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More than half (53.4%) of adolescents in the U.S. who reported current e-cigarette use said they intended to quit, and two-thirds recounted past-year attempts to quit, according to a national study.

Using data from the 2020 National Youth Tobacco Survey (NYTS) -- which produced 1,660 respondents ages 11 to 18 in the study's final analytical sample -- researchers found that intention to quit was lower among girls versus boys (adjusted OR [aOR] 0.7, P=0.0004), in users of modifiable vapes versus disposable e-cigarettes (aOR 0.4, P=0.0204), and in those who used other tobacco products in tandem with their e-cigarettes versus sole e-cigarette users (aOR 0.7, P=0.0144), reported Hongying Dai, PhD, of the University of Nebraska Medical Center in Omaha.

However, E-cigarette harm perception was positively associated with both intention to quit (aOR 2.2, P<0.0001) and past-year attempts to quit (aOR 1.6, P=0.0037), Dai noted in .

Reasons for vaping were related to cessation behaviors, she explained. Teens who started using e-cigarettes out of curiosity had higher odds of a past-year attempt to quit (aOR 1.4, P=0.0306). On the other hand, those who used e-cigarettes to disguise their use were less likely to report both intention to quit (aOR 0.4, P<0.0001) and past-year quit attempts (aOR 0.7, P=0.0126).

On average, the number of past-year quitting attempts was 5.3; this number was lower for girls and young women, users of a refillable device such as JUUL, and those who reported experiencing nicotine cravings.

The number of adolescents in the U.S. who reported intention or past-year attempts to quit vaping in this study was significantly higher than a , which used 2017 Population Assessment on Tobacco and Health (PATH) data and found that 44.5% of middle and high schoolers were seriously considering quitting and 24.9% made past-year quit attempts.

While Dai noted that this difference may be due in part to the location of the surveys -- NYTS is school-based, while PATH is home-based -- and variations in question phrasing, she also pointed out that the constantly changing e-cigarette market likely played its own role. For example, she wrote, the widespread media coverage on vaping risks in 2019 following reports of lung injuries may have had an impact on adolescents' attitudes towards e-cigarettes.

Additionally, since 2017, there has been a growing body of research detailing the adverse health effects of adolescent e-cigarette use disseminated through social media and news outlets. New legislation -- such as Tobacco 21, which has made it harder for those under 21 to buy tobacco and nicotine products -- has also likely contributed to cessation behaviors.

"The findings from this study may inform the development of future evidence-based vaping cessation interventions," Dai wrote. "Perceived harm of e-cigarette use is strongly associated with both intention to quit vaping and past-year quit attempts. As shown in the previous qualitative studies, health effect is one of the top reasons for adolescents to quit vaping."

Along these lines, this study found that students who had heard of the FDA's anti-vaping campaign, "The Real Cost," had a higher prevalence of intention to quit vaping.

Still, Dai said, the high percentage (44.5%) of current e-cigarette users that don't understand the full impact that vaping can have on health outcomes is cause for alarm. She pointed out the possible link between refillable vapes being exempt from the flavor ban in 2020 and the fact that those who used such modifiable systems had a lower prevalence of intention to quit.

"Vaping products with a modifiable system allow users to customize voltage, temperature, and electronic liquids, tending to deliver nicotine to the lungs more efficiently," she noted. "These features may increase the appeal and nicotine uptake from vaping."

Dai acknowledged that the study's self-report design does pose a significant limitation to her findings, as the self-reporting of intention to quit and past-year attempts may be subject to recall and social desirability biases. In addition, the definition of past-year quit attempts -- requiring at least 1 day of attempting to quit -- may inflate the number of true quit attempts, since those who only dabble in e-cigarette use may go days without vaping.

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