Free SMS program helps teens quit smoking e-cigarettes

A randomized, double-blind trial found that adolescent e-cigarette users who participated in a free text-message cessation program were 35% more likely to quit smoking seven months later.

In the study of more than 1,500 teenagers, 38% of participants in the This Is Quitting program reported abstinence at the 7-month follow-up, compared with 28% of participants in a control group (relative risk 1.35, 95% CI 1.17-1.57, P

It is the first randomized trial to demonstrate an effective intervention to help adolescents quit e-cigarettes, reported the authors, who detailed the results in JAMA.

They found that the interactive, youth-tailored program demonstrated consistent benefits across all subgroups, including teens with severe nicotine dependence and those with mental health problems.

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

“We also saw no evidence that youth who quit vaping transitioned to smoking,” she continued. “The intervention was effective in reducing dual use (smoking and vaping) and preventing youth in this study from starting smoking.”

53% of participants in the intervention group reported double abstinence after 7 months, compared with 35% of the control group (P

“It may be that changes in one form of tobacco use (e.g., cessation of vaping) had a positive impact on other tobacco use behaviors (e.g., decisions to refuse or quit CTPs (combustible tobacco products),” the researchers suggest in their article, adding that “there is no evidence that adolescents who quit vaping switched to CTPs.”

The automated program sends users messages that focus on the risks of vaping and the benefits of quitting. The messages are written based on the participant’s age, planned quit date, and brand of e-cigarette. For example, it offers a possible response such as “I don’t use JUUL at all anymore.” This Is Quitting also sends information about nicotine replacement therapy and can offer mental health support, among other things.

According to data from the 2023 National Youth Tobacco Survey, 10% of all high school students and 5% of middle school students in the United States reported using an e-cigarette in the past month – the most common form of tobacco use among these age groups.

Although they are considered less harmful than traditional cigarettes and serve as a potential smoking cessation tool for adult smokers, e-cigarettes can contain various toxic substances and high concentrations of the addictive nicotine and have been associated with various health effects.

Studies show that many teens who smoke e-cigarettes would like to quit – primarily for health reasons – but find it difficult to do so, wrote Dr. Bonnie Halpern-Felsher of Stanford University in California in an accompanying editorial.

No nicotine replacement therapies are approved by the FDA for anyone under 18, she said, but doctors often prescribe them to teens outside of approved indications, according to recommendations from the American Academy of Pediatrics. Therefore, Halpern-Felsher said, it is imperative that interventions are tailored to teens who vape, which is what makes the current study findings “so important.”

“This Is Quitting uses key proven methods when it comes to intervention programs for youth,” she wrote. “These include being free and accessible via mobile phone, being evidence-based and theory-based, being tailored to youth based on where they are in terms of age, quit date and type of e-cigarette use, and empowering youth to quit smoking.”

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

The current study by Graham’s group randomized 1,501 adolescents ages 13 to 17 recruited through social media to either the texting intervention or a control group – in which only participants’ smoking habits were tracked via text message. To be eligible, people had to report having vaped in the past month, be interested in quitting, and have a texting-capable cell phone.

Regardless of study assignment, participants received gift cards and could receive up to $95 in total for participating in the study if they responded at various time points. Response rates decreased from 83% at one month to 71% at seven months, with no difference between groups.

The primary outcome measure of the study, assessed at 7 months, was self-reported 30-day abstinence from vaping in the intent-to-treat population, with missing responses recorded as continued vaping.

The average age of participants was 16 years, with 51% identifying as female, 42% male, and 7% nonbinary; 43% identified as LGBTQ+. The study population was 63% White, 19% multiracial, and 10% Black, with 16% of the population being of Hispanic descent.

The participating teenagers were highly addicted, according to the authors. Three-quarters began vaping within 30 minutes of waking up, 94% reported feeling somewhat or very addicted, and 87% had tried to quit smoking in the year prior to participating.

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 the fact that changes in cannabis or alcohol use were not examined in this publication.