{"id":20289,"date":"2025-11-16T18:31:44","date_gmt":"2025-11-16T17:31:44","guid":{"rendered":"https:\/\/drugprevent.org.uk\/ppp\/?p=20289"},"modified":"2025-12-07T18:06:53","modified_gmt":"2025-12-07T17:06:53","slug":"dual-abstinence-from-nicotine-vaping-and-cannabis-use-among-young-people-secondary-analyses-from-two-u-s-based-randomized-controlled-trials-of-vaping-cessation","status":"publish","type":"post","link":"https:\/\/drugprevent.org.uk\/ppp\/2025\/11\/dual-abstinence-from-nicotine-vaping-and-cannabis-use-among-young-people-secondary-analyses-from-two-u-s-based-randomized-controlled-trials-of-vaping-cessation\/","title":{"rendered":"Dual abstinence from nicotine vaping and cannabis use among young people: secondary analyses from two U.S.-based randomized controlled trials of vaping cessation"},"content":{"rendered":"
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from BioMed\/Substance Abuse Policy unit –\u00a0

by\u00a0Amanda L. Graham,\u00a0Sarah Cha,\u00a0\u00a0Elizabeth K. Do,\u00a0\u00a0Megan A.\u00a0 Jacobs,\u00a0\u00a0Giselle Edwards &\u00a0\u00a0George D. Papandonatos\u00a0<\/span><\/h1>\n

Substance Abuse Treatment, Prevention, and Policy<\/i>\u00a0volume<\/span>\u00a020<\/b>, Article\u00a0number:\u00a048\u00a0(2025)\u00a0Cite this article<\/span><\/p>\n

[References not included – ignore all reference numbers. To see references, click on the Source link at the foot of this article]<\/em><\/span><\/p>\n

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Abstract<\/span><\/strong><\/p>\n<\/div>\n<\/div>\n

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Objective<\/span><\/h3>\n

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.<\/span><\/p>\n

Methods<\/span><\/h3>\n

Among adolescents with complete 7-month data (n<\/i>\u2009=\u20091,016) at baseline, 25.4% were\u00a0Exclusive E-cigarette Users<\/i>\u00a0(no past 30-day cannabis use) and 74.6% were\u00a0Dual Users<\/i>\u00a0(past 30-day cannabis use). Among YAs with complete 7-month data (n<\/i>\u2009=\u20091,829), 40.8% were\u00a0Exclusive E-cigarette Users<\/i>\u00a0and 59.2% were\u00a0Dual Users<\/i>\u00a0at baseline. Primary analyses examined the proportion of participants who were\u00a0Dual Abstinent<\/i>\u00a0at 7-months by treatment arm differences. We also examined for interaction effects between baseline product use and vaping status at 7\u2009months on cannabis use outcomes.<\/span><\/p>\n

Results<\/span><\/h3>\n

At 7-months, adolescent categories of use were:\u00a0Dual Abstinent<\/i>, 31.7% (95% CI: 28.8, 34.6);\u00a0Exclusive E-cigarette Users<\/i>, 18.2% (95% CI: 15.9, 20.7);\u00a0Exclusive Cannabis Users<\/i>, 15.1% (95% CI: 12.9, 17.4);\u00a0Dual Users<\/i>, 35.0% (95% CI: 32.1, 38.1). Among YAs:\u00a0Dual Abstinent<\/i>, 15.6% (95% CI: 13.9, 17.3);\u00a0Exclusive E-cigarette Users<\/i>, 29.4% (95% CI: 27.3, 31.6);\u00a0Exclusive Cannabis Users<\/i>, 12.8% (95% CI: 11.3, 14.5);\u00a0Dual Users<\/i>, 42.2% (95% CI: 39.9, 44.5). Intervention outperformed Control in promoting rates of\u00a0Dual Abstinence<\/i>\u00a0among adolescents (38.5% vs. 25.0%,\u00a0p<\/i>\u2009<\u20090.0001) and YAs (17.9% vs. 13.3%,\u00a0p<\/i>\u2009=\u20090.007). A higher proportion of\u00a0Exclusive E-cigarette Users<\/i>\u00a0compared to\u00a0Dual Users<\/i>\u00a0were\u00a0Dual Abstinent<\/i>\u00a0at follow-up (adolescents: 37.6% vs. 29.7%,\u00a0p<\/i>\u2009=\u20090.019; YAs: 25.8% vs. 8.5%,\u00a0p<\/i>\u2009<\u20090.001).<\/span><\/p>\n

