Tobacco, smoking

from BioMed/Substance Abuse Policy unit – 03 November 2025

by Amanda L. Graham, Sarah Cha, Elizabeth K. Do, Megan A. Jacobs, Giselle Edwards & George D. Papandonatos

Substance Abuse Treatment, Prevention, and Policy volume 20, Article number: 48 (2025) Cite this article

[References not included – ignore all reference numbers. To see references, click on the Source link at the foot of this article]

Abstract

Objective

To examine patterns of abstinence from nicotine vaping and cannabis use among adolescent and young adult (YA) e-cigarette users in two text message vaping cessation trials.

Methods

Among adolescents with complete 7-month data (n = 1,016) at baseline, 25.4% were Exclusive E-cigarette Users (no past 30-day cannabis use) and 74.6% were Dual Users (past 30-day cannabis use). Among YAs with complete 7-month data (n = 1,829), 40.8% were Exclusive E-cigarette Users and 59.2% were Dual Users at baseline. Primary analyses examined the proportion of participants who were Dual Abstinent at 7-months by treatment arm differences. We also examined for interaction effects between baseline product use and vaping status at 7 months on cannabis use outcomes.

Results

At 7-months, adolescent categories of use were: Dual Abstinent, 31.7% (95% CI: 28.8, 34.6); Exclusive E-cigarette Users, 18.2% (95% CI: 15.9, 20.7); Exclusive Cannabis Users, 15.1% (95% CI: 12.9, 17.4); Dual Users, 35.0% (95% CI: 32.1, 38.1). Among YAs: Dual Abstinent, 15.6% (95% CI: 13.9, 17.3); Exclusive E-cigarette Users, 29.4% (95% CI: 27.3, 31.6); Exclusive Cannabis Users, 12.8% (95% CI: 11.3, 14.5); Dual Users, 42.2% (95% CI: 39.9, 44.5). Intervention outperformed Control in promoting rates of Dual Abstinence among adolescents (38.5% vs. 25.0%, p < 0.0001) and YAs (17.9% vs. 13.3%, p = 0.007). A higher proportion of Exclusive E-cigarette Users compared to Dual Users were Dual Abstinent at follow-up (adolescents: 37.6% vs. 29.7%, p = 0.019; YAs: 25.8% vs. 8.5%, p < 0.001).

Conclusion

A text message nicotine vaping cessation intervention promoted dual abstinence from e-cigarettes and cannabis among adolescents and YAs. Dual abstinence rates were higher among exclusive vapers than dual users, signaling the need to optimize cessation programs for dual users.

Trial Registration

Studies included were registered on ClinicalTrials.gov (NCT04251273, registered on January 31, 2020; NCT04919590, registered on June 9, 2021)

Background

E-cigarettes have been the most used tobacco product among young people for a decade [1]. More recently, co-use of cannabis alongside nicotine e-cigarettes (“co-use”) has become more common among adolescents and young adults (YA) [2, 3]. Estimates for the prevalence of nicotine vaping and cannabis co-use range from 16 to 50% among adolescent e-cigarette users [4, 5] and 34–60% among YA e-cigarette users [6,7,8].

Despite the high prevalence of co-use, few studies have addressed concurrent nicotine and cannabis use or cessation [9,10,11] and there are no clinical practice guidelines regarding cessation treatment approaches for co-use. In the limited number of nicotine vaping cessation trials that have been conducted among young people [12,13,14,15], high rates of co-use were documented (72–75% among adolescents, 59% among YA) but treatment effects on cannabis use or co-use were not examined [16].

This research gap is particularly concerning given the compounded health risks associated with co-use. Nicotine vaping carries serious consequences including respiratory problems [17], mental health issues [18], and addiction [19]. Cannabis use during adolescence is associated with structural brain changes affecting cognitive function [20, 21], increased depression and suicidality risk [22], and heightened addiction liability [23]. Cannabis vaping, in particular, introduces additional risks including respiratory symptoms [24], EVALI [25], and acute psychological effects [26, 27]. Co-use of nicotine and cannabis compounds these risks, leading to increased frequency and dependence for both products, poorer cessation outcomes [28, 29], and worse overall health functioning compared to single-substance use [30]. Research is needed to inform the development of cessation treatment approaches for nicotine and cannabis co-use [11].

The nicotine vaping cessation intervention tested in two trials among young people demonstrated a significant treatment effect in promoting dual abstinence from nicotine e-cigarettes and combustible tobacco products [14, 31], suggesting that targeting one form of substance use may have broader impacts on related substance use behaviors through shared mechanisms of behavior change. This study builds on these earlier findings to examine the following research questions about the co-use of nicotine e-cigarettes and cannabis: 1) What were the overall patterns of abstinence from nicotine e-cigarettes and cannabis at the primary 7-month study endpoint? 2) Were there treatment group differences in promoting abstinence from nicotine e-cigarettes and cannabis at follow-up? and 3) Did treatment effects vary by baseline product use? We also explored interactions between nicotine vaping status at 7 months and baseline tobacco product use on cannabis use outcomes. Addressing these questions is crucial for understanding the interplay between nicotine vaping and cannabis use in the context of cessation interventions, with important implications for the development of efficient and effective cessation programs for young people.

Methods

Trial design

This manuscript presents secondary analyses of data from two separate parallel, two-group, double-blind individually randomized controlled trials (RCT) that compared a tailored, interactive vaping cessation text message intervention to a text message assessment-only control. Study methods in the two trials were nearly identical. The RCT among n = 1,503 adolescent (13–17 years old) e-cigarette users was conducted from October 2021 to October 2023 and randomized participants to intervention (n = 759) or assessment-only control (n = 744); a third waitlist control group was included in the parent study [14] but is not included in these analyses. The RCT among n = 2,588 young adult (YA; 18–24 years old) e-cigarette users was conducted from December 2019 to November 2020 and randomized participants to intervention (n = 1304) or assessment-only control (n = 1284) [13].

Interventions

This is Quitting: This is Quitting (TIQ, now part of EX^® Program), is an automated, tailored, interactive text message program for nicotine vaping cessation designed for adolescents (13–17 years old) and young adults (18–24 years old) [32]. It is grounded in best practices [33] and our experience delivering digital tobacco cessation interventions to people of all ages and informed by formative research with young people. The program is anchored around social cognitive theory [34] and positioned as a nonjudgmental friend. To reinforce perceived social norms and social support for quitting, messages written by other users (with appropriate editorial review) are incorporated throughout the program. The program is tailored to a user’s age, enrollment date or quit date, and vape brand. Those who do not set a quit date receive 4 weeks of messages focused on building skills and confidence. Those who set a quit date receive messages 6 weeks before and 8 weeks after their quit date that focus on the risks of vaping and benefits of quitting, exercises to build coping skills and self-efficacy, encouragement and support. Mental health support (e.g., mindfulness training, self-care), breathing training, and information about Crisis Text Line are delivered to all users. For adolescents, messages about nicotine replacement therapy describe its utility but note that consultation with a healthcare provider is required. Keywords such as TIPS, FEELS, and STRESS deliver cognitive and behavioral strategies for quitting and on-demand support for managing mood and stress, respectively. Support for quitting cannabis was not explicitly provided in the intervention.

From 2020 through December 2024, TIQ was promoted nationally through the truth^® campaign, earned media, and local/national outreach. To isolate treatment effects and ensure participant blinding, all branding was removed from the intervention.

Assessment-Only Control: After a text message confirming enrollment, participants received only the retention messages described below. After completing the 7-month assessment, participants were instructed how to enroll in TIQ, if interested.

Recruitment, enrollment, and randomization

Eligibility criteria for both parent trials included: age (adolescents: 13–17 years; YAs: 18–24 years), past 30-day nicotine e-cigarette use, interest in quitting vaping in the next 30 days, mobile phone ownership with active text message plan, and US residence. Advertisements on Facebook/Instagram, Twitter, and Snapchat promoted a quit vaping study. Interested individuals were asked to complete online eligibility screening. A link to online informed assent/consent was emailed, requiring a valid email for study enrollment. Assent/consent information indicated that participants would be randomly assigned to a text message intervention; specific details about the nature of each study group were not provided, ensuring double blinding.

