Text-message interventions significantly reduce vaping among young adults

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A friendly text-message intervention program successfully encouraged young adults to stop vaping. (AP Photo/Richard Vogel)

Young adults were substantially more likely to abstain from smoking e-cigarettes, or vaping, after participating in a free text-message intervention program designed by Truth Initiative, according to a new double-blind, individually randomized clinical trial of the program.

The intervention, This Is Quitting, sends supportive and nonjudgmental messages to young adults to encourage them to stop smoking tobacco. An associated study, published May 17 in JAMA Internal Medicine, is the first to show significant results from a vaping-intervention program. A team from the Truth Initiative, the Mayo Clinic and Brown University surveyed 2,588 young adult users, ages 18 to 24. Half the users served as a control group, and the other half were enrolled in This Is Quitting. After 7 months, 24.1% of participants who received the text-message intervention abstained from e-cigarette use compared with 18.6% of the control.

"While youth e-cigarette use [has] threatened to reverse the progress made on smoking, my crystal ball has me hopeful. Young people want to quit. We know this because scores of young people have enrolled in This Is Quitting over the past two years," lead author Amanda L. Graham, an adjunct professor at both Georgetown University and the Mayo Clinic and innovations chief at Truth Initiative, told The Academic Times. Truth Initiative, a nonprofit dedicated to ending tobacco and nicotine addiction, was named as one of the world's 50 most innovative companies in 2020 by Fast Company.

In what the researchers describe as a concerning trend, e-cigarette use has rapidly increased among young adults in recent years. The U.S. Centers for Disease Control and Prevention found that 9.3% of young adults used e-cigarettes some days or every day in 2019 compared to 5.2% in 2014. In the current study, 82.3% of participants vaped within 30 minutes of waking up.

Vaping can be especially hazardous to teens and young adults because nicotine has been shown to negatively affect brain development, including developmental processes that continue through one's mid-20s. Some of nicotine's harmful direct effects include addiction, a permanent reduction in impulse control and a lower attention span. And while they may look safer than conventional cigarettes, e-cigarettes are still a harmful way to deliver nicotine; aerosols from the vapes have tiny carcinogenic particles that can become lodged in a vaper's lungs.

"Stronger federal policies must be put in place immediately that are clear, comprehensive and consistently enforced. This includes removing all flavored products from the market and closing the loopholes that allow cheap, disposable e-cigarettes to easily get into the hands of young people," Graham said. But until such a policy is in place, other interventions are needed to fight what Graham calls the youth vaping epidemic. That's where This Is Quitting enters the picture.

The texts are designed to sound casual, like they are coming from a friend, to encourage users to trust the program. Additionally, all users can remain anonymous, potentially further increasing their comfort. "Messages [are] written in the first person or as quotes from other users," Graham said. "To help users envision life after quitting, they are instructed to 'Close your eyes. Envision what your life is like without vaping. What's better or different about it? What do you feel like? Reply and tell me.'"

"Teens and young adults are not simply 'small adults.' Their developmental phase, social norms, social context, etc., are entirely different," Graham said. Having spearheaded two other digital programs aimed at tobacco users, she noted that the current one had to mold to the habits of younger users, hence the text-message platform.

Not only is the program designed to inculcate, but it is also flexible, depending on the user's enrollment and quit date. If needed, the quit date can be easily reset via text message. And the program is meant to make quitting as easy as possible, recommending concrete actions that a user can take in their everyday life to leave electronic cigarettes behind — for example, prompts for users to practice refusing an e-cigarette in a social situation. ("Practice — like actually say out loud in front of a mirror at home or in your car — how you'll turn down a JUUL if they offer it to you.")

Aside from examining tobacco use, the researchers also accounted for age, mental health and substance use. The participants were 20.4 years old on average. In addition, the gender split among them was nearly equal; 48.4% of users were male. Unexpectedly, none of these variables were shown to moderate the results from This Is Quitting — not even nicotine dependence. This result, said Graham, underscores the efficiency of the program.

Graham is hopeful for the next generation. "I anticipate that 5 to 10 years from now, vaping rates among teens and young adults are vastly lower, hopefully at rates typical of substance-use experimentation rather than the epidemic levels we see today," she said. Graham thinks that technology is key to getting there.

"When I started my career as an academic researcher, I wanted my science to make a difference in helping people to live healthier lives and not simply sit on a shelf in peer-reviewed journals," she said. Over the past two decades, her impact has been felt across the United States: "I'm proud to have helped shape recent recommendations from the Surgeon General for web and text-message interventions for tobacco cessation," Graham added.

The study, "Effectiveness of a vaping cessation text message program among young adult e-cigarette users," published May 17 in JAMA Internal Medicine, was authored by Amanda L. Graham, Truth Initiative, Mayo Clinic College of Medicine and Science and Georgetown University Medical Center; Michael S. Amato, Truth Initiative and Mayo Clinic College of Medicine and Science; Sarah Cha, Megan A. Jacobs and Mia M. Bottcher, Truth Initiative; and George D. Papandonatos, Brown University.

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