Conclusion<\/span><\/h3>\n

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.<\/span><\/p>\n

Trial Registration<\/span><\/h3>\n

Studies included were registered on ClinicalTrials.gov (NCT04251273, registered on January 31, 2020; NCT04919590, registered on June 9, 2021)<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Background<\/span><\/h2>\n
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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 (\u201cco-use\u201d) has become more common among adolescents and young adults (YA) [2,\u00a03]. Estimates for the prevalence of nicotine vaping and cannabis co-use range from 16 to 50% among adolescent e-cigarette users [4,\u00a05] and 34\u201360% among YA e-cigarette users [6,7,8].<\/span><\/p>\n

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\u201375% among adolescents, 59% among YA) but treatment effects on cannabis use or co-use were not examined [16].<\/span><\/p>\n

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,\u00a021], 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,\u00a027]. Co-use of nicotine and cannabis compounds these risks, leading to increased frequency and dependence for both products, poorer cessation outcomes [28,\u00a029], 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].<\/span><\/p>\n

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,\u00a031], 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\u2009months 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.<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Methods<\/span><\/h2>\n
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Trial design<\/span><\/h3>\n

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\u00a0n<\/i>\u2009=\u20091,503 adolescent (13\u201317\u2009years old) e-cigarette users was conducted from October 2021 to October 2023 and randomized participants to intervention (n<\/i>\u2009=\u2009759) or assessment-only control (n<\/i>\u2009=\u2009744); a third waitlist control group was included in the parent study [14] but is not included in these analyses. The RCT among\u00a0n<\/i>\u2009=\u20092,588 young adult (YA; 18\u201324\u2009years old) e-cigarette users was conducted from December 2019 to November 2020 and randomized participants to intervention (n<\/i>\u2009=\u20091304) or assessment-only control (n<\/i>\u2009=\u20091284) [13].<\/span><\/p>\n

Interventions<\/span><\/h3>\n

This is Quitting:<\/i>\u00a0This is Quitting (TIQ, now part of EX\u00ae<\/sup>\u00a0Program), is an automated, tailored, interactive text message program for nicotine vaping cessation designed for adolescents (13\u201317\u2009years old) and young adults (18\u201324\u2009years 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\u2019s age, enrollment date or quit date, and vape brand. Those who do not set a quit date receive 4\u2009weeks of messages focused on building skills and confidence. Those who set a quit date receive messages 6\u2009weeks before and 8\u2009weeks 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.<\/span><\/p>\n

From 2020 through December 2024, TIQ was promoted nationally through the\u00a0truth<\/b>\u00ae<\/b><\/sup>\u00a0campaign, earned media, and local\/national outreach. To isolate treatment effects and ensure participant blinding, all branding was removed from the intervention.<\/span><\/p>\n

Assessment-Only Control:<\/i>\u00a0After 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.<\/span><\/p>\n

Recruitment, enrollment, and randomization<\/span><\/h3>\n

Eligibility criteria for both parent trials included: age (adolescents: 13\u201317\u2009years; YAs: 18\u201324\u2009years), past 30-day nicotine e-cigarette use, interest in quitting vaping in the next 30\u2009days, 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.<\/span><\/p>\n

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\u2009hours were fully enrolled.<\/span><\/p>\n

Detailed descriptions of the study samples have been published elsewhere [13,\u00a014]. Briefly, the adolescent sample (n<\/i>\u2009=\u20091,503) had an average age of 16.4\u2009years (SD\u2009=\u20090.8), 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<\/i>\u2009=\u20092,588) had an average age of 20.4\u2009years (SD\u2009=\u20091.7), 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\u2009minutes of waking. Study groups in both samples were balanced on baseline characteristics.<\/span><\/p>\n

