So, You Want to Quit Vaping...
If you've ever tried to quit vaping and failed—or just thought about it, but weren't sure where to start—you're not alone. Last year, the FDA started taking action to combat what it calls an “epidemic of addiction” to e-cigarettes and vape products among young people. Fortunately, anyone looking to kick the habit just got a little extra help.
Truth Initiative, the nonprofit public health organization behind those memorable anti-smoking campaigns you grew up with, has launched a first-of-its-kind texting-based tool to help people stop vaping, in addition to a new campaign called Safer ≠ Safe.
“We were starting to see people talking about wanting to quit vaping and struggling with wondering how to go about it, if the same strategies apply, if other people were having trouble, where to go,” Amanda Graham, Ph.D., research investigator and senior vice president of the innovations team at Truth Initiative that developed the new program, tells SELF.
Truth Initiative’s new program is explicitly for people who want to quit vaping.
“Cessation programs have almost all been structured for traditional cigarette users,” Jonathan D. Klein, M.D., M.P.H., an adolescent medicine specialist in the department of pediatrics at University of Illinois Health, tells SELF.
But vape users typically don’t identify themselves as smokers, Edward Trapido, Sc.D., F.A.C.E., professor, chair of cancer epidemiology, and associate dean for research at Louisiana State University New Orleans School of Public Health, tells SELF. So all the quitting campaigns and programs targeted at smokers aren't actually speaking to people who vape.
There are other good reasons for putting vape users in a separate category. For instance, although breaking either habit is hard—given nicotine dependence is the mechanism of addiction associated with both—vaping and smoking are not the same, and neither is quitting them. “Some of the issues associated with addiction to electronic cigarettes definitely are a little different than with regular cigarettes,” Trapido says, including things like vape-users' ages and the social acceptance of their habit compared to smokers. Experts are aware of these unique challenges, and the need for a cessation program accounting for them.
Unlike traditional smokers, vape users get decidedly mixed messaging about the safety of their devices.
While the science on the negative health consequences of conventional tobacco use (e.g. combustible cigarettes) couldn’t be more clear, the jury is still out on the health effects of vaping and e-cigarettes; they simply haven’t been around yet long enough to study them.
But “there’s no question that e-cigarettes are safer than cigarettes,” Donna Shelley, M.D. M.P.H., a professor in the departments of Population Health and Medicine at NYU Langone Health, tells SELF. There is also mounting evidence that e-cigarettes can indeed help some people quit smoking, although we need more research, Dr. Shelley says. Unlike nicotine replacement therapy (NRT) or NRT products such as nicotine patches, gum, and lozenges, e-cigarettes are not an FDA-approved tobacco cessation product.
However, as SELF explained previously, e-cigarettes may have the opposite effect in younger people who are not already smokers, possibly making it more likely that they'll transition to traditional cigarettes.
This positioning of vaping products as a consistently safe alternative has led to some hazy understanding about the potential harms of e-cigarettes and vaping—because in fact vaping makes starting easier and quitting harder. “There's a lot of misinformation and basic information lacking about the fact that these are not benign products,” says Dr. Klein (who is also scientific director of the American Academy of Pediatrics Julius B. Richmond Center of Excellence, a national center dedicated to preventing children's exposure to tobacco). For starters: “Young people especially are not always aware that all vape products contain nicotine, and often in high amounts,” Trapido says.
Understanding the chemical dependence that makes e-cigarettes so highly addicting may prevent teens from starting to vape in the first place, of course—but it’s also a crucial thing to grasp if you’re trying to quit. One Truth Initiative study published in the journal Tobacco Control in April 2018 conducted an online survey assessing Juul perception and usage among 1,012 young adults aged 15 to 24. While 25 percent of the respondents recognized a photo of a Juul, only 25 percent of that subset reported that all Juul products contain nicotine. Among the 8 percent of respondents who reported using a Juul in the last month, only 37 percent said they knew Juul products contain nicotine.
Another big obstacle unique to vaping is how widespread and commonplace it has become. “People know the risks of cigarette smoking," Trapido says, and smokers may have friends or family that look down on their habit. But that’s not the case with vaping, the sheer popularity of which makes it more socially acceptable and difficult to escape from—especially for young people.
