- The COVID pandemic has led to reduced overall prevalence of teen vaping, but a remaining population of teens who are highly addicted to nicotine.
- There’s an opportunity now to focus on providing teens with the tools, information, and support they need to reduce or quit vaping.
- Technology-based interventions that have been helping teens quit smoking may be applied to help teens to quit vaping as well.
- Adding a social component to tech-based quit vaping interventions may add benefit for teens.
This summer, I listened to The Vaping Fix podcast. It tells the story of the rise and controversy around the company Juul and the personal story of its founders, who went from Stanford design students to tobacco-industry sellouts. As a researcher in teen substance use, including vaping, this was a story I had heard many times before; as a psychologist and a mom, the story left me newly fired up about how to combat vaping now that teens are returning to school in person, some for the first time in over a year.
The current situation
Pre-COVID vaping rates were alarmingly high. As of the 2020 National Youth Tobacco Survey, nearly 20% of high school students and nearly 5% of middle-schoolers reported past month e-cigarette use. The pandemic brought teens inside, which limited social contact and exchange in numerous detrimental ways; but it also limited teens’ access to vaping in social situations which is the most common context for starting use. Restricted pandemic conditions afforded an opportunity for some young people to cut down or quit vaping, and for others frequency increased, likely reflecting the strong addictive potential of vaping. What we have now is a reduced overall prevalence of teen vaping, which is great, but a remaining population of teens who are highly addicted to nicotine.
With kids returning to school in person, the variable of social exchange returns, and with the highly transmissible COVID delta variant blazing through communities, yet another vaping hazard is on the table. A study conducted in the first few months of the pandemic found that e-cigarette use was associated with COVID diagnosis among adolescents and young adults. There’s an opportunity now to focus on providing teens with the tools, information, and support they need to reduce or quit vaping.
We’re in a moment of transition right now where a lot of kids are making decisions, consciously or unconsciously, about who they are going to be in this next chapter. The return to school is a timely vehicle for cessation support. Teens want to quit now. Young people have repeatedly cited health as one of the main reasons they want to quit, and the perceived risk of vaping went up during the pandemic. This moment, before the inertia and routines of school life take hold, presents a critical opportunity for teens to quit or reduce their vaping. And schools can help.
Tech. Technology-based interventions that have been helping teens quit smoking may be applied to help teens to quit vaping as well. For example, in a randomized clinical trial of the text message-based program, This Is Quitting, young adults ages 18-24 who used the tool had vaping quit rates nearly 30% higher than those in a control group. The study was large (n=2588) and used a “fully automated text message program” that incorporated both social support and cognitive and behavioral coping skills training. Benefits of text message interventions include that they are easy to access and deliver and don’t require much lift from teens to participate.
Social. Adding a social component to tech-based quit vaping interventions may add benefit for teens. During the pandemic, young people reported that social tools have been “very important” for staying connected. The quality of online relationships can be extremely rich and supportive: A 2018 study found that, among adolescents, the core qualities of friendship — self-disclosure, validation, companionship, instrumental support, and conflict resolution — persist online. And while parents and teachers may have hard-earned wisdom and advice to dispense, adolescents often look to their peers for support, because it’s mainly their peers who are navigating similar life experiences.
In addition to peer support, I’ve seen in my own research that person-focused support like direct coaching can further boost cessation program efficacy. Outcomes from our Facebook cessation intervention, the Tobacco Status Project, found that live coaching independently predicted quitting over and above the rest of the social media intervention. This finding directly influenced Quit the Hit, an Instagram-based vaping cessation program developed by Hopelab and Rescue Agency, featuring both peer support groups and live coaching.
Teens may not be turning to parents or teachers directly for advice on how to navigate peer pressure or quit vaping, but that doesn’t mean there’s nothing we can do. Now is a great time for parents to start conversations with their middle- and high-schoolers as they head back to class. And mental health providers can direct parents to support resources for both themselves and their children. Schools can also bring digital cessation support programs into their community, meeting kids where they are (or where they are about to be), and give them access to an evidence-based toolkit that may not otherwise know was out there.
If we respond now, we have an opportunity to make a dent in the vaping problem before it gets worse. We’re in a moment of transition, and kids are paying attention.
Amato, M. S., Bottcher, M. M., Cha, S., Jacobs, M. A., Pearson, J. L., & Graham, A. L. (2021). “It’s really addictive and I’m trapped:” A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addictive Behaviors, 112, 106599. https://doi.org/10.1016/j.addbeh.2020.106599
Gaiha SM, Lempert LK, Halpern-Felsher B. Underage Youth and Young Adult e-Cigarette Use and Access Before and During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open. 2020;3(12):e2027572. doi:10.1001/jamanetworkopen.2020.27572
Smith TT, Nahhas GJ, Carpenter MJ, et al. Intention to Quit Vaping Among United States Adolescents. JAMA Pediatr. 2021;175(1):97–99. doi:10.1001/jamapediatrics.2020.2348
Stokes AC. Declines in Electronic Cigarette Use Among US Youth in the Era of COVID-19—A Critical Opportunity to Stop Youth Vaping in Its Tracks. JAMA Netw Open. 2020;3(12):e2028221. doi:10.1001/jamanetworkopen.2020.28221
Thrul J, Meacham MC, Tice C, Kelly O, Ramo DE. Live counselor contact in a Facebook intervention predicts smoking cessation outcomes. Psychol Addict Behav. 2020 Mar;34(2):360-369. doi: 10.1037/adb0000541. Epub 2019 Dec 12. PMID: 31829664; PMCID: PMC7453643.
Wang TW, Neff LJ, Park-Lee E, Ren C, Cullen KA, King BA. E-cigarette Use Among Middle and High School Students — United States, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1310–1312. DOI: http://dx.doi.org/10.15585/mmwr.mm6937e1
Yau, J.C., Reich, S.M. Are the Qualities of Adolescents’ Offline Friendships Present in Digital Interactions?. Adolescent Res Rev 3, 339–355 (2018). https://doi.org/10.1007/s40894-017-0059-y