Assent/consent differed in the two trials. In the adolescent trial, a waiver of parental consent was approved by the review board. Eligible adolescents were required to provide assent and correctly answer a series of questions indicating decisional capacity to enroll. Providing assent and answering all decisional capacity questions correctly launched the baseline assessment. In the YA trial, acceptance of informed consent launched the baseline assessment. For both trials, those who completed the baseline assessment were randomly assigned to intervention or control via the survey platform and instructed to text the study number to complete enrollment. Those who responded to the confirmation text message within 24 hours were fully enrolled.

Detailed descriptions of the study samples have been published elsewhere [13, 14]. Briefly, the adolescent sample (n = 1,503) had an average age of 16.4 years (SD = 0.8), was 50.6% female, 42.5% sexual minority, 16.2% Hispanic ethnicity, and 62.6% White race. Participants were primarily daily e-cigarette users (median vaping days in the past month: 30) with moderate-high scores on multiple measures of nicotine dependence. The young adult sample (n = 2,588) had an average age of 20.4 years (SD = 1.7), was 50.3% female, 19.0% sexual minority, 10.6% Hispanic ethnicity, and 83.4% White race. A majority reported vaping nicotine daily (93.1%) and 82.3% reported vaping within 30 minutes of waking. Study groups in both samples were balanced on baseline characteristics.

Retention

To minimize differential attrition and optimize follow-up rates in both trials, incentivized text message assessments ($5 each) regarding e-cigarette use were sent to all participants 14 days post-randomization (Checking in: Have you cut down how much you vape nicotine in the past 2 weeks? Respond w/letter: A = I still use the same amount, B = I use less, C = I don’t use at all anymore) and monthly thereafter through the 6-month follow-up (How’s the quit going? When was the last time you vaped nicotine, even a puff of someone else’s? Respond w/letter: A = In the past 7 days, B = 8–30 days ago, C = More than 30 days ago). Data from these assessments were not used in outcome analyses.

Measures

The baseline survey in both trials was conducted online, hosted on a secure server. The 7-month assessment was conducted via mixed-mode follow-up: online non-responders were contacted by phone by research staff blind to treatment assignment; text messages and emails were final means of gathering data on vaping abstinence from non-responders. Participants earned $20 for completing the follow-up, with a $10 incentive for responding within 24 hours of initial invitation.

The full battery of measures administered at baseline and 7 months have been previously described [13, 14]. These secondary analyses focus on self-reported past 30-day use of nicotine e-cigarettes and cannabis at baseline and 7 months post-randomization. For e-cigarette use, participants were instructed at both timepoints “For these questions, please think of your use of vape product(s) that contain nicotine in your responses” and responded to the question “In the past 30 days, did you vape at all, even a puff of someone else’s?” Similarly, participants reported past 30-day use of other substances, including cannabis; the mode of cannabis use was not specified.

Statistical analyses

At baseline, participants were categorized as 1) Exclusive E-cigarette Users if they reported no past 30-day cannabis use, or 2) Dual Users if they also reported past 30-day cannabis use. At 7 months post-randomization, four groups of interest were defined: 1) Dual Abstinent, no past 30-day nicotine e-cigarette or cannabis use, 2) Exclusive E-cigarette Users: no past 30-day cannabis use, but any past 30-day nicotine e-cigarette use, 3) Exclusive Cannabis Users: no past 30-day nicotine e-cigarette use, but any past 30-day cannabis use, and 4) Dual Users: any past 30-day use of nicotine e-cigarettes and cannabis.

Primary analyses focused on the proportion of participants who were Dual Abstinent as the outcome of interest. We employed 2-sample Z-tests based on a normal approximation to the binomial distribution to examine between-arm differences in Dual Abstinence rates, both in the overall sample and by baseline substance use pattern (Exclusive E-cigarette vs. Dual Use).

Within-subject comparisons of cannabis use at baseline and 7-month follow-up were based on McNemar’s test [35]. Additional analyses of 7-month follow-up data explored whether cannabis use at follow-up was associated with nicotine vaping cessation.

All statistical analyses were conducted in R (v 4.5) [36].

Results

Among 1,503 adolescents randomized, the 7-month follow-up rate was 70.8% (n = 1,064). Data on cannabis use was missing for 48 participants, who provided data only on 7-month nicotine vaping status. Thus, the adolescent analytic sample comprised n = 1,016 participants with follow-up data on both e-cigarette and cannabis use. There was no differential attrition by treatment assignment (p = 0.20), with 66.0% (501 of 759) of Intervention participants retained at 7 months versus 69.2% (515 of 744) of Control. Likewise, there was no differential attrition by baseline cannabis use (p = 0.74), with 68.4% (258 of 377) of Exclusive E-cigarette Users retained at 7 months versus 67.3% (758 of 1126) of Dual Users. At baseline, 74.6% (95% CI = 71.8, 77.3) of adolescents reported past 30-day cannabis use, which decreased to 50.1% (47.0, 53.2) at 7 months, a 24.5% point change (95% CI = 20.8, 28.0; McNemar’s test p < 0.001).

Among 2,588 YAs randomized, the 7-month follow-up rate was 76.0% (n = 1,967). Data on cannabis use was missing for 138 participants, who provided data only on 7-month nicotine vaping status. Thus, the YA analytic sample comprised n = 1,829 participants with follow-up data on both e-cigarette and cannabis use. There was no differential attrition by treatment assignment (p = 0.14), with 69.3% (904 of 1304) of Intervention participants retained at 7 months versus 72.0% (925 of 1284) of Control. Likewise, there was no differential attrition by baseline cannabis use (p = 0.86), with 70.9% (747 of 1053) of Exclusive E-cigarette Users retained at 7 months versus 70.5% (1,082 of 1534) of Dual Users. At baseline, 59.2% (95% CI = 56.9, 61.4) of YAs reported past 30-day cannabis use, which decreased to 55.0% (95% CI = 52.7, 57.3) at 7 months, a 4.2% point change (95% CI = 1.9, 6.4; McNemar’s test p < 0.001).

What were the overall patterns of abstinence from e-cigarettes and cannabis at 7-months?

As shown in Table 1, 31.7% (95% CI = 28.8, 34.6) of adolescents were Dual Abstinent, 18.2% (95% CI = 15.9, 20.7) were Exclusive E-cigarette Users, 15.1% (95% CI = 12.9, 17.4) were Exclusive Cannabis Users, and 35.0% (95% CI = 32.1, 38.1) were Dual Users.

Table 1 Dual use of nicotine e-cigarettes and cannabis at 7 months by treatment assignment and baseline product use among adolescents (13–17 years) enrolled in a randomized trial of vaping cessation, n (%)

As shown in Table 2, 15.6% (95% CI = 13.9, 17.3) of YAs were Dual Abstinent, 29.4% (95% CI = 27.3, 31.6) were Exclusive E-cigarette Users, 12.8% (95% CI = 11.3, 14.5) were Exclusive Cannabis Users, and 42.2% (95% CI = 39.9, 44.5) were Dual Users.

Table 2 Dual use of nicotine e-cigarettes and cannabis at 7 months by treatment assignment and baseline product use among young adults (18–24 years) enrolled in a randomized trial of vaping cessation, n (%)

Was there a treatment effect in promoting dual abstinence at follow-up?

Yes. As shown in Table 1, among adolescents, the rate of Dual Abstinence was 13.5% points higher (95% CI = 7.8, 19.1; p < 0.0001) among those randomized to Intervention (38.5%; 95% CI = 34.4, 42.9) vs. Control (25.0%; 95% CI = 21.5, 29.0). As shown in Table 2, among YAs, the rate of Dual Abstinence was 4.6% points higher (95% CI = 1.3, 7.9; p = 0.007) among those randomized to Intervention (17.9%; 95% CI = 15.5, 20.6) vs. Control (13.3%; 95% CI = 11.2, 15.7).

Did treatment effects in promoting dual abstinence vary by baseline product use?

