Pharmacotherapy and Behavioral Cessation Methods Used by Adolescents Who Vape Nicotine

Purpose

E-cigarettes are the most widely used tobacco product among U.S. adolescents. In 2024, over 1.5 million adolescents reported nicotine vaping, with lifetime prevalence ranging from 9.6% in 8th grade to 21% in 12th grade. ¹ Initiating nicotine use during adolescence is especially concerning given the unique vulnerability of the developing adolescent brain, neural networks, and the increased risk of long-term nicotine dependence. ²

While two recent clinical trials have demonstrated that pharmacotherapy ³ and behavioral therapy ⁴ are efficacious for nicotine vaping cessation in adolescents in clinical trial settings, the real-world applicability of these approaches remains unclear. National survey data also show that most adolescents try to quit unassisted, ⁵ showing a disconnect between evidence-based interventions and actual cessation behaviors. Importantly, data is sparse on which cessation methods, including pharmacotherapy, are being used by adolescents who vape nicotine. Because no pharmacotherapy is currently FDA-approved for adolescent vaping cessation, meaning any such use is off-label, it is crucial to understand which methods adolescents use in practice. The current study addresses this gap by examining the use of pharmacotherapy and behavioral cessation methods among U.S. adolescents. Identifying which cessation methods adolescents use in practice can inform efforts to tailor and scale cessation resources to support adolescents who vape nicotine.

Methods

Results

Among U.S. adolescents between 2022-2023 who indicated past-year nicotine vaping, 10.6% used at least one vaping cessation therapy in the past year. Additionally, 4.4% and 3.3% reported NRTs and medication use, respectively. In a sensitivity analysis excluding the app-based item, the prevalence of any cessation-aid use was (7.4%) (Table 1).

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Table 1.

Cessation Methods Among Adolescents who Vaped Nicotine in the Past Year in the 2022/2023 PATH Study

Adolescents who vaped nicotine in the past year, N = 1181	Unweighted n	Weighted % (95% CI)
Past-year use of “mobile app” or “app on tablet computer or smartphone” to quit
No	1141	96.6 (95.5, 97.4)
Yes	40	3.4 (2.6, 4.5)
Past-year use of NRTs to quit
No	1129	95.6 (94.1, 96.7)
Yes	52	4.4 (3.3, 5.9)
Past-year use of cessation medications to quit
No	1139	96.7 (95.4, 97.6)
Yes	42	3.3 (2.4, 4.6)
ƚ Any past-year use of cessation therapy
No	1053	89.4 (87.4, 91.1)
Yes	128	10.6 (8.9, 12.6)
ƚ Any past-year use of cessation therapy (excluding app-based)
No	1053	92.6 (90.6, 94.2)
Yes (NRTs and/or medications only)	88	7.4 (5.8, 9.4)

Adolescents who reported wanting to vape within 30 minutes of waking (aOR: 2.83; 95% CI: 1.49, 5.36) had higher odds of using any cessation therapy compared to those who reported wanting to vape more than 1 hour of waking. Similarly, adolescents who were planning to quit in the next 12 months (aOR: 1.88; 95% CI: 1.10, 3.20) had higher odds of any cessation therapy compared to those who were not planning to quit. Adolescents who identified as Hispanic had lower odds (aOR: 0.46, 95% CI: 0.25, 0.85) of reporting any cessation treatment compared to non-Hispanic White adolescents. We did not detect significant associations for other demographic or behavioral factors. Given the sparse cells and limited power, these are interpreted as inconclusive rather than as evidence of no association (Appendix Table 2).

Among adolescents who made a quit attempt in the past year, 21.5% used at least one cessation therapy in that year, and 78.5% that did not use any cessation therapy (Appendix Table 3).

In disaggregated models, the two cessation modalities showed distinct correlates. For pharmacotherapy-based methods (NRT or cessation medications; Appendix Table 4), wanting to vape within 30 minutes of waking was associated with higher odds of use in both unadjusted (OR 4.45, 95% CI 2.16, 9.18) and adjusted (aOR 3.06, 95% CI 1.93, 4.85) models, whereas planning to quit within 12 months was not significantly associated with pharmacotherapy use (Appendix Table 4). For app-based use (Appendix Table 5), shorter time to first vape after waking and planning to quit within 12 months were each associated with higher odds of use, with the 30-minute-to-1-hour dependence category (aOR 2.47, 95% CI 1.05, 5.79) and planning to quit within 12 months (aOR 9.70, 95% CI 3.87, 24.31) remaining significant, while the strongest dependence category (<30 minutes) was attenuated and no longer significant (aOR 3.59, 95% CI 0.95, 13.54). (Appendix Table 5).

