How physicians can help teens kick vaping

Vaping has taken off in recent years—especially among teenagers—giving rise to concerns that they will move “up” to e-cigarettes, further putting their health at risk.

Physicians may be able to help them quit. They can address vaping among younger patients by utilizing the “five A’s” strategies: asking, advising, assessing, assisting, and arranging.

Oral nicotine products popular among teens

In July 2022, the FDA banned the sale and distribution of all Juul Labs products in the US. This decision intended to hold vaping and e-cigarette companies to the FDA’s public health standards, and recognized that Juul Labs products likely played a significant role in the rise of youth vaping.^[]

According to a 2022 study published by Pediatrics which looked at the prevalence of nicotine product use, e-cigarettes were most commonly used among teens in Southern California.^[]

Of the 3,516 participants, 9.6% had used e-cigarettes at some point, while 5.5% used them in the past 6 months. The second most prevalent product used by teens reportedly was non-tobacco oral nicotine products (ever used: 3.4%, past 6 months: 1.7%).

This research suggests that while teens seek nicotine in several ways, vaping is still their favorite.

Many teens wish to quit

A study published by Addictive Behaviors surveyed 1,000 youths between the ages of 13–17 about why they’d like to kick their vape-driven nicotine addiction.^[]

According to the data, 50.9% of teens reported wanting to quit primarily for health-related reasons. “I'm an athlete and don't want vaping to affect my lung capacity," one participant wrote. "Excelling in my sport is so much more than getting a good buzz."

The second most popular reason, cited by 21.7% of participants, had to do with the financial loss associated with vaping. One teen reported not having enough money to “feed” their addiction.

Outside of health and finances, teens wanted to quit vaping to free themselves from addiction, as well as to maintain social relationships.

Vape reduction strategies: The 5 A’s

An article published by the Journal of Adolescent Health listed the five A’s—five actions you can take:^[]

• Ask. The first step in helping teens reduce vape use: screen them. Try to phrase your questions in a way that speaks to youth. For example, instead of asking, “In the past year, how many times have you used tobacco?,” try, “How often do you vape in a day?,” or “How long after you wake up do you start vaping?” Remember that the more often patients vape, the greater the likelihood they’ll experience withdrawal symptoms.

• Advise. Once you’ve screened patients for vape use, you’re in a good position to teach them about its potential harms. Explain how vaping may lead to EVALI (e-cigarette or vaping use-associated lung injury), seizures, and nicotine addiction. Steer clear of scare tactics; this conversation should be educational.

• Assess. After teaching patients about the potential dangers of vaping, gauge their readiness to quit. Make a vaping pros and cons list with your patient to help them see why they do it. Those who want to quit may feel they can do so whenever they want, but struggle when actually challenged to quit for a period of time. Employ different strategies to meet patients where they’re at—even if your goal is to lessen their vaping frequency.

• Assist. Point your patient to strategies that support their decision to quit. CBT, individual or group counseling, motivational interviewing, and mindfulness approaches are often available to teens who’d like to incorporate these steps in their wellness plan. There are also apps, such as My Life My Quit, which help teens access support on their phones. Physical exercise and fidget toys may be helpful, too.

• Arrange. Schedule follow-up appointments to check in with patients and track their progress. At this stage, you can address relapse early on, look at their current treatment plan, and adjust it as needed.