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Adolescent e-cigarette users enrolled in a free text-message-based vaping-cessation program were 35% more likely to quit 7 months later, a double-blind randomized trial showed.

In the study of more than 1,500 teens, 38% of the participants assigned to the "This Is Quitting" program reported abstinence at their 7-month follow-up compared with 28% of those in a control group (relative risk 1.35, 95% CI 1.17-1.57, P<0.001), according to researchers led by Amanda Graham, PhD, of the Innovations Center at the Truth Initiative in Washington, D.C.

It's the first randomized trial to demonstrate an effective intervention for helping adolescents quit e-cigarettes, reported the authors, who detailed the findings in .

They noted that the interactive and youth-tailored program showed consistent benefit across subgroups, including teens with high levels of nicotine dependence and those with mental health concerns.

"Healthcare providers, teachers, and parents have been asking how to help teens quit vaping. This study is a critical breakthrough that demonstrates the power of a behavioral intervention for vaping cessation," Graham said in a statement.

"We also did not see evidence that teens who quit vaping transitioned to smoking," she continued. "The intervention was effective in reducing dual use (smoking and vaping) and keeping teens in this study from starting to smoke."

Dual abstinence at 7 months was reported by 53% of those in the intervention group compared with 35% of controls (P<0.001).

"It may be that changes in one form of tobacco use (i.e., vaping cessation) positively affected other tobacco use behaviors (i.e., the decision to reject or quit CTPs [combustible tobacco products])," the researchers suggested in their paper, adding that "there was no evidence that adolescents who quit vaping transitioned to CTPs."

The automated program sends users messages that focus on vaping risks and the benefits of quitting, crafting messages based on a participant's age, planned quit date, and brand of e-cigarette -- offering "I don't JUUL at all anymore," as a potential response, for example. This Is Quitting also sends out information on nicotine-replacement therapy and can give mental health support, among other features.

According to data from the 2023 National Youth Tobacco Survey, 10% of all high schoolers and 5% of middle schoolers in the U.S. said they used an e-cigarette in the past month -- the most common form of tobacco use in these age groups.

While viewed as less harmful than traditional cigarettes and as a potential cessation tool for adult smokers, e-cigarettes can contain various toxic substances, high levels of addictive nicotine, and have been linked with various harms.

Studies show that many teens who vape are interested in quitting -- primarily over concerns about their health -- yet struggle to do so, wrote Bonnie Halpern-Felsher, PhD, of Stanford University in California, in an .

No nicotine-replacement therapies are FDA approved for people under 18, she said, but providers often prescribe them off-label for adolescents, in line with from the American Academy of Pediatrics. As such, said Halpern-Felsher, it's imperative that interventions be tailored to youth who vape, making the current study findings "so important."

"This Is Quitting uses key best practices when it comes to adolescent intervention programs," she wrote, "including being free and available via cell phone; evidence-informed; based in theory; tailored to meet the adolescent 'where they are' with respect to age, quit date, and type of e-cigarette using; and empowers the adolescent to quit."

Since its launch in 2019, over 750,000 young people have used This Is Quitting, according to a from the Truth Initiative, the nonprofit that developed the program. The program has also shown benefit in a of young adults.

The current study from Graham's group randomized 1,501 adolescents ages 13 to 17 years who were recruited via social media to either the text messaging intervention or a control group -- where only participants' smoking habits were assessed over text. To be eligible, the individuals needed to report vaping in the past month, be interested in quitting, and had to own a text-message-capable cellphone.

Regardless of study assignment, individuals received gift card incentives and could receive up to $95 total for participating in the trial by responding at various points. Response rates dropped from 83% at 1 month to 71% at 7 months, with no difference between groups.

Assessed at 7 months, the study's primary endpoint was self-reported 30-day vaping abstinence in the intent-to-treat population, with missing responses marked down as continued vaping.

Average participant age was 16 years, with 51% identifying as female, 42% as male, and 7% as nonbinary; 43% identified as LGBTQ+. The study population was 63% white, 19% multiracial, and 10% Black, with 16% reporting Hispanic ethnicity.

Teens enrolled were highly addicted, according to the authors. Three-fourths vaped within 30 minutes of waking up, 94% said they felt somewhat or very addicted, and 87% had tried to quit in the year prior to enrollment.

Limitations cited by Graham and co-authors included the lack of biochemically verified abstinence, a potential for social desirability bias in the intervention group, and that changes in use of cannabis or alcohol were not assessed in this publication.

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