Retention<\/span><\/h3>\n

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\u2009days post-randomization (Checking in: Have you cut down how much you vape nicotine in the past 2\u2009weeks? Respond w\/letter: A\u2009=\u2009I still use the same amount, B\u2009=\u2009I use less, C\u2009=\u2009I don\u2019t use at all anymore)<\/i>\u00a0and monthly thereafter through the 6-month follow-up (How\u2019s the quit going? When was the last time you vaped nicotine, even a puff of someone else\u2019s? Respond w\/letter: A\u2009=\u2009In the past 7\u2009days, B\u2009=\u20098\u201330\u2009days ago, C\u2009=\u2009More than 30\u2009days ago).<\/i>\u00a0Data from these assessments were not used in outcome analyses.<\/span><\/p>\n

Measures<\/span><\/h3>\n

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\u2009hours of initial invitation.<\/span><\/p>\n

The full battery of measures administered at baseline and 7\u2009months have been previously described [13,\u00a014]. These secondary analyses focus on self-reported past 30-day use of nicotine e-cigarettes and cannabis at baseline and 7\u2009months post-randomization. For e-cigarette use, participants were instructed at both timepoints \u201cFor these questions, please think of your use of vape product(s) that contain nicotine in your responses\u201d and responded to the question \u201cIn the past 30\u2009days, did you vape at all, even a puff of someone else\u2019s?\u201d Similarly, participants reported past 30-day use of other substances, including cannabis; the mode of cannabis use was not specified.<\/span><\/p>\n

Statistical analyses<\/span><\/h3>\n

At baseline, participants were categorized as 1)\u00a0Exclusive E-cigarette Users<\/i>\u00a0if they reported no past 30-day cannabis use, or 2)\u00a0Dual Users<\/i>\u00a0if they also reported past 30-day cannabis use. At 7\u2009months post-randomization, four groups of interest were defined: 1)\u00a0Dual Abstinent<\/i>, no past 30-day nicotine e-cigarette or cannabis use, 2)\u00a0Exclusive E-cigarette Users<\/i>: no past 30-day cannabis use, but any past 30-day nicotine e-cigarette use, 3)\u00a0Exclusive Cannabis Users<\/i>: no past 30-day nicotine e-cigarette use, but any past 30-day cannabis use, and 4)\u00a0Dual Users<\/i>: any past 30-day use of nicotine e-cigarettes and cannabis.<\/span><\/p>\n

Primary analyses focused on the proportion of participants who were\u00a0Dual Abstinent<\/i>\u00a0as 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).<\/i><\/span><\/p>\n

Within-subject comparisons of cannabis use at baseline and 7-month follow-up were based on McNemar\u2019s test [35]. Additional analyses of 7-month follow-up data explored whether cannabis use at follow-up was associated with nicotine vaping cessation.<\/span><\/p>\n

All statistical analyses were conducted in R (v 4.5) [36].<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Results<\/span><\/h2>\n
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Among 1,503 adolescents randomized, the 7-month follow-up rate was 70.8% (n<\/i>\u2009=\u20091,064). 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\u00a0n<\/i>\u2009=\u20091,016 participants with follow-up data on both e-cigarette and cannabis use. There was no differential attrition by treatment assignment (p<\/i>\u2009=\u20090.20), with 66.0% (501 of 759) of Intervention participants retained at 7\u2009months versus 69.2% (515 of 744) of Control. Likewise, there was no differential attrition by baseline cannabis use (p<\/i>\u2009=\u20090.74), with 68.4% (258 of 377) of\u00a0Exclusive E-cigarette Users<\/i>\u00a0retained at 7\u2009months versus 67.3% (758 of 1126) of\u00a0Dual Users<\/i>. At baseline, 74.6% (95% CI\u2009=\u200971.8, 77.3) of adolescents reported past 30-day cannabis use, which decreased to 50.1% (47.0, 53.2) at 7\u2009months, a 24.5% point change (95% CI\u2009=\u200920.8, 28.0; McNemar\u2019s test\u00a0p<\/i>\u2009<\u20090.001).<\/span><\/p>\n

