Electronic Cigarette Cessation in Youth and Young Adults: A Case Series

Abstract

Introduction: Electronic cigarette (e-cigarette) usage use has increased exponentially, especially in youth and young adults. For many, the usage of these products results in a severe addiction, one that is difficult to discontinue. Further, e-cigarette cessation is challenging as there are no specific guidelines directing such medical management for patients and their respective clinicians. Here, we report a case series of patients who we are attempting to wean from e-cigarettes with medical guidance. Methods: Six patients who self-reported daily e-cigarette usage and were enrolled in our Tobacco Treatment Clinic (TTC) were followed for 12-months. An inventory of the e-cigarette product and usage was captured, along with responses to identify when the patients experienced majority of their cravings. Co-morbidities, if present, were documented. Documentation of interventions, counseling with or without pharmacological therapies, were captured. Primary outcome was cessation at 6-months. Results: The 6 patients enrolled in clinic ranged in age from 17 to 31 years, with 4 of the patients identifying as males and 2 as females. Patients were using e-cigarettes for 1 to 6 years prior to enrolling into the TTC. As for interventions, all patients received counseling and pharmacological interventions in the form of nicotine replacement therapies (NRTs). Three of the 6 patients were weaned off e-cigarettes by 6-months, with a fourth patient weaned off at the 8-month mark. Variables identified as barriers to cessation included non-compliance with medical regimen and peer influence. Discussion: Here we present a case series of attempting to wean persons from electronic cigarettes use. Given the lack of international guidelines in e-cigarette addiction management, we believe this case series will be of value for clinicians and their patients. Further studies are warranted to help patients with e-cigarette addiction in their attempt at cessation.

Scoping review of guidance on cessation interventions for electronic cigarettes and dual electronic and combustible cigarettes use

“…60 Among the target population categories, youth were the most commonly studied population ( n = 11), 48 – 50 , 52 – 54 , 56 – 60 followed by adolescents ( n = 4) 48 , 51 , 52 , 54 and adults ( n = 2). 55 , 57 …”

“…Of the vaping cessation interventions discussed, behavioural interventions (i.e., 5As approach, motivational interviewing, individual or group counselling, cognitive behavioural therapy, mindfulness approach, “This is Quitting” text messaging program, smokeSCREEN videogame and smartphone apps) were recommended by 10 papers, 48 – 50 , 53 , 54 , 56 – 60 nicotine replacement therapy (NRT) (i.e., nicotine patch, gum, lozenge and spray) by 6 papers, 52 – 55 , 57 , 59 combined behavioural counselling and NRT by 4 papers, 53 , 54 , 57 , 59 non-NRT medications (i.e., bupropion and varenicline) for those aged 17 years and older by 3 papers 53 – 55 and tapering of e-cigarette use by 2 papers 58 , 60 ( Table 1 , Appendix 2). One of the included guidance documents included e-cigarette as a tobacco product and concluded that there was insufficient evidence 61 to assess the net benefit of behavioural counselling and medications as cessation interventions among adolescents.…”

“…This resulted in 13 papers included in the final review. [48][49][50][51][52][53][54][55][56][57][58][59][60] We did not find any publications providing recommendations on complete cessation of cigarettes and e-cigarettes for dual users. Hence, the final 13 papers reflected evidence or current practice recommendations on cessation interventions for exclusive e-cigarette use only (Table 1, Appendix 2).…”

Sarcoidosis Associated With Electronic Cigarette Use in an Adult: A Case Report

“…This motivated her to seek counseling and guidance on her electronic cigarette addiction. During the clinic visit, electronic cigarette addiction management included counseling, motivational interviewing, and transdermal nicotine replacement therapy [ 10 ].…”

A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation

“…However, e-cigarette cessation intervention research has not kept pace with the demand for cessation assistance. The current evidence-base for e-cigarette cessation interventions is largely limited to youth and young adults, and consists of an observational study of treatment-seeking teens and young adults (n=27000) 13 ; several clinical case reports [14][15][16][17] ; a single-arm pilot study (n=8) 18 ; 2 pilot randomized controlled trials (RCT) (n=24; n=27) 19,20 ; and one fully powered randomized controlled trial (RCT) of an automated text message vaping cessation intervention (n=2588) 21 . The fully powered RCT reported higher e-cigarette abstinence rates among young adults (18-24 years) randomized to the intervention than Control (24.1% vs 18.6%) at 7 months post randomization 21 .…”