Challenges faced by young adult users

High stress, heavy dependence, and mental health concerns shape the quitting journey for young adult e-cigarette users, emphasizing the need for targeted and supportive interventions.

Study: A Randomized Clinical Trial of a Quitline Vaping Cessation Intervention: Baseline Characteristics of Young Adult Exclusive E-Cigarette Users Seeking Treatment. Image Credit: xyfen / Shutterstock.com

A recent study published in the International Journal of Environmental Research and Public Health study examines the characteristics of young adults (YA) who were exclusive e-cigarette (EC) users and seeking treatment.

Tailored cessation for young adult e-cigarette users

Current estimates indicate that the prevalence of EC use among YA between 18 and 24 years of age in the United States is between 11% and 26.2%. Several YAs have made attempts to quit EC use; however, few options are specifically targeted to YA EC users.

Furthermore, it remains unclear what is the most effective approach to engage YA EC users in effective cessation resources. Despite similarities in their reasons for quitting vaping or smoking, there are unique facilitators and barriers to vaping cessation in the YA population.

Thus, additional research is needed to determine effective cessation methods for EC users interested in quitting by understanding the characteristics of those seeking treatment.

About the study

Data on treatment-seeking YA who completed a randomized clinical trial baseline survey were included in the current study. The trial involved the remote delivery of an intervention to support EC cessation.

Study participants were randomized to one of four groups: those who received and did not receive the mHealth intervention, those who underwent nicotine replacement therapy (NRT) for eight weeks with or without the mHealth intervention, and controls.

A total of 981 participants completed the baseline survey, which included information on demographic factors, educational attainment, employment status, chronic conditions, tobacco use behaviors, and measures for depression, anxiety, and stress. The key objective of the current study was to characterize treatment-seeking YAs who exclusively use EC and explore the differences between those willing to talk on the phone and those who do not.

Study findings

Over 72% of YA EC users were female, with a similar proportion of 70% identifying as Caucasian. About 57% of the study cohort reported college or vocational training, with most of these characteristics similar among participants and non-participants. The largest difference was in terms of age, with 52.2% of non-participants slightly older than those who were enrolled in the study.

About 78% of study participants used ECs daily, 87% of whom had been using them for at least one year. Disposable EC use was slightly higher. According to the Pennsylvania State E-cigarette Dependence Index, most were categorized as heavily dependent.

Some of the different reasons why the study participants were interested in quitting included health concerns, freedom from addiction, cost, and others. About 88% previously attempted to quit, with approximately 30% reporting their longest EC abstinence period between one and six days.

Over 31% of those interested in quitting previously used a cessation medication, the most common of which was NRT in the form of a lozenge, gum, or patch. At the time of the baseline survey, NRT use was higher among non-participants.

In the total sample, behavioral health concerns were high, with 44.8%, 55.4%, and 73.1% screening positive for depression, anxiety, and high stress, respectively. The incidence of anxiety and depression was higher among non-participants.

Furthermore, 57.4% of the study cohort reported engaging in binge drinking at least once a month, whereas about 89% and 60% reported alcohol and cannabis use in the preceding month, respectively. The prevalence of these habits was similar between non-participants and participants.

Study limitations

A key limitation of the current study is the lack of diversity in the study cohort, which was not representative of the U.S. population. Furthermore, since advertisements for participating in the study were published on specific social media platforms, only YAs who engage and are active on those websites were able to be recruited.

The overlap of the intervention period with the coronavirus disease 2019 (COVID-19) pandemic may have influenced participant characteristics, including stress levels. Furthermore, the potential presence of fraudulent participants due to the fully remote design and online recruitment approach cannot be ruled out.

Although the study controlled for several psychosocial, behavioral, tobacco use, and demographic factors, unknown external factors may have also influenced the differences in those who completed quit coach calls.

Future direction

Additional research is needed to identify better ways to engage with YAs seeking treatment for EC use and whether these treatments can be improved by considering behavioral health concerns in this population. Future studies should also examine cognitive barriers and cessation intervention preferences to better understand why YAs may or may not be open to participating in one-on-one coaching by phone.