E-cigarettes are the most commonly used tobacco products among teenagers, with over two million middle and high school students reporting their use. Nicotine exposure can adversely affect memory, learning, and attention span, as well as increase the risk of respiratory illness due to inhaled toxins, as well as mental illness and substance abuse.

A recent paper published in the Journal of the American Medical Association (JAMA) examines the effectiveness of a quitting program targeting teenagers that relies on text messaging.

Study: A vaping cessation text message program for adolescent e-cigarette users: a randomized controlled trial. Image Credit: Mariia Masich / Shutterstock.com

About the study

The current double-blinded randomized control trial (RCT) included teenagers between 13 and 17 years of age who reported using vapes and wanting to quit within the past month. Social media was used for recruitment.

At 14 days, all participants received text messages for self-assessment in the assessment-only arm. If answered, each message was worth $5.

The intervention arm used a free, nationally promoted initiative called ‘This is Quitting. ‘ This initiative is an interactive automated program for young people built on social cognitive theory.

Since its inception in January 2019, over 247,000 teenagers have participated in ‘This is Quitting. ‘ The program’s various features are specific to each user, including age, date of entry, quit date, and vape brand.

In the intervention arm, confidence- and skill-building messages were sent for four weeks if the user did not set a quit date. If a quit date was selected, users received messages from six weeks before to eight weeks after the quit date. These messages reinforced the benefits of their decision and the risks of vaping.

Users were also taught how to build their own inner strength and coping skills and provided with encouraging and supportive text messages. Training in self-care, mindfulness, intentional breathing, and knowledge about the Crisis Text Line was also provided. Education about nicotine replacement therapy and encouragement to discuss it with healthcare providers were also included.

What did the study show?

A total of 1,681 individuals were included in the study, 759 and 744 of whom were randomized to the intervention and assessment arms, respectively. There were 178 individuals in the waitlist control arm.

All study participants were vapers, 33% of whom also used cigarettes, whereas 75% reported using marijuana. Between 10 and 15% of study participants used nicotine pouches and cigars of various sizes.

The average age of the study cohort was 16.4 years, with a median of 30 vaping days each month. Most study participants reported a strong desire to quit but lower confidence that it was possible. Over 87% of the study cohort attempted to quit over the last year, whereas 53.4% tried quitting three or more times.

The target group had an unexpectedly large proportion of sexually diverse individuals, as well as those with severe psychological problems, including substance use, moderate to high dependence on vaping, and addiction to vaping. Loneliness was also frequently reported, with 95% of the participants being at intermediate to high risk of toxic stress.

Response rates

At one month, 83% of study participants responded to the text messages. At seven months, there was no significant difference, with a response rate of 71% in the intervention group as compared to 68.6% and 74% in the assessment-only and waitlist control groups, respectively.

Quitting rates

The analysis at seven months showed a 35% increase in quitting rates as compared to controls. With repeated analyses, the intervention led to twice as high quitting rates as compared to controls.

Dual abstinence

A total of 1,016 participants reported using e-cigarettes and combustible tobacco products (CTP) throughout the study period. About 60% used only vapes, and 40% used both vapes at CTP at the beginning of the study.

At the end of the study period, 44% of study participants reported dual abstinence, whereas 32% and 20% used only vapes or both products, respectively. About 24% of study participants used CTP in the last 30 days, a reduction of 17 percentage points.

In the intervention group, 53% quit both e-cigarettes and vapes, which reflected an 18% reduction from 35% of controls. Dual abstinence rates increased to 54% and 51% among only-vape and dual users in the intervention group, respectively, as compared to 38.6% and 30% among controls.

Conclusions

The significant treatment effect against this backdrop underscores the power of a digital behavior change intervention to drive clinically meaningful outcomes.”.

The study findings demonstrate the effectiveness of a customizable, interactive, scalable, and inexpensive text message program targeting adolescents who want to quit vaping. The program achieved a 35% higher vaping cessation rate, irrespective of nicotine dependence, mental illness, or poor psychosocial conditions, as compared to controls.  

The success rate of this program exceeds those achieved by most smoking cessation programs among teenagers and young adults. Some of the different factors that may have contributed to this outcome include the coronavirus disease 2019 (COVID-19) pandemic and the rise in quitting intentions due to nationwide campaigns to prevent vaping.

Posters and notices in patient waiting rooms and clinics may spread awareness of these types of programs and encourage teenagers to join if they want to quit. Healthcare providers should also ask their teen patients about vaping and offer such interventions.