No. In the adolescent sample, the treatment advantage of Intervention over Control was comparable for Exclusive E-cigarette Users (12.4 points; 95% CI = 0.6, 23.8) and Dual Users (13.9 points; 95% CI = 7.4, 20.3), interaction p = 0.82 (Table 1). Among Exclusive E-cigarette Users, 44.0% of adolescents randomized to Intervention were Dual Abstinent (95% CI = 35.1, 53.1) compared to 31.6% of Control (95% CI = 23.8, 40.2). Among Dual Users, 36.7% of Intervention participants were Dual Abstinent (95% CI = 31.8, 41.8) compared to 22.8% of Control (95% CI = 18.7, 27.3).

Likewise, in the YA sample, the treatment advantage of Intervention over Control was comparable for Exclusive E-cigarette Users (7.4 points; 95% CI = 1.1, 13.7; p = 0.02) and Dual Users (3.7 points; 95% CI = 0.0, 7.1, p = 0.03), interaction p = 0.28 (Table 2). Among Exclusive E-cigarette Users, 29.7% of YAs randomized to Intervention were Dual Abstinent (95% CI = 25.0, 34.8) compared to 22.3% of Control (95% CI = 18.3, 26.8). Among Dual Users, 10.3% of Intervention participants were Dual Abstinent (95% CI = 7.9, 13.2) compared to 6.6% of Control (95% CI = 4.6, 9.0).

Was there an interaction effect between vaping status at 7 months and baseline tobacco product use on cannabis use outcomes?

Among adolescents, the difference in cannabis use at follow-up between continuing vapers and vaping abstainers was significantly weaker among baseline Exclusive E-cigarette Users than among baseline Dual Users (interaction p < 0.001). As shown in Supplemental Table 1, among 258 adolescent baseline Exclusive E-cigarette Users, cannabis use at 7 months was reported by 31.1% (95% CI = 23.4, 39.6) of those who were still nicotine vaping versus 21.1% (95% CI = 14.8, 29.2) of those who were vaping abstinent, a 10% point difference (95% CI = −0.8, 20.3). Among 758 baseline Dual Users, cannabis use at 7 months was reported by 77.3% (95% CI = 72.9, 81.3) of those who were still nicotine vaping versus 36.1% (95% CI = 31.1, 41.3) of those who were vaping abstinent, a 41.3% point difference (95% CI = 34.5, 47.4). In total, 97 out of 258 baseline Exclusive E-cigarette Users were dual abstinent (37.6%) compared to 225 out of 758 baseline Dual Users (29.7%), a significant difference at p = 0.019.

Among YAs, the difference in cannabis use at follow-up between continuing vapers and vaping abstainers was comparable (interaction p = 0.81) for baseline Exclusive E-cigarette Users and baseline Dual Users. As shown in Supplemental Table 2, among 747 YA baseline Exclusive E-cigarette Users, cannabis use at 7 months was reported by 27.2% (95% CI = 23.4, 31.2) of continuing nicotine vapers versus 16.8% (95% CI = 12.2, 22.3) of vaping abstainers, a 10.4% point difference (95% CI = 3.9, 16.2, p < 0.001). Among 1,082 baseline Dual Users, cannabis use at 7 months was reported by 79.5% (95% CI = 76.5, 82.2) of continuing nicotine vapers versus 68.1% (95% CI = 62.3, 73.4) of vaping abstainers, an 11.4% point difference (95% CI = 5.5, 17.6). In total, 193 out of 747 baseline Exclusive E-cigarette Users were dual abstinent (25.8%) compared to 92 out of 1082 baseline Dual Users (8.5%), a significant difference at p < 0.001.

Discussion

This study provides the first evidence that a text message intervention designed to promote nicotine vaping cessation also promoted dual abstinence from both nicotine e-cigarettes and cannabis among adolescents and young adults. The observed treatment effect is particularly noteworthy given that the intervention contained no explicit cannabis-specific content, highlighting the potential for spillover effects across substances that share common use patterns, contexts, and delivery mechanisms. The magnitude of the treatment effect was substantial, with the intervention demonstrating a 13.5% point advantage over control in promoting dual abstinence among adolescents (38.5% vs. 25.0%) and a 4.6% point advantage among young adults (17.9% vs. 13.3%). Importantly, these treatment effects were observed regardless of baseline cannabis use status, indicating the intervention’s broad efficacy across different patterns of substance use. The stronger effect observed in adolescents compared to young adults suggests potentially greater malleability of substance use behaviors during earlier developmental stages.

Several mechanisms may explain this beneficial spillover effect on cannabis use. First, it may reflect the increasingly common practice of cannabis vaping [37] the use of electronic delivery systems similar or identical to those used for nicotine to aerosolize liquid tetrahydrocannabinol (THC). When young people successfully quit using their vaping devices for nicotine, this behavior change would naturally extend to decreased cannabis consumption via the same delivery method, creating an incidental cessation effect for both substances simultaneously. Additionally, as young people stopped using e-cigarettes, they may have experienced decreased exposure to the people, places, and cues associated with cannabis use. The fact that baseline dual users who successfully quit vaping were significantly less likely to continue cannabis use compared to those who continued vaping aligns with this hypothesis. Second, participation in a cessation study may have triggered broader self-reflection about substance use patterns, prompting young people to reconsider their cannabis use independently. Third, the cognitive and behavioral skills taught for nicotine vaping cessation (e.g., identifying triggers, developing coping strategies, building self-efficacy) may have generalized to cannabis use behaviors through shared psychological mechanisms of behavior change. Fourth, the text message intervention may have resonated with dual users’ motivations to reduce multiple substances. Finally, young people’s perceptions of health risks associated with vaping may have extended to cannabis due to shared delivery mechanisms and overlapping health concerns. While some observed changes in cannabis use may reflect experimentation, the significant treatment group differences and interaction effects with vaping cessation status suggest intervention-specific mechanisms beyond spontaneous cessation patterns. These potential mechanisms represent a critical area for future research that could inform more efficient interventions addressing polysubstance use.

While these findings demonstrate promising spillover effects, they also reveal important heterogeneity in treatment response that has implications for future intervention development. The lower dual abstinence rates among baseline dual users compared to exclusive e-cigarette users suggest that while some young people may benefit from shared behavioral strategies that address both nicotine vaping and cannabis use simultaneously, individuals with established patterns of polysubstance use may require additional or enhanced intervention components beyond those targeting nicotine vaping alone. The nature of this additional support – whether it involves cannabis-specific content, modified behavioral strategies, increased intervention intensity, or entirely different therapeutic approaches – represents a critical area for future research. Developing and testing interventions that systematically address both substances while identifying which young people are most likely to benefit from integrated versus sequential treatment approaches are critical next steps.

The remarkably high rates of cannabis use observed in both trials (74.6% among adolescents and 59.2% among young adults) far exceeded national prevalence estimates from population-based surveys (approximately 25% for adolescents and 23% for young adults [38]). This disparity suggests that young people who vape nicotine represent a distinct high-risk population for polysubstance use. Notably, similarly high rates of cannabis use (71%) were reported in another recent vaping cessation trial targeting 16- to 25-year-olds [12], confirming that this pattern is not unique to our sample but rather characteristic of young people seeking nicotine vaping cessation support.

A notable age-related pattern emerged in our data: while adolescents reported higher baseline rates of cannabis use compared to young adults (74.6% vs. 59.2%), they also demonstrated substantially greater reductions in cannabis use at follow-up (24.5% points vs. 4.2% points). Adolescents also achieved higher rates of dual abstinence compared to young adults (31.7% vs. 15.6%), suggesting that younger populations may be more responsive to cessation interventions, potentially due to shorter duration of use, less entrenched habits, or greater neuroplasticity during this developmental period [39].

This study has several notable strengths. To our knowledge, it is the first to document treatment effects on cannabis use from a nicotine vaping cessation intervention that did not explicitly target cannabis. This finding is significant as it provides evidence that substance-specific interventions may yield beneficial effects on other substances, potentially reducing implementation burden for addressing multiple substance use. The large sample sizes across two distinct age groups enhance the generalizability of our findings and allow for meaningful age comparisons, which are particularly important given developmental differences in substance use patterns and cessation outcomes. Additionally, the randomized controlled trial design with high follow-up rates and no differential attrition provides robust evidence of intervention effects while mitigating selection bias.