Among 2,588 YAs randomized, the 7-month follow-up rate was 76.0% (n<\/i>\u2009=\u20091,967). 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\u00a0n<\/i>\u2009=\u20091,829 participants with follow-up data on both e-cigarette and cannabis use. There was no differential attrition by treatment assignment (p<\/i>\u2009=\u20090.14), with 69.3% (904 of 1304) of Intervention participants retained at 7\u2009months versus 72.0% (925 of 1284) of Control. Likewise, there was no differential attrition by baseline cannabis use (p<\/i>\u2009=\u20090.86), with 70.9% (747 of 1053) of\u00a0Exclusive E-cigarette Users<\/i>\u00a0retained at 7\u2009months versus 70.5% (1,082 of 1534) of\u00a0Dual Users<\/i>. At baseline, 59.2% (95% CI\u2009=\u200956.9, 61.4) of YAs reported past 30-day cannabis use, which decreased to 55.0% (95% CI\u2009=\u200952.7, 57.3) at 7\u2009months, a 4.2% point change (95% CI\u2009=\u20091.9, 6.4; McNemar\u2019s test\u00a0p<\/i>\u2009<\u20090.001).<\/span><\/p>\n

What were the overall patterns of abstinence from e-cigarettes and cannabis at 7-months?<\/span><\/h3>\n

As shown in Table\u00a01, 31.7% (95% CI\u2009=\u200928.8, 34.6) of adolescents were\u00a0Dual Abstinent<\/i>, 18.2% (95% CI\u2009=\u200915.9, 20.7)\u00a0were Exclusive E-cigarette Users<\/i>, 15.1% (95% CI\u2009=\u200912.9, 17.4) were\u00a0Exclusive Cannabis Users<\/i>, and 35.0% (95% CI\u2009=\u200932.1, 38.1) were\u00a0Dual Users<\/i>.<\/span><\/p>\n

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Table 1 Dual use of nicotine e-cigarettes and cannabis at 7\u2009months by treatment assignment and baseline product use among adolescents (13\u201317\u2009years) enrolled in a randomized trial of vaping cessation, n (%)<\/b><\/span><\/figcaption>
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As shown in Table\u00a02, 15.6% (95% CI\u2009=\u200913.9, 17.3) of YAs were\u00a0Dual Abstinent<\/i>, 29.4% (95% CI\u2009=\u200927.3, 31.6) were\u00a0Exclusive E-cigarette Users<\/i>, 12.8% (95% CI\u2009=\u200911.3, 14.5) were\u00a0Exclusive Cannabis Users<\/i>, and 42.2% (95% CI\u2009=\u200939.9, 44.5) were\u00a0Dual Users<\/i>.<\/span><\/p>\n

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Table 2 Dual use of nicotine e-cigarettes and cannabis at 7\u2009months by treatment assignment and baseline product use among young adults (18\u201324\u2009years) enrolled in a randomized trial of vaping cessation, n (%)<\/b><\/span><\/figcaption><\/figure>\n<\/div>\n

Was there a treatment effect in promoting dual abstinence at follow-up?<\/span><\/h3>\n

Yes. As shown in Table\u00a01, among adolescents, the rate of\u00a0Dual Abstinence<\/i>\u00a0was 13.5% points higher (95% CI\u2009=\u20097.8, 19.1;\u00a0p<\/i>\u2009<\u20090.0001) among those randomized to Intervention (38.5%; 95% CI\u2009=\u200934.4, 42.9) vs. Control (25.0%; 95% CI\u2009=\u200921.5, 29.0). As shown in Table\u00a02, among YAs, the rate of\u00a0Dual Abstinence<\/i>\u00a0was 4.6% points higher (95% CI\u2009=\u20091.3, 7.9;\u00a0p<\/i>\u2009=\u20090.007) among those randomized to Intervention (17.9%; 95% CI\u2009=\u200915.5, 20.6) vs. Control (13.3%; 95% CI\u2009=\u200911.2, 15.7).<\/span><\/p>\n

