Digital gamification and serious games for preventing e-cigarette use in adolescents: A systematic review without
Siti Idayu Hasan1,2,3, Ruthashini R Selvasingam1, Farizah Mohd Hairi1,3
1Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Introduction:
Adolescent e-cigarette use has reached alarming levels worldwide, creating a major public health concern. Digital gamification and serious games have emerged as an innovative approach to engage youth in e-cigarette prevention through interactive and immersive technologies. However, existing reviews on gamification and serious games for health have not specifically examined theoretical frameworks or behavioral outcomes in digital gamification for e-cigarette prevention among adolescents. This systematic review aims to assess the effectiveness of digital gamification and serious game interventions for e-cigarette prevention in adolescents and to identify the theoretical foundations underlying these interventions.
Methods:
Eight electronic databases were searched (MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, Education Research Complete, Scopus, PubMed, Web of Science, and Google Scholar) up to 25 October 2025. Inclusion criteria covered randomized and nonrandomized studies involving adolescents (aged 10-19 years) using digital gamification and serious games for vape prevention or cessation. Study quality was assessed and a narrative synthesis was conducted.
Results:
Twelve studies met the inclusion criteria. Most reported improvements in knowledge, risk perception, and self-efficacy among adolescents. Theoretical frameworks included the Theory of Planned Behavior, Social Cognitive Theory, and the Attention, Relevance, Confidence, and Satisfaction motivation model. Study quality ranged from weak to strong.
Conclusions:
Digital gamification and serious games show promise in supporting e-cigarette prevention among youth. Interventions grounded in behavioral theory and incorporating social and motivational elements are most effective.