An important limitation of our study is that assessment of cannabis use did not distinguish between different modes of administration (e.g., smoking, vaping, dabbing, edible). This limitation prevents us from determining whether reported reductions were specific to certain modes of administration, particularly vaping. We also cannot examine whether the intervention might have had stronger effects on cannabis vaping specifically, given similarities with nicotine vaping in terms of behavior patterns, devices, and contexts of use. Future research should assess mode of administration to enable more nuanced analyses of cessation patterns and intervention effects across different cannabis products. A second limitation is that abstinence from vaping and cannabis were not biochemically verified. Biochemical verification of substance use has shown to be challenging in other digital cessation studies [40]. Despite reliance on self-reported data that may be susceptible to social desirability bias, this low-intensity, fully automated intervention trial with low-demand characteristics that did not explicitly intend to address cannabis use, rates of misreporting are anticipated to be minimal. Two aspects of our measurement approach warrant comment: examination of interim timepoints beyond baseline and 7-month endpoints could provide important insights into the temporal dynamics of behavior change, and our use of a 30-day assessment window for cannabis use may not have captured infrequent or experimental use patterns, potentially underestimating baseline prevalence of cannabis use or overestimating cessation rates among less-than-monthly users. Another limitation is that both trials were conducted during the COVID-19 pandemic, which introduced unique stressors [41] and altered substance use patterns among young people [42, 43]. This context may have influenced both baseline substance use rates and cessation outcomes in ways that limit generalizability to non-pandemic conditions.

Conclusions

A text message nicotine vaping cessation intervention was effective in promoting abstinence from nicotine e-cigarettes and cannabis among adolescents and young adults, with stronger effects observed in adolescents. Treatment efficacy was comparable across exclusive e-cigarette users and dual users, though baseline exclusive e-cigarette users achieved higher dual abstinence rates. These findings demonstrate that substance-specific interventions can yield broader health benefits across multiple substances simultaneously, while also highlighting the need for enhanced approaches specifically targeting young people who use multiple substances.

Continued monitoring of substance use patterns among youth is needed given the evolving e-cigarette and cannabis landscape. The increasing prevalence of co-use highlights the growing need for concurrent treatment approaches [11]. This study demonstrates a promising, efficient pathway to address polysubstance use by leveraging existing intervention frameworks, potentially reducing implementation burden while maximizing public health impact.

Source: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-025-00679-1

Filed under: Cannabis/Marijuana,Culture,Drug use-various effects,Prevention and Intervention,Tobacco, smoking,USA,Vaping,Youth :

Abstract

Alcohol, tobacco, and drug misuse continue to rise globally, with adolescents at particular risk. In response, school-based prevention programs have been widely implemented, yet their efficacy and long-term impact remain under-discussed. This scoping review synthesised evidence on the effectiveness of three commonly used programs (Preventure, Unplugged, and IPSYcare) in Europe. A search of four databases (PubMed, Embase, PsycInfo, and Web of Science) identified 21 peer-reviewed articles published between 2008 and 2023, spanning 12 European countries. Unplugged was most frequently evaluated (10 studies), followed by Preventure (6 studies) and IPSYcare (5 studies). Findings showed that Preventure yielded mixed outcomes, delaying binge drinking and reducing substance use among high-risk groups but with limited generalisability. Unplugged was associated with reductions in cannabis use and heavy drinking at 15 months post-intervention. IPSYcare demonstrated longer-term benefits, including improved school connectedness and reductions in alcohol and tobacco use. Results suggest that while standardised programs such as Unplugged enable scalability, contextual adaptations may enhance effectiveness, and tailored approaches are valuable for high-risk populations. Overall, the programs show potential, but variability indicate the need for further longitudinal and qualitative research in order to improve program delivery and sustain long-term impacts.

Source: https://pubmed.ncbi.nlm.nih.gov/41154973/

Filed under: Alcohol,Drug use-various effects on foetus, babies, children and youth,Europe,Prevalence,Prevention and Intervention,Tobacco, smoking,Youth :

Press Release – Washington, DC – October 09, 2025

A popular class of therapies for treating diabetes and obesity may also have the potential to treat alcohol and drug addiction, according to a new paper published in the Journal of the Endocrine Society.

The therapies, known as Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs), present an encouraging approach to treating alcohol and other substance use disorders.

“Early research in both animals and humans suggests that these treatments may help reduce alcohol and other substance use,” said lead researcher Lorenzo Leggio, M.D., Ph.D., of the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), both part of the National Institutes of Health (NIH) in Bethesda, Md. “Some small clinical trials have also shown encouraging results.”

Current Treatment Options Are Limited

Substance use disorders are diagnosed based on criteria that can be grouped into four categories: physical dependence, risky use, social problems, and impaired control.

The negative consequences of substance use disorders represent a global problem, affecting individuals, families, communities, and societal health at large. For instance, research indicates that alcohol is the most harmful drug, with consequences that extend beyond individual health to include related car accidents as well as gun and domestic violence, researchers note.

Despite the high prevalence and consequences of alcohol and other substance use disorders, less than a quarter of people received treatment in 2023.

Underutilization is due to a variety of barriers at the patient, clinician, and organizational levels, not the least of which is the stigma associated with substance use disorders, according to the study. “Current treatments for [alcohol and other substance use disorders] fall short of addressing public health needs,” the researchers wrote.

GLP-1s and Their Potential to Treat Addiction

GLP-1 therapies have gained widespread renown in recent years for their ability to address obesity and significantly reduce weight.

In addition to its inhibitory effects on gastrointestinal systems, GLP-1 has key functions in the central nervous system, the study notes. Among them, GLP-1R activation within the central nervous system curbs appetite and encourages individuals to eat when hungry and stop eating when they are full.

Some forms of obesity have been shown to present biochemical characteristics that resemble addiction, including neurocircuitry mechanisms, the study says, acknowledging that such conclusions are controversial.

“Pathways implicated in addiction also contribute to pathological overeating and obesity,” the study says.

With this pathway in mind, researchers in recent years have looked at GLP-1s as a potential therapy to address substance use disorders. Preclinical and early clinical investigations suggest that GLP-1 therapies modulate neurobiological pathways underlying addictive behaviors, thereby potentially reducing substance craving/use while simultaneously addressing comorbid conditions.

Studies that examine GLP-1 effects on substance use disorders include:

Alcohol use disorder (AUD): A randomized controlled trial with exenatide, the first GLP-1receptor agonist approved for diabetes, showed no significant effect on alcohol consumption, although a secondary analysis indicated reduced alcohol intake in the subgroup of people with AUD and comorbid obesity. A more recent randomized controlled trial showed that low-dose semaglutide — a newer GLP-1 receptor agonist approved for both diabetes and obesity —reduced laboratory alcohol self-administration, as well as drinks per drinking days and craving, in people with AUD.
Opioid use disorder: In rodent models, several GLP-1 receptor agonists have been shown to reduce self-administration of heroin, fentanyl and oxycodone. The studies also found that these medications reduce reinstatement of drug seeking, a rodent model of relapse in drug addiction.
Tobacco use disorder: Preclinical data show that GLP-1 receptor agonists reduce nicotine self-administration, reinstatement of nicotine seeking, and other nicotine-related outcomes in rodents. Initial clinical trials suggest the potential for these medications to reduce cigarettes per day and prevent weight gain that often follows smoking cessation.

Leggio and his colleagues caution that more and larger studies are needed to confirm how well these treatments work. Additional studies will help unveil the mechanisms underlying GLP-1 therapies in relation to addictive behaviors and substance use.

But that hasn’t dampened the optimism for these therapies to address the serious problems found in substance use disorders.

“This research is very important because alcohol and drug addiction are major causes of illness and death, yet there are still only a few effective treatment options,” Leggio said. “Finding new and better treatments is critically important to help people live healthier lives.”

Other study authors are Nirupam M. Srinivasan of the University of Galway in Galway, Ireland; Mehdi Farokhnia of NIDA and NIAAA; Lisa A. Farinelli of NIDA; and Anna Ferrulli of the University of Milan and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) MultiMedica in Milan, Italy.