Did treatment effects in promoting dual abstinence vary by baseline product use?<\/span><\/h3>\n

No. In the adolescent sample, the treatment advantage of Intervention over Control was comparable for\u00a0Exclusive E-cigarette Users<\/i>\u00a0(12.4 points; 95% CI\u2009=\u20090.6, 23.8) and\u00a0Dual Users<\/i>\u00a0(13.9 points; 95% CI\u2009=\u20097.4, 20.3), interaction\u00a0p<\/i>\u2009=\u20090.82 (Table\u00a01). Among\u00a0Exclusive E-cigarette Users<\/i>, 44.0% of adolescents randomized to Intervention were\u00a0Dual Abstinent<\/i>\u00a0(95% CI\u2009=\u200935.1, 53.1) compared to 31.6% of Control (95% CI\u2009=\u200923.8, 40.2). Among\u00a0Dual Users<\/i>, 36.7% of Intervention participants were\u00a0Dual Abstinent<\/i>\u00a0(95% CI\u2009=\u200931.8, 41.8) compared to 22.8% of Control (95% CI\u2009=\u200918.7, 27.3).<\/span><\/p>\n

Likewise, in the YA sample, the treatment advantage of Intervention over Control was comparable for\u00a0Exclusive E-cigarette Users<\/i>\u00a0(7.4 points; 95% CI\u2009=\u20091.1, 13.7;\u00a0p<\/i>\u2009=\u20090.02) and\u00a0Dual Users<\/i>\u00a0(3.7 points; 95% CI\u2009=\u20090.0, 7.1,\u00a0p<\/i>\u2009=\u20090.03), interaction\u00a0p<\/i>\u2009=\u20090.28 (Table\u00a02). Among\u00a0Exclusive E-cigarette Users<\/i>, 29.7% of YAs randomized to Intervention were\u00a0Dual Abstinent<\/i>\u00a0(95% CI\u2009=\u200925.0, 34.8) compared to 22.3% of Control (95% CI\u2009=\u200918.3, 26.8). Among\u00a0Dual Users<\/i>, 10.3% of Intervention participants were\u00a0Dual Abstinent<\/i>\u00a0(95% CI\u2009=\u20097.9, 13.2) compared to 6.6% of Control (95% CI\u2009=\u20094.6, 9.0).<\/span><\/p>\n

Was there an interaction effect between vaping status at 7\u2009months and baseline tobacco product use on cannabis use outcomes?<\/span><\/h3>\n

Among adolescents, the difference in cannabis use at follow-up between continuing vapers and vaping abstainers was significantly weaker among baseline\u00a0Exclusive E-cigarette Users<\/i>\u00a0than among baseline\u00a0Dual Users<\/i>\u00a0(interaction\u00a0p<\/i>\u2009<\u20090.001). As shown in Supplemental Table\u00a01, among 258 adolescent baseline\u00a0Exclusive E-cigarette Users<\/i>, cannabis use at 7\u2009months was reported by 31.1% (95% CI\u2009=\u200923.4, 39.6) of those who were still nicotine vaping versus 21.1% (95% CI\u2009=\u200914.8, 29.2) of those who were vaping abstinent, a 10% point difference (95% CI\u2009=\u2009\u22120.8, 20.3). Among 758 baseline\u00a0Dual Users<\/i>, cannabis use at 7\u2009months was reported by 77.3% (95% CI\u2009=\u200972.9, 81.3) of those who were still nicotine vaping versus 36.1% (95% CI\u2009=\u200931.1, 41.3) of those who were vaping abstinent, a 41.3% point difference (95% CI\u2009=\u200934.5, 47.4). In total, 97 out of 258 baseline\u00a0Exclusive E-cigarette Users<\/i>\u00a0were dual abstinent (37.6%) compared to 225 out of 758 baseline\u00a0Dual Users<\/i>\u00a0(29.7%), a significant difference at\u00a0p<\/i>\u2009=\u20090.019.<\/span><\/p>\n

