Intention to Quit Vaping Among United States Adolescents

In 2019, 25.2% of high school students in the US reported current use (ie, past 30 days) and 11.7% reported daily use of electronic nicotine products (ie, e-cigarettes, vaping).⁵ Adolescents who vape are at risk for nicotine addiction, toxicant exposure, and transitioning to cigarettes.^1,2 The development, evaluation, and dissemination of evidence-based vaping cessation interventions for adolescents could be critical to curbing the vaping epidemic; however, vaping cessation interventions are not widely disseminated, and existing programs have received little empirical investigation. It is necessary to assess interest in quitting and quit attempts in this population to drive funding and guide treatment development. Further, understanding interest in quitting among groups that experience tobacco-related health disparities, including sociodemographic minorities and individuals with mental health symptoms, could guide development of treatment programs for specific subgroups. This study estimated interest in quitting and past e-cigarette quit attempts among US adolescents who vape. To our knowledge, this is the first such report.

Data were collected as part of wave 4 of the Population Assessment on Tobacco and Health (PATH) study, a nationally representative, longitudinal survey conducted in the United States. The PATH study protocol was approved by the Westat institutional review board. Parents of participating youth and youth provided written permission and assent, respectively. We focus on the most recent wave of data collection (December 2016 to January 2018), given the recent proliferation of high-nicotine delivery devices.³ The sample included adolescents aged 12 to 17 years who had vaped more than once in their lifetime and at least once in the past 30 days (ie, current vapers), weighted to be representative of all US adolescents who vape. Details on interview procedures, questionnaires, sampling, and weighting are available elsewhere.⁴

We report outcome data for 2 questions: (1) are you seriously thinking about quitting electronic nicotine products? (response options: yes, within the next 30 days; yes, within the next 6 months; yes, within the next year; yes, but not within the next year; no; do not know) and (2) have you tried to completely stop using electronic nicotine products within the past 12 months? (response options: yes; no; do not know). Weighted Ns were used, and analyses accounted for the complex sampling structure of PATH. Results were reported overall as well as by select demographic, tobacco use, and mental health variables (eg, depression symptoms, anxiety symptoms). Data were analyzed using SAS version 9.4 (SAS Institute) and χ² tests examined differences by demographic group in the prevalence of responding yes vs no for each outcome (α = 0.05). Analysis began January 2020 and ended February 2020.

In total, 14 798 youth aged 12 to 17 years completed the survey, of whom 498 (3.6%) had used e-cigarettes in the past 30 days, constituting the analytic sample. Sample characteristics and main outcomes are reported in the Table. Approximately 44.5% reported seriously thinking about quitting. Of those, most reported thinking about quitting within the next 30 days (50.2%), followed by beyond 1 year (22.9%), within the year (16.9%), and within the next 6 months (10.1%). Overall, 24.9% had tried to quit vaping completely within the past year. Motivation to quit and incidence of quit attempts were largely consistent across demographic and smoking history subgroups.

Public health experts have focused on preventing vaping initiation among youth. However, 44.5% of adolescents who vape are seriously interested in quitting and 24.9% tried to quit in the past year, suggesting that vaping cessation interventions are urgently needed. Interest in quitting was of appreciable prevalence across a variety of subgroups. Thus, the development and dissemination of vaping cessation interventions should be disseminated widely, across those with and without demographic and mental health risk factors. For those not interested in quitting, public education campaigns and interventions to increase motivation to quit may be most useful.

Corresponding Author: Tracy T. Smith, PhD, Medical University of South Carolina, 103D Bioengineering Building, 68 President St, Charleston, SC 29425 (smithtra@musc.edu).

Accepted for Publication: March 18, 2020.

Published Online: August 17, 2020. doi:10.1001/jamapediatrics.2020.2348

Author Contributions: Dr Smith had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Smith, Carpenter, Leventhal, Dahne.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Smith, Nahhas, Squeglia, Leventhal, Dahne.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Nahhas, Leventhal.

Obtained funding: Leventhal.

Administrative, technical, or material support: Smith, Dahne.

Supervision: Leventhal.

Conflict of Interest Disclosures: Dr Carpenter reports consulting honoraria from Pfizer outside the submitted work. No other disclosures were reported.

Funding/Support: Salary support was provided by the National Institute on Drug Abuse, the National Cancer Institute, and the National Institute on Alcohol Abuse and Alcoholism (grants K23-DA045766 to Dr Dahne, K01-DA047433 to Dr Smith, K23-AA025399 to Dr Squeglia, U54-CA180905 and K24-DA048160 for Dr Leventhal). This study was supported in part by the Biostatistics Shared Resource, Hollings Cancer Center, Medical University of South Carolina (grant P30-CA138313).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.