Research reported in this press release was supported in part by NIDA and NIAAA. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Source: https://www.endocrine.org/news-and-advocacy/news-room/2025/glp1s-show-promise-in-treating-alcohol-and-drug-addiction

Filed under: Addiction,Alcohol,Drug use-various effects,Tobacco, smoking,Treatment and Addiction,USA :

by Herschel Baker – Director Queensland Director, Drug Free Australia – 03 August 2025

Story by Kat Lay, Global health correspondent

Avatars smoke in an image shared on social media of a gathering in the metaverse. A packet of Djarum LA cigarettes, an Indonesian brand, sit on the table. Photograph: iceperience.id Instagram via Canary© Photograph: iceperience.id Instagram via Canary

In the image, a group of friends is standing in a bar, smoke winding upwards from the cigarettes in their hands. More lie in an open packet on the table between them. This is not a photograph taken before smoking bans, but a picture shared on social media of a gathering in the metaverse.

Virtual online spaces are becoming a new marketing battleground as tobacco and alcohol promoters target young people without any legislative consequences.

A report shared at the World Conference on Tobacco Control last month in Dublin set out multiple examples of new technologies being adopted to promote smoking and vaping, including tobacco companies launching digital tokens and vape companies sponsoring online games.

It comes from a monitoring project known as Canary – because it seeks to act as the canary in a coalmine – run by the global public health organisation Vital Strategies.

“Tobacco companies are no longer waiting for regulations to catch them up. They are way ahead of us. We are still trying to understand what we’re seeing in social media, but they’re already operating in unregulated spaces like the metaverse,” says Dr Melina Magsumbol, of Vital Strategies India. “They’re using NFTs [non-fungible tokens]. They’re using immersive events to get our kids to come and see what they’re offering.”

In India, one tobacco company made and promoted an NFT, which represents ownership of digital assets, to celebrate its 93rd anniversary.

Canary scans for and analyses tobacco marketing on social media platforms and news sites in India, Indonesia and Mexico. It is expanding to more countries, including Brazil and China, and to cover alcohol and ultra-processed food marketing.

Digital platforms are being used to bypass traditional advertising restrictions and target young audiences

Melina Magsumbol, Vital Strategies India

It is not set up to scan the metaverse – a three-dimensional, immersive version of the internet that uses technology such as virtual reality headsets to enable people to interact in a digital space. But it has picked up references to what is going on there via links and information shared on older social media sites.

Researchers say that children are likely to be exposed to any tobacco marketing in the new digital spaces given the age profile of users – more than half of the metaverse’s active users are aged 13 and below.

Social media companies have deep knowledge of how to drive engagement and keep people coming back for more views, says Dr Mary-Ann Etiebet, chief executive of Vital Strategies.

“When you combine that with the experience and the knowledge of the tobacco industry on how to hook and keep people hooked … those two things together in a space that is unknown and opaque – that scares me.”

Mark Zuckerberg, metaverse’s prominent backer, says in future “you’ll be able to do almost anything you can imagine” there. Already, that includes shopping and attending virtual concerts.

But Magsumbol describes it as “a new battleground for all of us” that is “being taken over by corporate entities that actually push health-harming products”.

“My daughter is very quiet, she’s an introvert. But online, on [gaming platform] Roblox, when she is killing zombies and ghosts, she morphs into a different avatar – she’s like Alexander the Great mixed with Bruce Lee and John Wick. She is so bloodthirsty,” she says.

“Online we behave differently. Social norms change … the tobacco industry knows that very well. And it’s so easy to subtly sell the idea that you can be anything, anyone you want.”

The metaverse art the team saw in Indonesia was shared on an Instagram account for electronic music lovers linked to Djarum, one of Indonesia’s largest cigarette companies. Another example showed a group having coffee, and looking for a lighter.

It all amounts to efforts to “normalise” smoking and vaping, says Magsumbol. “This kind of behaviour is happening and being done by your avatars, but is it seeping into your real life?

“Digital platforms are being used to bypass traditional advertising restrictions and target young audiences,” she says. “What we’re seeing here is not just a shift in marketing, it’s a shift in how influence works.”

Other researchers have set out examples of alcohol being promoted and even sold in virtual stores.

Online marketing is a global issue. At the same conference, Irish researchers shared findings that 53% of teenagers saw e-cigarette posts daily on social media.

A World Health Organization official (WHO) says a rise in youth smoking in Ukraine is due, in part, to Covid and the war pushing children “too much online” and exposing them to marketing.

Related: Vapes threaten to undo gains in tackling dangers of tobacco, health leaders warn

In India, Agamroop Kaur, a youth ambassador at the Campaign for Tobacco-Free Kids, includes social media marketing when speaking to schoolchildren about the dangers of tobacco and vaping. She has seen vapes suggested as a “wellness” item.

“I think educating youth on what an advertisement looks like, why it’s false, how you might not even see that it’s from the tobacco industry and it’s [content posted by an] influencer is really powerful because then that builds a skill – so that when they’re on social media, because they are digital natives, they’re able to see all of that and know that it’s fake and it’s not something they should be attracted by. I think building those skills early from high school to middle school, and even younger, is really important.”

The WHO Framework Convention on Tobacco Control requires countries to implement bans on tobacco advertising, promotion and sponsorship. Last year, signatories agreed that action was needed to tackle the increasing focus on “digital marketing channels such as social media, which increases adolescent and young people’s exposure to tobacco marketing”.

But there is no easy answer, says Andrew Black at the framework’s secretariat.

“The challenge of regulating the internet is not a problem that’s unique to tobacco. It’s a real challenge for governments to think about how they can provide the protections that society is used to in a world where borders are broken down because of these technologies.”

Nandita Murukutla, who oversees Canary, says regulators should take note: “What starts out small and you ignore, rises up to a certain point when you’ve got critical mass, and after that, it just explodes, and dialing something back is virtually impossible.”

Herschel Baker

International Liaison, Director Queensland Director, Drug Free Australia – Web https://drugfree.org.au/

Source: https://www.msn.com/en-au/news/other/smoking-avatars-and-online-games-how-big-tobacco-targets-young-people-in-the-metaverse/ar-AA1J2WHU?

Filed under: Australia,Drug use-various effects,Nicotine,Tobacco, smoking,Vaping,Youth :

by Hailey M. Warner and Kelly Corr

ESSAY — Volume 22 — July 17, 2025

Although cigarette use among high school students and adults has declined since its peak in 1997, in North Dakota, nearly 1 in 3 high school students instead use e-cigarettes, and approximately 1 in 5 adults continue to smoke (1). The prevalence of tobacco and nicotine dependence poses substantial public health challenges, especially in rural communities (2).

More than 480,000 people, equivalent to the average capacity of 8 professional football stadiums, die from cigarette smoking annually in the US (3). In North Dakota, 1,000 adult deaths annually are attributed to cigarette use (1). Of cancer-related deaths in North Dakota, approximately 1 in 4 are associated with smoking (1). Cigarette use results in a high economic burden: in 2018, it cost the US more than $600 billion, including $240 billion in health care spending and nearly $185 billion in lost productivity due to smoking-related illnesses and health conditions (4). In 2021, health care expenditures attributed to tobacco use in North Dakota totaled $326 million, approximately equivalent to spending $421 for each person living in the state that year (1). Annual smoking-related lost productivity equates to nearly $185 billion in the US and $233 million in North Dakota (1,4). It is clear why the Centers for Disease Control and Prevention cites cigarette smoking as the leading cause of preventable disease, disability, and death in the US (3).

Smoking is a behavior that can harm nearly every organ in the human body, increasing the risk of heart disease, stroke, lung disease, diabetes, and cancer, and resulting in a substantial impact on population health (3). This essay explores and promotes providing tobacco and nicotine dependence treatment in the community pharmacy setting to increase patient care opportunities and improve health outcomes, particularly in rural areas.

The Profession of Pharmacy

Pharmacists are highly accessible and trusted health care professionals (5). Community pharmacies are a key component of the health care system, especially in rural, medically underserved areas, and they present an opportunity to help people quit using tobacco and nicotine products (5). Our ethnographic graduate research focuses on piloting an education-based intervention to assist independent community pharmacies in North Dakota in addressing tobacco and nicotine use among their clients. Our preliminary research results support the concept that in smaller communities, people often have close relationships with each other, including their local pharmacist. In one of our research pilot sites, a pharmacy in a rural town, a staff pharmacist said, “We care about our patients, and we want the best for their health.” To expand their scope of practice and fill gaps in access to health care services, independent community pharmacies are increasingly offering clinical services and improving patient outcomes (6).

