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How do we get teens to stop vaping?

As Washington state considers ban of flavored vapes, Fred Hutch research informs new quit-vaping app for teens and young adults
Close-up photo of a woman holding a smartphone and an e-cigarette
Washington state is distributing a first-of-its-kind new smartphone app to help teens and young adults kick the vaping habit. The app is based on research done by smoking cessation expert Dr. Jonathan Bricker of Fred Hutchinson Cancer Research Center. Photo by Violeta Stoimenova / Getty Images

The headlines are terrifying, especially for parents: “Vaping illnesses soar past 1,000 with investigators no closer to pinpointing cause.” “More deaths expected from vaping lung illnesses, CDC says.”

Vaping, the wildly popular new way to consume nicotine, marijuana or just flavored chemicals, has suddenly turned out to be more risky than expected with at least a dozen deaths and nearly a thousand sickened. At the same time, the use of vaping products — especially among teens — has skyrocketed.

New findings released from the National Institute of Drug Abuse, or NIDA, show that “in 2019, the prevalence of past month nicotine vaping was more than one in four students in 12th grade, one in five in 10th grade, and one in 11 in eighth grade,” prompting NIDA Director Dr. Nora D. Volkow to declare vaping nicotine “a public health crisis.”

In response to this crisis, retail giant Walmart stopped selling e-cigarettes in all of its U.S. locations; New York called for an emergency ban on the sale of flavored e-cigs; federal prosecutors in California have started a criminal probe into e-cig maker Juul (whose CEO just stepped down) and the White House seems poised to pull the plug on a slew of vaping and/or e-cig products.

In Washington state, Gov. Jay Inslee called on the state health board to impose an emergency ban on flavored vape products of any kind as a way to “protect the health of Washingtonians, particularly youth.”  The proposed ban will likely be voted on by the board when it meets Oct. 9.

But it’s not the only action the state is taking.

Inslee and public health officials also called for mandatory warning signs in retail outlets that sell vaping cartridges and full disclosure from manufacturers regarding vape ingredients and additives, and announced a new, science-based smartphone app to help teens and young adults kick the vaping habit.

The app, the first of its kind to tackle youth vaping, is based on research done by smoking cessation expert Dr. Jonathan Bricker of Fred Hutchinson Cancer Research Center.

Public health partnership to stop teen vaping

Photo composite of screenshots of new quit-vaping app
The new app, designed to help teens and young adults quit vaping, is available to Washington state residents for free. Image courtesy of 2Morrow Inc.

Offered free from the Washington State Department of Health via digital health company 2Morrow Inc., the app was developed based on Bricker’s years-long research into quitting combustible tobacco. A psychologist and addiction expert, Bricker collaborated with 2Morrow in 2012 to create his first smoking cessation app.

His research group at the Fred Hutch HABIT Lab and collaborators have since conducted studies and mobile interventions to help people stop other unhealthy behaviors — such as overeating and excessive drinking — and tailored their smoking cessation apps for high-risk groups such as cancer patients.

“The state was desperate for something to help young people stop vaping and asked if the current smoking cessation app that 2Morrow has been offering for five years could be revamped to help young people stop vaping,” he said, explaining its genesis.   

Bricker pairs the psychotherapy approach called acceptance and commitment therapy, or ACT, with smartphone or web-based apps to help people navigate and overcome their cravings to smoke — or in this case, vape. ACT encourages people to acknowledge cravings rather than stifle them, with the understanding that cravings will eventually pass. The design offers immediacy — helping people deal with their cravings in the moment — as well as a strong support structure.

Neither Bricker nor Fred Hutch have received any financial remuneration for the vaping cessation app. The Hutch does receive payments from 2Morrow for the tobacco smoking-cessation app through a previous licensing agreement and has an equity position in the company.

“It’s going out to the public because of an urgent need, and so will start now with being field-tested with the public,” Bricker said. “We hope to learn its effectiveness in future research.”

TIPS FROM THE WASHINGTON STATE DEPARTMENT OF HEALTH

  • Vaping devices — also known as JUULs, e-cigarettes, e-cigs, vapes, e-hookahs, vape pens, mods, tanks or electronic nicotine delivery systems — can contain nicotine, marijuana or other substances like flavoring agents and chemicals.

  • The healthiest option is to not smoke or vape. Nicotine and marijuana can be harmful in any form. Anyone using tobacco or vaping products and attempting to quit should use evidence-based treatments, including counseling and Food and Drug Administration-approved medications.

  • If you need help quitting tobacco or vaping products, contact your health care provider or access online resources to quit tobacco and/or marijuana.

  • If you continue to use vaping devices, you should monitor yourself for symptoms (e.g., cough, shortness of breath, chest pain) and promptly seek medical attention if you have concerns about your health.

  • Never buy vaping products with THC or other cannabinoids off the street, and do not modify or add any substances to these products not intended by the manufacturer.

Little research on vaping

Until now, most of research’s focus has been on whether vaping leads young people to start smoking, he said, which it absolutely does. But there’s little science on the cessation of vaping in young people.

“I look at this as a start,” said Bricker, who’s done extensive research on teens and smoking. “With this initial release, we’ll learn about what’s working and not working.”

In a 2016 study, the smoking cessation app used as the basis for the vaping cessation app helped 21% of its users quit cigarettes — a success rate two to three times higher than other methods. The app also helped 75% of the trial participants reduce their smoking.

Bricker hopes that helping teens stop vaping will not only protect them from the lung illness that’s killed at least a dozen and sickened many more — many under the age of 21 — it will keep teens and young adults from later turning to tobacco, which kills more than 480,000 people annually, per the nonprofit Campaign for Tobacco Free Kids.

“If you vape, you’re four times more likely to take up smoking,” he said, citing a recent analysis of 17,000 youth. “So if you can get a young person to stop vaping or never vape in the first place, you’re likely to cut their risk of going on to use cigarettes.”   

‘You need resources for people’

In the Friday press conference, Inslee pointed to “predatory marketing by industry” — i.e., the use of catchy packaging and flavors like bubble gum, raspberry and cinnamon — to make vapes more appealing to youth and “get kids hooked and hooked for life.”

Last April, Inslee signed the state’s Tobacco 21 law in a ceremony at Fred Hutch, making it illegal to sell or give tobacco or vaping products to people under age 21 starting in January 2020. The new regulations are another effort to “stop kids from another path to nicotine addiction,” he said.

Bricker said he’s glad that the anti-vaping app has been made available to the public since people who are already hooked on the highly addictive drug nicotine absolutely need help.

“These people have a habit and they have cravings and they need a way to deal with the cravings,” he said, adding that some people may turn to underground sources for vapes. Black market vaping products are already being eyed as a potential source for the chemicals driving the vaping-related deaths.

The vaping cessation app takes a completely different tack, addressing the actual addiction.

“You need resources for people who want to stop,” Bricker said. “Policies don’t change human addiction. They don’t change cravings. Policies work from the outside. These apps work from the inside. It’s important to have both.”

In January 2019, Dr. Jonathan Bricker of Fred Hutch testified before the Washington House Health Care & Wellness Committee about the scientific research on nicotine addiction in young people as the state considered legislation to raise the age of tobacco and nicotine sale to 21, which passed later that year. Video: TVW

Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has written extensively about health issues for NBC News, TODAY, CNN, MSN, Seattle Magazine and other publications. A breast cancer survivor, she blogs at doublewhammied.com and tweets @double_whammied. Email her at dmapes@fredhutch.org.

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Last Modified, October 10, 2019