Among YAs, the difference in cannabis use at follow-up between continuing vapers and vaping abstainers was comparable (interaction\u00a0p<\/i>\u2009=\u20090.81) for baseline\u00a0Exclusive E-cigarette Users<\/i>\u00a0and baseline\u00a0Dual Users<\/i>. As shown in Supplemental Table\u00a02, among 747 YA baseline\u00a0Exclusive E-cigarette Users<\/i>, cannabis use at 7\u2009months was reported by 27.2% (95% CI\u2009=\u200923.4, 31.2) of continuing nicotine vapers versus 16.8% (95% CI\u2009=\u200912.2, 22.3) of vaping abstainers, a 10.4% point difference (95% CI\u2009=\u20093.9, 16.2,\u00a0p<\/i>\u2009<\u20090.001). Among 1,082 baseline\u00a0Dual Users<\/i>, cannabis use at 7\u2009months was reported by 79.5% (95% CI\u2009=\u200976.5, 82.2) of continuing nicotine vapers versus 68.1% (95% CI\u2009=\u200962.3, 73.4) of vaping abstainers, an 11.4% point difference (95% CI\u2009=\u20095.5, 17.6). In total, 193 out of 747 baseline\u00a0Exclusive E-cigarette Users<\/i>\u00a0were dual abstinent (25.8%) compared to 92 out of 1082 baseline\u00a0Dual Users<\/i>\u00a0(8.5%), a significant difference at\u00a0p<\/i>\u2009<\u20090.001.<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Discussion<\/span><\/h2>\n
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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\u2019s 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.<\/span><\/p>\n

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\u2019 motivations to reduce multiple substances. Finally, young people\u2019s 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.<\/span><\/p>\n

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 \u2013 whether it involves cannabis-specific content, modified behavioral strategies, increased intervention intensity, or entirely different therapeutic approaches \u2013 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.<\/span><\/p>\n

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.<\/span><\/p>\n

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].<\/span><\/p>\n

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.<\/span><\/p>\n

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,\u00a043]. This context may have influenced both baseline substance use rates and cessation outcomes in ways that limit generalizability to non-pandemic conditions.<\/span><\/p>\n<\/div>\n<\/div>\n<\/section>\n

\n
\n

Conclusions<\/span><\/h2>\n
\n

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.<\/span><\/p>\n

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.<\/span><\/p>\n<\/div>\n

Source: https:\/\/substanceabusepolicy.biomedcentral.com\/articles\/10.1186\/s13011-025-00679-1<\/span><\/p>\n<\/div>\n<\/section>\n<\/article>\n

<\/main><\/div>\n","protected":false},"excerpt":{"rendered":"

from BioMed\/Substance Abuse Policy unit –\u00a0 03 November 2025 by\u00a0Amanda L. Graham,\u00a0Sarah Cha,\u00a0\u00a0Elizabeth K. Do,\u00a0\u00a0Megan A.\u00a0 Jacobs,\u00a0\u00a0Giselle Edwards &\u00a0\u00a0George D. Papandonatos\u00a0 Substance Abuse Treatment, Prevention, and Policy\u00a0volume\u00a020, Article\u00a0number:\u00a048\u00a0(2025)\u00a0Cite 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 […]<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30,129,68,40,130,19,134,61],"tags":[],"class_list":["post-20289","post","type-post","status-publish","format-standard","hentry","category-cannabis-marijuana","category-culture","category-drug-use-various-effects","category-prevention-research","category-tobacco-smoking","category-usa","category-vaping","category-youth"],"_links":{"self":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/20289","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/comments?post=20289"}],"version-history":[{"count":2,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/20289\/revisions"}],"predecessor-version":[{"id":20291,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/posts\/20289\/revisions\/20291"}],"wp:attachment":[{"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/media?parent=20289"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/categories?post=20289"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drugprevent.org.uk\/ppp\/wp-json\/wp\/v2\/tags?post=20289"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}