Tobacco and Nicotine Dependence Treatment

Smoking cessation, the process of quitting the use of cigarettes, is more formally called tobacco dependence treatment (7). To encompass cigarette use as well as use of other tobacco or nicotine products, we use the term “tobacco and nicotine dependence treatment.” The main components of this treatment are behavioral therapies and medications. Among the behavioral therapy options are cognitive behavioral therapy, motivational interviewing, mindfulness practices, and support from technology-based options such as telephone quitlines, text message communications, or online media platforms (7). Nicotine replacement therapy (NRT) products are offered in various formulations, including patches, gum, lozenges, and nasal spray. All NRT products are deemed equally effective and are estimated to increase treatment success by 50% to 70% (7). Multiple NRT products can be used concurrently and are thought to provide better relief of withdrawal symptoms and cravings (7). The US Food and Drug Administration (FDA) has approved bupropion and varenicline as oral tobacco cessation medications. Bupropion and NRT have been shown to be equally effective, and some studies suggest varenicline is more effective than bupropion alone or the use of a single form of NRT (7). Bupropion and varenicline can be used in combination with NRT, which allows prescribers to tailor a person’s tobacco and nicotine dependence treatment plan to their individual needs (7).

Implementing Tobacco and Nicotine Dependence Treatment in Community Pharmacies

The implementation of tobacco and nicotine dependence treatment in community pharmacies can bolster the clinical capabilities and public health impact of community pharmacies. As of March 2025, eighteen states had implemented legislation allowing pharmacists prescriptive authority to provide patients with tobacco and nicotine dependence treatment medications (8). Of these, 9 states allow pharmacists to prescribe all medications approved by the FDA for smoking cessation, and the other 9 allow NRT only (8). In 2021, pharmacists in North Dakota were granted the authority to independently prescribe all FDA-approved medications, including varenicline, bupropion, and NRT (9). In the following year, the state’s Medicaid program expanded their coverage to include tobacco and nicotine dependence counseling provided by pharmacists (10). This expanded coverage broadened the impact of pharmacists on the adult Medicaid population in North Dakota, whose prevalence of smoking is more than double the prevalence among all adults in the state (39.1% vs 17.4%) (10).

Other insurers permit pharmacists to become recognized as medical providers, which allows them to submit reimbursement claims for tobacco and nicotine dependence treatment consultations as well as for the medications and NRT products they prescribe (5). These additional incentives may increase the number of encounters between pharmacists and people who smoke and lead to a reduction in cigarette use. During an unstructured interview conducted as part of our ethnographic graduate research, a pharmacist offering tobacco and nicotine dependence treatment services said, “These people have control over it [their tobacco and nicotine use]. If we can get them to stop, they can have such a better life. I honestly . . . I feel very strongly about this.”

Some independently owned community pharmacies in North Dakota have become pioneers in offering tobacco and nicotine dependence treatment to their patients. They use Ask-Advise-Refer/Connect, a method that combines the approaches of Ask-Advise-Refer and Ask-Advise-Connect (11). Both approaches share the steps of engaging patients by asking about tobacco use and advising them to quit. The difference lies in what actions are taken in the last step. In Ask-Advise-Refer, the patient is given a referral to a resource for quitting, whereas in Ask-Advise-Connect, the patient is directly connected to a resource for quitting (11). A pharmacist using Ask-Advise-Refer/Connect can choose to make a referral or connect with the patient to provide treatment at the pharmacy, whichever the patient prefers (11). Referrals can be made to state quitlines or local public health units, which assist in providing behavioral counseling and free NRT products. Because pharmacists in North Dakota have the authority to prescribe tobacco and nicotine dependence treatment medications, patients who are ready to quit can be immediately connected to pharmacists and receive treatment at the pharmacy. Regardless of whether a patient is provided with a referral or a connection, the pharmacist should follow up with patients on their progress toward cessation during future pharmacy visits. The second author (K.C.) developed a flowchart describing how a patient progresses through a tobacco and nicotine dependence treatment support process.

Figure.
Basic pharmacy workflow for tobacco and nicotine dependence treatment in North Dakota. NDQuits is the state tobacco quitline. Over-the-counter (OTC) products refer to nicotine replacement products that can be acquired without a prescription. [A text version of this figure is available.]

Call to Action

Pharmacists are called to be public health professionals and capitalize on opportunities to provide tobacco and nicotine dependence treatment for their patients, especially in rural areas. This expansion of services necessitates strengthening knowledge of tobacco and nicotine dependence treatment medications, learning how to provide behavioral counseling, and completing the requirements to be recognized as a provider of tobacco and nicotine dependence treatment services by health insurers.

The training of pharmacy students should be studied to ensure they can take the initiative to offer new services, apply population health strategies, and as a result, better serve their patients’ health care needs. Practicing pharmacists may need to refresh their knowledge and skills to provide tobacco and nicotine dependence treatment. Continuing education is a professional requirement, and pharmacists should actively seek opportunities to learn about topics such as motivational interviewing, tobacco and nicotine dependence treatment counseling, and current trends in tobacco use. In states where tobacco and nicotine dependence treatment provided by pharmacists is not yet authorized, pharmacists are encouraged to work with their board of pharmacy and local pharmacy organizations to advocate for expanding patients’ access to clinical services in community pharmacy settings.

Billions of dollars and hundreds of thousands of lives are lost to cigarette smoking every year in the US. Promoting pharmacy services and ensuring future pharmacists’ readiness for success should be a top priority for the profession. The next step toward preventing the disease, disability, and death attributable to tobacco use lies with pharmacists implementing tobacco and nicotine dependence treatment in community pharmacies across the country.

Source: https://www.cdc.gov/pcd/issues/2025/25_0088.htm

Filed under: Addiction,Brain and Behaviour,Nicotine,Tobacco, smoking,USA :

Published by NIH/NIDA 14 May 2025

Cannabis vaping is making headlines worldwide, often promoted as a “safer” alternative to smoking. Meanwhile, Drug Trends data from Australia reveal that non-prescribed cannabis use remains high among people who regularly use drugs. But are wider permission models and positive propaganda about cannabis leading to greater engagement, especially among those most at risk? This article dives into Australian data from the Ecstasy and Related Drugs Reporting System (EDRS) and Illicit Drugs Reporting System (IDRS), exploring what’s really happening with cannabis products, vaping, and why honest health education is more critical than ever.

Cannabis Vaping and Drug Trends in Australia (2014–2024): What the Data Tells Us

Cannabis vaping, once an afterthought, now claims a growing share of the global market. Many believe vaping to be less harmful, with marketers highlighting vaping’s lack of smoke and alleged respiratory benefits. However, recent Drug Trends research in Australia challenges some of these assumptions and uncovers troubling patterns.

The Rise of Electronic Vaping Products

Electronic vaping products started as oversized gadgets in the late 1990s. Initially intended to vaporise dried cannabis herb, they eventually shrank, morphing into today’s sleek e-cigarettes. While vaping nicotine products has become mainstream, cannabis vaping is following close behind, spurred in part by changes to medicinal and recreational cannabis laws overseas.

A North American review found a seven-fold increase in monthly cannabis vaping among adolescents, with notable shifts from dried herb to potent cannabis oils. However, the situation in Australia is different, shaped by stricter regulations and unique market conditions.

Drug Trends in Non-Prescribed Cannabis Use

Australia’s EDRS and IDRS surveys collect real-world data on non-prescribed cannabis and cannabinoid-related products. Between 2014 and 2024, most participants in both systems reported using cannabis recently, with rates as high as 90% in the EDRS and 74% in the IDRS.

Hydroponic and Bush Cannabis Still Dominate

Hydroponic cannabis was the most popular, with usage rates ranging from 63%–83% among EDRS respondents, and a remarkable 88%–94% for IDRS participants.
Bush cannabis also stayed common, with 51%–77% (EDRS) and 37%–54% (IDRS) reporting use.
Other cannabis products, such as THC extracts and commercially-prepared edibles, have appeared in recent years, showing increased product diversity—but are far less popular than traditional forms.

