Effectiveness of a Vaping Cessation Text Message Program Among Young Adult e-Cigarette Users

Abstract

IMPORTANCE e-Cigarettes are the most commonly used tobacco product among young adults (YAs). Despite the harms of nicotine exposure among YAs, there are few, if any, empirically tested vaping cessation interventions available.OBJECTIVE To determine the effectiveness of a text message program for vaping cessation among YAs vs assessment-only control. DESIGN, SETTING, AND PARTICIPANTSA parallel, 2-group, double-blind, individually randomized clinical trial was conducted from December 2019 to November 2020 among YA e-cigarette users. Eligible individuals were US residents aged 18 to 24 years who owned a mobile phone with an active text message plan, reported past 30-day e-cigarette use, and were interested in quitting in the next 30 days. Participants were recruited via social media ads, the intervention was delivered via text message, and assessments were completed via website or mobile phone. Follow-up was conducted at 1 and 7 months postrandomization; follow-up data collection began January 2020 and ended in November 2020. The study was prespecified in the trial protocol. INTERVENTIONS All participants received monthly assessments via text message about e-cigarette use. The assessment-only control arm (n = 1284) received no additional intervention. The active intervention arm (n = 1304) also received This is Quitting, a fully automated text message program for vaping cessation that delivers social support and cognitive and behavioral coping skills training. MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 7 months analyzed under intention-to-treat analysis, which counted nonresponders as vaping. Secondary outcomes were 7-day ppa under intention-to-treat analysis and retention weighted complete case analysis of 30-day and 7-day ppa. RESULTSOf the 2588 YA e-cigarette users included in the trial, the mean (SD) age was 20.4 (1.7) years, 1253 (48.4%) were male, 2159 (83.4%) were White, 275 (10.6%) were Hispanic, and 493 (19.0%) were a sexual minority. Most participants (n = 2129; 82.3%) vaped within 30 minutes of waking. The 7-month follow-up rate was 76.0% (n = 1967), with no differential attrition. Abstinence rates were 24.1% (95% CI, 21.8%-26.5%) among intervention participants and 18.6% (95% CI, 16.7%-20.8%) among control participants (odds ratio, 1.39; 95% CI, 1.15-1.68; P < .001). No baseline variables moderated the treatment-outcome relationship, including nicotine dependence.CONCLUSIONS AND RELEVANCE Results of this randomized clinical trial demonstrated that a tailored and interactive text message intervention was effective in promoting vaping cessation among YAs. These results establish a benchmark of intervention effectiveness.

Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study

“…This program offers young people a minimum of 4 weeks of messages tailored to age and a resettable quit date, which are focused on skills and confidence building [ 37 ]. Results from a randomized control trial revealed that this program achieved 30-day point prevalence abstinence of 24.1% at 7 months compared with the control (18.6%) [ 12 ], adding support to our findings in relation to the value of personalization and positive-message framing. Our findings also suggest that there is an appeal among users for gamification and behavioral self-monitoring when it comes to e-cigarette interventions.…”

“…Given the popularity of smartphones among young adults [ 10 ], a few mobile-based interventions are now on the market. One of them includes an SMS text messaging intervention to promote e-cigarette cessation among young adults [ 11 ], for which preliminary evidence in relation to user engagement and effectiveness is promising [ 11 , 12 ].…”

Intentions and Attempts to Quit JUUL E-Cigarette Use: The Role of Perceived Harm and Addiction

“…A pilot trial showed promise for nicotine replacement therapy, tapering use, and self-guided methods for e-cigarette cessation among young adults ( 26 ). A randomized clinical trial among more than 2,000 young adult e-cigarette users found better cessation rates in a text-messaging program (24.1%) than in an assessment-only control condition after 7 months (18.6%) ( 27 ). The cessation program, This is Quitting, used a combination of social support and cognitive and behavioral coping skills training conducted entirely through text messages ( 27 ).…”

“…A randomized clinical trial among more than 2,000 young adult e-cigarette users found better cessation rates in a text-messaging program (24.1%) than in an assessment-only control condition after 7 months (18.6%) ( 27 ). The cessation program, This is Quitting, used a combination of social support and cognitive and behavioral coping skills training conducted entirely through text messages ( 27 ). Among our sample, those who attempted to quit primarily did it “cold turkey” and almost half of those who attempted reported that cessation lasted less than a month.…”

Shared Decision-Making Model for Adolescent Smoking Cessation: Pilot Cohort Study

“…These studies did not mention shared decision making; however, similar concepts and strategies could be taken into consideration. Two studies regarding adolescent smoking cessation using text message and smartphone apps showed a positive effect and a cessation rate of 31% using an interactive, supportive, self-motivating design, which are important features [18,19]. A recent systematic review highlighted the principles and effectiveness of multiple behavioral interventions and personalized counseling, which are also important in our SDM model [17].…”