Discussion

These exploratory findings show that about 1 in 10 U.S. adolescents who vape nicotine use cessation aids. Those who reported higher nicotine dependence and readiness to quit had higher odds of using any cessation therapy, while Hispanic adolescents had lower odds of reporting any cessation therapy.

The results showing low use of NRTs and cessation medications among adolescents in the same year they made a vaping quit attempt, suggest a disconnect between available interventions and actual youth behavior. Additionally, the use of these cessation tools even among adolescents who did not indicate a ‘quit’ attempt suggests some youth may be using these therapies for other reasons (e.g., limiting their vaping frequencies) ¹¹ rather than completely quitting, as demonstrated in other studies with adults. ¹² Low use may also reflect the cost of these products and adolescents’ reluctance to disclose vaping to parents or clinicians, which constrains access to prescription-based cessation options. In the U.S., most cessation medications are not FDA-approved for adolescents, and this regulatory context likely contributes to the low utilization and may limit clinician prescribing. Because PATH does not capture how these cessation aids were obtained, we cannot determine whether the reported medication use reflects clinician prescribing or informal access. Therefore, findings should be interpreted cautiously. Additionally, prior research shows that unassisted quitting (“cold turkey” quitting) remains a predominant real-world cessation strategy among adolescents ⁵ and should be considered when interpreting the low uptake of cessation aids observed in this study. A recent systematic review and meta-analysis synthesizing vaping cessation interventions provides broader evidence that behavioral and pharmacologic approaches show promise for youth, ¹³ underscoring the need for more accessible and youth-oriented cessation resources with messaging that could potentially enhance readiness to quit.

Our findings also suggest that nicotine dependence and readiness to quit were associated with higher odds of using cessation aids. ¹⁴ Cessation therapists could optimize the delivery of behavioral therapy and pharmacotherapy by leveraging information on readiness to quit and nicotine dependence severity for tailored interventions, thereby enhancing success. Furthermore, the observed lower odds of cessation therapy use among Hispanic compared to non-Hispanic White adolescents likely reflects a complex interplay of cultural, linguistic, structural, and access factors. Potential mechanisms include limited availability of culturally appropriate services, language barriers, immigration-related concerns, lower healthcare engagement, and family-based decision-making norms. Because the models did not include contextual variables or interaction terms, the mechanisms underlying this disparity cannot be isolated, and these findings should be interpreted cautiously and treated as hypothesis-generating. This warrants further investigation and targeted public health strategies to ensure equitable support.

This study has some limitations. First, the cross-sectional design does not allow for causal inference. Second, the self-reported data may be subject to recall bias. Third, the low prevalence of cessation therapy use produced sparse cells for several variables, limiting statistical power to detect significant associations; as a result, null findings should be interpreted as inconclusive rather than evidence of effect. Fourth, because the app-based item was assessed only among established users who reported a quit attempt and app use, the composite outcome is likely underestimated and may be subject to misclassification. These prevalence estimates should be interpreted as lower bounds, and app use among adolescents who reduced rather than fully quit could not be captured. Because the composite groups have modalities of differing mechanisms and evidence base, it should be read as a marker of any aided cessation effort rather than of a single, uniform intervention. Fifth, although time to first vape after waking was adapted from recent youth vaping studies, which support its use, it may not robustly capture e-cigarette dependence, and the overall sample size and sparse cells precluded the use of more detailed PATH dependence indicators. Sixth, data were collected in 2022-2023, and the adolescent nicotine landscape, including product types, emerging cessation tools, and regulatory and legislative actions, is evolving rapidly; current patterns of cessation-aid use may differ from those observed here. Finally, there may be residual confounders such as parental involvement and healthcare access, which were not accounted for in the analysis.

Overall, these findings highlight the need for youth-oriented vaping cessation interventions. Tailoring accessible, culturally responsive cessation support that integrates both behavioral and pharmacotherapeutic components^14,15 may improve the use of cessation therapies among adolescents who vape nicotine, reduce nicotine dependence and advance health equity.

SO What?

Supplemental Material