Cannabis Vaping Emerges, But Smoking Prevails

Despite media attention around cannabis vaping, the majority of Australians captured in these studies still smoke cannabis. From 2014 to 2024:

Smoking remained the dominant route of administration (ROA) in both groups.
Cannabis vaping (inhaling/vaporising) trended upward, but stayed a minority choice. Vaporising among EDRS participants increased from 12% to 25%, and from 2% to 9% for IDRS.

Notably, few users chose vaping as their only method. Most combined it with smoking, suggesting the rise in vaping hasn’t replaced traditional habits.

Concerns About Cannabis Vaping and Permission Models

The Problem with Changing Perceptions

There is growing concern that permission models and positive messaging around cannabis use (whether through legislation or social media) may downplay its risks. Vaping, in particular, is surrounded by claims of being a “safer” alternative to smoking. While it’s true that vaping doesn’t involve combustion and may expose users to fewer toxic chemicals, it’s not risk-free.

Key Issues Include:

Potency extremes: Some vape oils and extracts reach THC concentrations of 70–90%, far higher than the average 10%–20% in cannabis herb. Highly potent products carry greater risks for dependence, anxiety, and psychosis.
Unknown health risks: The long-term effects of inhaling cannabis vapour, especially from unregulated or home-made devices, are not fully understood.
Discreet use and normalisation: Portability and subtlety make vaping easier to hide, particularly from parents and teachers. For some users, this can enable more frequent use or uptake at a younger age.
Unhealthy dual use: Most vapers continue smoking, increasing overall exposure to both methods. (for complete research WRD News)

Source: https://www.dalgarnoinstitute.org.au/index.php/resources/drug-information-sheets/2672-cannabis-vaping-and-drug-trends-among-youth-in-australia-2014-2024-a-growing-concern?

Statement by the Queensland Cabinet and Ministerial Directory

Published Tuesday, 06 May, 2025 at 10:09 AM

The Honourable Tim Nicholls – Minister for Health and Ambulance Services

Record-breaking raids in war on illicit tobacco and dangerous vapes

Queensland has seized the nation’s largest ever haul of illegal cigarettes and vapes by a health authority, under Queensland Health-led Operation Appaloosa.
More than 30 locations were raided, with 76,000 vapes, 19 million cigarettes and 3.6 tonnes of loose tobacco seized.
The raids come as more than $5 million in fines were issued in the first week of the Government’s nation-leading fines – over $1 million more than in the final four months of Labor.

Queensland has stepped up the war against illicit tobacco and dangerous vapes, with the nation’s largest ever haul of illegal products by a health authority, in an effort to keep them out of the hands of kids.

More than 76,000 vapes, 19 million illicit cigarettes and 3.6 tonnes of loose illicit tobacco – with a combined estimated street value of $20.8 million – were seized during the record-breaking Operation Appaloosa in March.

Queensland Health raided more than 30 locations across Central Queensland, Wide Bay, Metro North, Metro South, and West Moreton, supported by the Queensland Police Service and the Therapeutic Goods Administration.

This crackdown came ahead of the 3 April 2025 commencement of the nation’s toughest on-the-spot fines for the sale of illicit tobacco and vapes, which means individuals can be fined $32,260 and businesses up to $161,300 if caught selling illicit tobacco and vapes.

In just the very first week of these new fines, illegal traders were hit with fines totalling $5,094,560. To put that into perspective, Labor averaged less than $250,000 in fines per week in their final months in office.

Minister for Health Tim Nicholls said the Crisafulli Government was determined to keep dangerous vapes out of the hands of children by stamping out illegal chop shops.

“Labor allowed organised crime gangs to set up illegal chop shops in plain sight across the State, putting our kids at great risk,” Minister Nicholls said.

“We need to do everything possible to keep dangerous illegal vapes away from Queensland’s young people, which is why we’ve boosted enforcement and introduced serious new fines.

“We’re hitting these illegal traders where it hurts most, by seizing their illicit goods to deprive them of generating a profit and hitting them with the nation’s toughest fines.

“The is the latest in our crackdown on illegal chop shops and we’ll continue to target this organised crime and keep dangerous vapes out of the hands of kids.”

Illicit tobacco or vape sales can be reported via the Queensland Health website or calling 13 QGOV (13 74 68).

Source: https://statements.qld.gov.au/statements/102504#:~:text=Queensland%20has%20s

Filed under: Australia,Crime/Violence/Prison,Tobacco, smoking,Vaping :

Abstract

The prevalence of substance use disorders in adults is higher if substance use is initiated during adolescence, underscoring the importance of youth substance use prevention. We examined whether the use of one substance by adolescents is associated with increased risk for using any other substance, regardless of use sequences. In 2017 we examined data from 17,000 youth aged 12–17 who participated in the 2014 National Survey on Drug Use and Health, a sample of nationally representative data on substance use among the U.S. civilian, noninstitutionalized population aged 12 or older. Descriptive analyses and multivariable logistic regression models were applied. After controlling for age, sex, and race/ethnicity, compared with youth without past-month marijuana use, youth with past-month marijuana use were 8.9 times more likely to report past-month cigarette use, 5.6, 7.9 and 15.8 times more likely to report past-month alcohol use, binge use, or heavy use (respectively), and 9.9 times more likely to report past-month use of other illicit drugs. The prevalence of past-month use of cigarettes, marijuana, and other illicit drugs was significantly higher among past-month alcohol users compared with youth without past-month alcohol use, and increased as intensity of alcohol use rose. Among past-month cigarette smokers, the prevalence of marijuana, other illicit drugs, and alcohol use were each significantly higher than youth without past-month cigarette use. Youth marijuana use, cigarette smoking, or alcohol consumption is associated with other substance use. This finding has importance for youth prevention, supporting a message no use by youth of any substance.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0091743518301658?via%3Dihub

Filed under: Alcohol,Cannabis/Marijuana,Tobacco, smoking,Youth :

Author(s): Hannah Elmore, PharmD,John Handshaw, PharmD, BCACP – December 23, 2024

Pharmacists can help address nicotine addiction by recommending FDA-approved smoking cessation methods and educating on the risks associated with electronic cigarette use.

Electronic cigarettes (E-cigarettes) have emerged as a popular alternative to traditional smoking. This method, known as vaping, involves inhaling an aerosol that contains nicotine, flavorings, and harmful chemicals including carcinogens, toxic substances, and metals. Nicotine is a highly addictive compound that activates the brain’s reward center by increasing dopamine levels, which creates sensations of pleasure and satisfaction. These euphoric feelings are often what leads to nicotine addiction.¹

Although vaping is often perceived as a safer option, it actually carries significant health risks similar to those of traditional cigarettes. Pharmacists can play a vital role in educating patients on the dangers of vaping and providing guidance on safe and effective smoking cessation methods.

E-cigarettes trace back to the 1960s when British American Tobacco created a smoking device under the codename Ariel. At that time, researchers were already aware of nicotine’s addictive properties, but new evidence linking smoking to lung cancer prompted cigarette companies to try and explore alternative products with less risks. They aimed to create an inhalation device with filters to reduce carcinogens and tar. However, it was discovered that filtered cigarettes were not a healthier alternative because all components of cigarette smoke have proven to be harmful. Additionally, if the device only contained pure nicotine, it would warrant classification as a drug-delivery system, subjecting it to stricter regulations. The company wanted to avoid this in order to bypass the stringent safety evaluations and extensive clinical trials required by drug delivery systems, which would allow the company to reduce their manufacturing costs, speed up production, and take this device to the market quicker. They were able to produce a product with 24% nicotine, which is 6 times the concentration found in traditional cigarettes. Despite this innovation, Ariel was discontinued to protect the company’s profitable traditional cigarette market. This marked the first instance of companies exploring the manipulative potential of nicotine.²

E-cigarettes were officially authorized for sale by the FDA in 2007 with over 460 brands. The most popular brand is Juul, accounting for nearly 75% of the e-cigarettes on the market.^3,4 In 2022, the FDA banned the sale of Juul products due to conflicting evidence regarding its associated risks, including the potential to cause strokes, respiratory failure, seizures, and cases of e-cigarette or vaping-use-associated lung injury (EVALI).⁴ EVALI is a condition in which the lungs become severely damaged and often results in admission to the intensive care unit (ICU) on mechanical ventilation.^3,4