“What we've heard from people and seen across social media over and over again is that, because e-cigarette use and Juuling have become so ubiquitous, it's literally in their face constantly,” Graham says. Plus, while you can’t get away with lighting up a cigarette anywhere indoors anymore, vapes are incredibly portable and easily concealed, Trapido points out, so people are using them everywhere. (Even if there are rules or laws against it.)
For the new program, Truth Initiative is tailoring strategies from their existing digital programs for tobacco cessation to those who want to quit vaping.
Here’s how it works: First, you text QUIT to 202-804-9884. Users can also join via Truth Initiative’s other quitting programs, the app This Is Quitting or BecomeAnEX.org. The system replies by asking your age range (or if you’re a parent of someone trying to quit) and giving you the option to enter a quit date.
From there, you’ll typically receive one message a day with specific information and advice (tips to combat withdrawal symptoms, for instance), with options to reply asking for more info, as well as more frequent messages as your quit date approaches. “It’s largely structured around helping people develop coping strategies to deal with withdrawal, social situations, cravings—addressing the behavioral aspects of nicotine addiction,” Graham explains. The library of messages includes tricks for dealing with cravings, strategies for navigating social situations, help with goal-setting, and information about NRT. “It’s full of concrete steps and recommendations based on our learnings from helping people quitting combustible cigarettes, but tweaked,” Graham says.
For instance, there are messages about why cutting down is easier than going cold turkey, and tips on how to do that—like reducing your ability to use your own vape by leaving your Juul at home when you go to school or out to a party, Graham says. But given the social pressure teens face, there are also messages offering specific suggestions on how to say no when somebody offers a Juul.
There is also information about withdrawal symptoms in order to help “normalize those feelings and let kids know to expect them, so they don’t become anxiety-provoking,” Graham explains. You can also text key words like crave, slip, or stress to get messages of encouragement, some of which are in the form of quotes from real quitters that Truth Initiative has collected from across its social media platforms.
The program was built to be as simple and low-lift as possible, Graham says. “We've learned that a light-handed approach with younger people tends to work the best,” Graham explains, “so this way we’re offering help that’s available if they want it, but we’re not bombarding them.”
The content of the messages is different based on your age.
To address the widening spectrum of nicotine addiction, users can get different messages depending on whether they are under 13, 13 to 17, 18 to 24, over 24, or a parent. For instance, Truth Initiative researchers have observed that different age groups tend to use different terms to describe their devices, Graham says, so the language of the messages reflect that. Younger teens usually refer to "Juuling" specifically, while adults talk about e-cigarettes and vaping more generally.
Another example: Adults can get NRT products over the counter or by prescription, while those under 18 need parental permission to get a prescription from a clinician and access treatment. So although both a 16-year-old and a 26-year-old will get information explaining how NRT works, the 16-year-old will be advised on talking to their parents about it.
An important call-out to the over-24 crowd here: While the bulk of the conversation right now is about adolescents, Dr. Shelley says there is absolutely a need for cessation assistance for ex-smoker adults now hooked on e-cigarettes—many of whom have essentially traded one addiction for another, albeit a less harmful one. For instance, a U.K. study of 886 smokers trying to quit that was published in the New England Journal of Medicine this week found that e-cigarettes were more effective than traditional nicotine replacement therapy (NRT) methods. But at the one-year mark, 80 percent of the successful quitters in the e-cigarette group were still using the product (compared to just 9 percent of successful quitters in the NRT group).
The program also looks pretty different for parents, of course. They will get messages that help validate their frustration and the feeling like they have failed to protect their kids, for example. There are also stress-management tips and information on how to both practically and emotionally support a child trying to quit, Graham says.
Experts are relieved to see this long-overdue resource.
They also encourage anyone trying to quit using any method to stick with it. “We need to help young people get off these products if they want to, and the Truth Initiative program is filling a big gap in public health resources,” Dr. Shelley says. "I hope it's the first of several steps."
Trapido agrees: “Any modality to help people stop is great, and I’m optimistic that this will be a major step forward."
At the same time, it’s important to remember that there is no easy fix or one-size-fits-all solution. “Changing one's behavior is pretty hard, and nicotine addiction is a serious issue that doesn’t have a magic cure,” Dr. Klein says, adding that anyone having a hard time should talk to their primary care doctor. “Just like with tobacco products, cessation is never simple and it’s never easy,” Trapido says. “So people shouldn’t be put off if they’re not successful the first time. It often takes repeated attempts to be successful.”
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