A Vaping Cessation Text Message Program for Adolescent E-Cigarette Users: A Randomized Clinical Trial

Abstract

Importance: E-cigarettes are the most commonly used tobacco product among adolescents. Despite known harms of nicotine exposure among teens, there are no empirically tested vaping cessation interventions.

Objective: To compare the effectiveness of a text message program for nicotine vaping cessation among adolescents with assessment-only control.

Design, setting, and participants: A parallel, 2-group, double-blind, individually randomized clinical trial with follow-ups at 1 and 7 months after randomization was conducted from October 1, 2021, to October 18, 2023. Participants were recruited via social media ads; the intervention was delivered via text message; and assessments were completed online or by telephone. Eligible individuals were US residents aged 13 to 17 years who reported past 30-day e-cigarette use, were interested in quitting within 30 days, and owned a mobile phone with an active text message plan. To optimize study retention, all participants received monthly assessments via text message about e-cigarette use.

Interventions: Assessment-only controls (n = 744) received only study retention text messages. Intervention participants (n = 759) also received an automated, interactive text message program for vaping cessation that delivers cognitive and behavioral coping skills training and social support.

Main outcomes and measures: The primary outcome was self-reported 30-day point-prevalence abstinence from vaping at 7 months analyzed as intention-to-treat, with missingness coded as vaping.

Results: Among n = 1503 adolescents randomized, average age was 16.4 (SD, 0.8) years. The sample was 50.6% female, 42.1% male, and 7.4% nonbinary/other; 10.2% Black/African American, 62.6% White, 18.5% multiracial, and 8.7% another race; 16.2% Hispanic; 42.5% sexual minority; and 76.2% vaped within 30 minutes of waking. The 7-month follow-up rate was 70.8%. Point-prevalence abstinence rates were 37.8% (95% CI, 34.4%-41.3%) among intervention participants and 28.0% (95% CI, 24.9%-31.3%) among control participants (relative risk, 1.35 [95% CI, 1.17-1.57]; P < .001). No baseline variables moderated the treatment-outcome relationship. There was no evidence that adolescents who quit vaping transitioned to combustible tobacco products.

Conclusions and relevance: A tailored, interactive text message intervention increased self-reported vaping cessation rates among adolescents recruited via social media channels.

Trial registration: ClinicalTrials.gov Identifier: NCT04919590.

Figure.. Recruitment, Randomization, and Participant Flow in a Randomized Trial of a Text Message Vaping Cessation Intervention for Adolescent E-Cigarette Users

Figure depicts 2 main trial groups (This is Quitting, assessment-only control; total sample n = 1503) and a third group (waitlist control), which was included to provide context for assessment-only control. Recruitment to waitlist control was stopped early due to budget constraints.