Additionally, there is also a lack of long-term safety data for these products.⁵ Although originally marketed as a healthier alternative to cigarettes, e-cigarettes have not demonstrated efficacy as a smoking cessation aid and rather, have led to a rise in the youth vaping epidemic.¹

There has been a lack of data correlating successful smoking cessation rates among those who use e-cigarettes. There have been a few studies that suggest that vaping may aid in quitting tobacco but is not effective for quitting nicotine use altogether.⁶ One study found that those who utilized e-cigarettes in combination with nicotine replacement therapy (NRT) and counseling were 24.3% less likely to quit smoking compared to those who used only NRT and counseling. Additionally, those who used e-cigarettes were 15.1% more likely to become dual users utilizing both tobacco and vaping products. Those who are considered dual users are at an even higher risk for health complications including myocardial infarction and a 4-fold increase in developing lung cancer.⁶

In another survey of 800 people who utilized vaping as a smoking cessation agent, it was reported that only 9% successfully quit when asked 1 year later, compared to 19.8% who utilized NRT.^1,7 These findings help highlight that vaping is not a reliable method for eliminating nicotine use entirely and can even lead to utilizing both traditional and electronic cigarette products.⁸

Vaping is now the most commonly used form of nicotine among adolescents. A study was conducted that showed high schoolers who had used e-cigarettes were 16.7% more likely to start smoking cigarettes within the next year.⁹ Nicotine’s impact on the developing brain can cause mood disorders, affect attention and learning, and amplify the desire for other mood-enhancing drugs such as cocaine or methamphetamine.¹ In 2018, e-cigarette use among high school students increased by 78%, which led the FDA to enforce stricter regulations on the sale of nicotine products. Despite their efforts, vaping remains a leading challenge that teens face today as they have already fallen victim to nicotine addiction.⁴

The FDA currently lists 7 approved quit aids that are safe and effective for smoking cessation. These include several forms of NRT as well as pharmacologic therapy with bupropion and varenicline. Some of the agents, including the NRT gum, patch, and lozenge, are even available OTC. Pharmacists can play a vital role in smoking cessation, especially in patients who lack access to a primary care provider to obtain prescription medications. Therefore, it is crucial for pharmacists to stay up to date on the current smoking cessation guidelines, dosing recommendations, and counseling points for these agents.

The primary goal of pharmacist-driven smoking cessation should always be to support the patient’s desire to quit smoking. Pharmacists should guide patients toward the FDA-approved agents, either prescription medications through a provider, or OTC therapies in the pharmacy, rather than electronic cigarettes due to lack of supportive data and increased risk for adverse health events. The appropriate selection of FDA-approved agent should be individualized based on the patient’s specific factors, contraindications, and goals of therapy. Pharmacists should educate the patient extensively on the appropriate options for smoking cessation and should not recommend the use of e-cigarettes. However, if a patient decides to use e-cigarettes, pharmacists should still serve as a support system for the patient by being the primary educator and providing extensive counseling on the associated risks of vaping. Patients should be made aware of both the known and unknown adverse reactions associated with electronic cigarettes as well as highlighting that the goal of vaping should be to achieve complete smoking cessation.¹⁰

Vaping e-cigarettes has become a popular alternative to traditional cigarettes, with unknown efficacy and safety surrounding these products.¹⁰ Pharmacists should continue to stay up to date on new literature published on e-cigarettes and should follow the FDA’s suggestions on smoking cessation methods. Pharmacists are the most widely accessible health care professionals available to patients. Therefore, pharmacists have the power and knowledge to be the most influential providers available to advise patients on the correct paths to smoking cessation. By offering education and support, pharmacists can help patients live healthier lives and take steps towards reversing the youth smoking epidemic one education at a time.

Source: https://www.pharmacytimes.com/view/clearing-the-air-the-influence-of-vaping-on-smoking-cessation

Filed under: Prevalence,Tobacco, smoking,USA,Vaping :

SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025

A study that was published last week in Addictive Behaviors found that alcohol and tobacco are more likely to be used on days when marijuana is used.

The study found that individuals consumed an average of 0.45 more alcoholic drinks on days when marijuana was used, compared to days when marijuana was not used. Similarly, the study found that individuals smoked an average of 0.63 more cigarettes on days when marijuana was used. Both of these findings were statistically significant (p=0.01).

Seeking to explain these findings, the researchers posited that “the impact of cannabis use on the endocannabinoid system may reinforce the use of alcohol and tobacco through mechanisms related to psychological reward.” They added that “bidirectionality must be considered,” given that the use of one substance may influence the effect of an additional substance––it may enhance a high, for example.

The researchers noted that “the observed within-person positive associations between cannabis use and same-day alcohol consumption and cigarettes smoked are consistent with previous research that has shown a tendency for substance use behaviors to co-occur.”

Indeed, cross-tabs from the 2023 National Survey on Drug Use and Health found that those who used marijuana in the past 30 days were three times as likely to have smoked cigarettes in the past 30 days (30.8% vs. 10.4%) and 63% more likely to have used alcohol in the past 30 days (70.7% vs. 43.4%), compared to those who did not use marijuana in the past 30 days.

Source: SAM Drug Report’s Friday Fact report – 11:31 Friday 10th Jan 2025 – The Drug Report’s

Smart Approaches to Marijuana (SAM) is an alliance of organizations and individuals dedicated to a health-first approach to marijuana policy. We are professionals working in mental health and public health. We are bipartisan. We are medical doctors, lawmakers, treatment providers, preventionists, teachers, law enforcement officers and others who seek a middle road between incarceration and legalization. Our commonsense, third-way approach to marijuana policy is based on reputable science and sound principles of public health and safety.

Filed under: Alcohol,Cannabis/Marijuana,Tobacco, smoking,USA :

by Brian Anthony Hernandez

Published on December 28, 2024 08:00AM EST

Teen cigarette use in 2024 was the lowest ever recorded since the Monitoring the Future study started tracking it in the 1970s. A national study discovered that teens in the United States consumed significantly less alcohol and drugs in 2024 compared to past years.

Teen alcohol use has steadily decreased from 2000 to 2024 — falling from 73% to 42% in 12th grade, 65% to 26% in 10th grade and 43% to 13% in 8th grade — according to data from Monitoring the Future (MTF), an annual federally funded study.

Every year, the University of Michigan’s Institute for Social Research uses grant money from the National Institute on Drug Abuse to conduct the MTF main study, which surveys more than 25,000 8th, 10th and 12th graders to monitor behaviors, attitudes and values of adolescents.

Meanwhile, the MTF’s panel study does follow-up surveys with roughly 20,000 adults ages 19 to 65 to continue to track trends over time.

The main study found that aside from the “long-term, overall decline” in teen alcohol use, in 2024, “alcohol use significantly declined in both 12th and 10th grade for lifetime and past 12-month use. In 10th grade, it also significantly declined for past 30-day use.”

Binge drinking, which researchers defined as “consuming five or more drinks in a row at least once during the past two weeks,” among teens also declined in 2024 for all three grades compared to 2023 and the past two-and-half decades.

Since 2000, binge drinking has fallen from 30% to 9% in 12th grade, from 24% to 5% in 10th grade and from 12% to 2% in 8th grade.

Teen cigarette use in 2024 was the lowest ever recorded since the survey started tracking 12th graders in 1975 and 10th and 8th graders in 1991.

“The intense public debate in the late 1990s over cigarette policies likely played an important role in bringing about the very substantial downturn in adolescent smoking that followed,” researchers said, adding that “an important milestone occurred in 2009 with passage of the Family Smoking Prevention and Tobacco Control Act, which gave the U.S. Food and Drug Administration the authority to regulate the manufacturing, marketing, and sale of tobacco products.”

Researchers emphasized that “over time this dramatic decline in regular smoking should produce substantial improvements in the health and longevity of the population.”

Teen marijuana use (non-medical) in 2024 also declined for all three grades, with the percentage of students using marijuana in the last 12 months at 26% in 12th grade, 16% in 10th grade and 7% in 8th grade.

“Levels of annual marijuana use today are considerably lower than the historic highs observed in the late 1970s, when more than half of 12th graders had used marijuana in the past 12 months,” researchers reported.

Filed under: Alcohol,Culture,Marijuana and Medicine,Tobacco, smoking,USA,Youth :