Across California, posters and billboards from the state health department warn young people about the dangers of vaping. State lawmakers introduced a bill this week to end all store sales of flavored tobacco, and the federal government recently moved to ban some e-cigarettes.
But experts say bans and information campaigns don’t get at one crucial problem: how to help young people who are already addicted to nicotine.
“The primary focus has been on prevention,” said Amanda Graham, a psychologist who serves as chief of innovations for a national anti-tobacco nonprofit called the Truth Initiative.
Graham and other experts say there’s been little guidance on how to help the more than 6 million U.S. teens who used tobacco products in 2019. E-cigarettes, or vapes, are the most common way for both high schoolers and middle schoolers to use tobacco, according to the latest data from the U.S. Centers for Disease Control and Prevention.
The Food and Drug Administration has only approved nicotine replacements — such as patches, lozenges or gums — for people over age 18. Parents who are interested in these options for younger children can talk to their doctors about a prescription. Many physicians have noted the lack of robust research on whether smoking cessation tools designed for adults will work on teenagers.
So California health and education officials are trying to find ways to tailor quitting programs to young people, but it’s a tough sell. The California Department of Public Health says teens are less likely than adults to seek help with nicotine addiction because of peer pressure and a sense of immunity to health consequences.
The department is spending some of its $9 million yearly budget for cessation programs on texting, mobile app and digital chat services. They’re hoping these options will appeal to teens and young people, who may not want to call a hotline or attend a support group.
Graham’s nonprofit runs a national texting service for teens who want to stop smoking or vaping. Young people can start by texting “DITCHJUUL” to 88709, a reference to the flash drive-sized JUUL vaping device. The response messages are tailored by age, and include tips for dropping the habit.
“Chunking quitting into manageable steps, where it’s not ‘I have to quit vaping’ all as one single action, but leaving their JUUL in their locker for one particular class and making it through that class period,” Graham said. “Or practicing how to say no to friends when they’re offered a hit off their JUUL. Very practical, action-oriented things that can help build that confidence to quit.”
Five weeks after the service launched in early 2019, more than 27,000 teens and young adults had joined, according to a report in the journal Nicotine & Tobacco Research from Graham and her team. A two-week follow-up assessment showed 61 percent of respondents had reduced or stopped using e-cigarettes altogether.
Schools also have a role to play in helping to wean teens off vapes, said Bonnie Halpern-Felsher, a Stanford University psychologist. She’s been working with the California Department of Education to introduce curriculums that both warn students about the dangers of vaping and give them resources for quitting.
“If you catch a kid using, rather than suspend them we’re hoping you’ll educate and help them gain motivation and quit,” she said. “We’re actually creating ways now that parents and health care providers, and kids themselves, can use these activities.”
School districts across California have taken a variety of approaches to this issue, including requiring students take a six-course curriculum on Saturdays or assigning them a research paper on the dangers of vaping in lieu of suspension. Santa Rosa City Schools is using a $1.37 million grant from the Department of Justice to hire tobacco prevention and cessation staff, with a focus on vaping.
In Stanislaus County, 27 high schools participate in the Protecting Health and Slamming Tobacco program. Co-coordinator Charmaine Monte said in an email that program staff are just starting to work with youth to help them quit vaping. That includes providing counseling sessions for students caught on campus with vaping products and connecting them with a No Vape helpline where they can receive cessation tools via text, app or smart speaker.
“Sending teens home for a few days and not providing them with resources to understand their use only increases the likelihood of them continuing to use,” Monte said.
“We have also found that the ‘just say no’ strategy doesn’t work either," she said. "It is important to provide teens with the facts in a non-judgmental way. We believe that once teens are given the truth about a product they will make an informed decision on what is best for them.”
The American Academy of Pediatrics recommends the following resources for teens and young adults trying to ditch the vape:
- SmokefreeTXT: SmokefreeTXT sends six weeks of teen-friendly quit texts to their cell phones.
- Smokefree Teen: This site provides tools to help teens make decisions about smoking.
- Become an Ex: (Must be 13 or older). Become an Ex uses a systematic program to prepare a customized quit plan and is sponsored by Truth Initiative.
- US Food and Drug Administration: The Real Cost: A new media campaign from the U.S. Food and Drug Administration details what smoking can cost, and offers information on different ways teens can quit smoking.
- I Quit: An interactive site designed for teens, including daily tips, reasons to quit, and advice about what to expect when quitting. The site also has printable quit plans for a cold turkey method and for a countdown method.
- I Quit Brochure: Adapted from the Anne Arundel County, Maryland Department of Health, this brochure helps adolescents manage the quitting process.
- My Last Dip: My Last Dip deals with chewing tobacco users. This site offers participants monetary rewards for participating in online surveys.
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