has made quitting hard for you? 3. What has made quitting easier for you? Have you felt supported in your cessation journey? App Likes and Dislikes 4. Have you tried any vaping cessation apps before? a. What apps? b. How long and frequently have you used the app? c. What features on the app kept you coming back? d. What features of the app did you dislike? 142 Provide a brief explanation of AR: AR is a type of immersive technology that overlays digital interfaces upon the user’s real-time and real-life physical surroundings, allowing users to interact with digital content through devices like smartphones, tablets, or AR glasses while still being aware of their surroundings. It is seen in apps like Pokémon Go, Google Map, and Snapchat filters. Interview Focus Questions: Augmented Reality Feature – questions will be posed using the Zoom Whiteboard tool. Participants will be asked to rank suggestions 1 (best) – 5 (worst) with the option to add ‘stick note’ comments and suggestions I am going to describe some possible AR interventions that could be built out to be used on a mobile device. A) Health Effects Visualization: Used as an educational tool, AR can simulate the short-term and long-term health effects of vaping on the user's body. For example, users can see visual representations of how vaping affects their lungs, cardiovascular system, brain, and overall health over time. Users could also see the health benefits of vaping cessation, i.e. how the body heals itself. a. Would you be interested in an AR feature that helps you visualize the health effects of vaping over time b. How would you like this information to be presented? Realistic or animated? AR can be used to visually represent users' progress in quitting vaping by overlaying virtual charts, graphs, or timelines that show their achievements and milestones. c. Where do you currently look for vaping information? B) Interactive Quitting Support: AR can provide interactive support for users trying to quit vaping. For instance, users can access virtual support sessions where they interact with AI generated support in real-time, share their experiences and get encouragement to stay vape-free. a. Would you be interested in accessing virtual support sessions with an AR avatar in real-time to share your experiences and get encouragement? b. Would you prefer the support to be human led or AI? C) Virtual Rewards and Incentives: AR can gamify the quitting process by offering rewards and incentives for reaching vaping cessation milestones. This could look like growing a virtual plant or pet with virtual currency collected from vaping abstinence or completing daily challenges. Users can unlock virtual badges, achievements, or rewards within the app, to purchase virtual goods or access premium features or the rewards could be tangible like coupons or discounts. a. Would you be interested in a feature that tracks your progress and evolves as you reach different milestones like a plant or pet? b. Would you participate in AR-based challenges or competitions with others trying to quit? c. What types of rewards or incentives would you like to see? Would a discounted gym membership be desirable? D) Trigger Identification and Management (Cue Exposure Therapy): AR can help users identify and manage triggers. For example, users can use their smartphone camera to scan common vaping triggers, such as vape products, or shops or social settings where vaping occurs and receive virtual 143 prompts or coping/stress management strategies to resist the urge to vape. Through AR, users can also be exposed to trigger objects (e.g. vaping device) in a controlled virtual environment, allowing them to practice coping strategies and build resilience against cravings. By repeatedly exposing users to triggers in a safe and controlled manner, the app aims to desensitize them to these cues and weaken their association with the urge to vape. a. How would you feel about an AR feature that provides real-time feedback when you feel the urge to vape, such as showing you a calming scene or guiding you through a relaxation exercise? Recommendations – comments can be shared on Whiteboard or outloud 5. Which of these AR features is the most intriguing to you? Why? Go through features individually and discuss 6. How important is it for you to personalize the AR features in the app, such as choosing different avatars, environments, or scenarios? 7. Would you like AR features that allow you to interact with friends or a support group within the app? 8. What do you think the limitations would be with an AR based app feature? Do you have any concerns? 9. What would make you want to continue using an AR-based app for vaping cessation over time? 10. What might cause you to lose interest? 11. Are there any additional features that you would like within or external to the app to support you in quitting vaping? Closing: Final comments (5 minutes) Thank you for joining me today and helping us understand more about the experiences of young Canadians using vaping cessation apps and how an AR feature could be incorporated. This information will help in the development of helpful cessation apps and help produce resources that support YYA like you with quitting vaping. We are at the end of this session, but do you have any final thoughts you would like to share before we leave? **Stop recording here** 144 Appendix H Email Template for Participant Communication Hello, We have you scheduled for an interview on ______________________. Please use the attached Zoom link to access the meeting: _______________________. (password: ____________) As our study focuses on the potential uses of augmented reality (AR) for vaping cessation, we wanted to ensure you know a little about the technology. AR for mobile phones is a technology that adds digital elements, like images, animations, or information, onto the real world through your phone's camera. Imagine pointing your phone at something and seeing extra things on your screen that aren't really there—like a virtual character walking around your living room or text labels popping up on a landmark. AR makes it seem like these digital items are part of the real world, enhancing what you see with extra layers of fun or useful information. We recommend downloading free apps like PokemonGO that use AR to familiarize yourself with the technology ahead of your session. Filters like those seen on Snapchat and TikTok also utilize AR. Here are some additional links that provide an overview of the technology: • https://youtu.be/IFgGzOpjlUM?si=nPxxP8LstMwfmbiG (AR vs. VR vs. MR) • https://youtu.be/XPNUmcEOYW0?si=9QPYTCkYzEEhpFWe (AR in 60 seconds) Please contact this email in the meantime if you have any questions or need to reschedule your interview session. Looking forward to chatting with you! Kindly, Karlee Karlee Fonteyne, RN, BScN Master of Science in Nursing Student | Research & Teaching Assistant Faculty of Health & Social Development | School of Nursing The University of British Columbia | Okanagan Campus | Syilx Okanagan Nation Territory 145 Appendix I Zoom Whiteboard Activity Example Note. Example of whiteboard activity showing an explanation of possible AR feature examples with visual representation and student ranking of the proposed AR features. Each student participated in this whiteboard activity during their Zoom interview session and a screenshot was retained.
Thesis/Dissertation
eng
Nursing
Vancouver : University of British Columbia Library
Attribution-NonCommercial-NoDerivatives 4.0 International
Graduate
Struik, Laura
Youth and young adult perspectives on augmented reality-driven vaping cessation interventions : an Interpretive description study
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