Electronic cigarette use or vaping is now very popular among adolescents and young adults. According to recent studies, about a quarter of 18-to-25-year-olds reported vaping in 2023, and in 2024, nearly 10% of high school students reported vaping. Vapes are viewed as an attractive alternative to cigarette smoking, as they are readily available and easier to conceal and use in public. In addition, many manufacturers of these products target younger users, offering stylish, brightly colored dispensers and interesting flavors. However, vaping carries many of the same risks as cigarette smoking, including high risk of nicotine dependence, exposure to carcinogens and heavy metals, and pulmonary inflammation.
There is substantial clinical, epidemiological, and preclinical evidence indicating that early nicotine exposure, especially during adolescence, increases the risk of subsequent use and addiction to other substances, including cocaine. Despite the popularity of vaping, about half of younger users report wanting to quit or cut back. However, we have limited information on how to support cessation efforts in youth.
A recent study published in JAMA by Eden Evins, MD and researchers from the Center for Addiction Medicine at Mass General Hospital examines whether varenicline (marketed as Chantix) — a twice-daily smoking cessation medication that has been FDA-approved for adults — is effective for nicotine vaping cessation in teens and young adults.
For this study, the researchers recruited youth, between the ages of 16 and 25 years, who vaped nicotine daily or near daily, but did not regularly smoke tobacco, who wanted to reduce or quit vaping. Participants were randomized to three groups:
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- Varenicline (n = 88) titrated to 1 mg twice daily over 7 days with weekly counseling and referral to text messaging vaping cessation support (This is Quitting – TIQ);
- Placebo (n = 87) with weekly counseling and referral to TIQ;
- Enhanced usual care (n = 86) with referral to TIQ only.
Participants received these interventions over the course of 12 weeks and were assessed monthly for 24 weeks. Each week, participants completed a questionnaire, reporting use of nicotine and vaping, and their responses were verified using cotinine saliva tests. (Cotinine is a metabolite of nicotine used to detect evidence of nicotine use.)
Of the 261 randomized participants (mean age, 21.4 years; 53% female), 254 completed the trial (97.3%).
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- Continuous abstinence rates were significantly higher in those taking varenicline compared to placebo during weeks 9 through 12 (51% vs 14%; adjusted odds ratio [aOR] 6.5 [95% CI, 3.0-14.1]; P < .001)
- During weeks 9 through 24, continuous abstinence rates were also higher in those receiving varenicline compared to placebo (28% vs 7%; aOR, 6.0 [95% CI, 2.1-16.9]; P < .001).
- Varenicline had higher continuous abstinence rates compared to enhanced usual care during weeks 9 through 12 (51% vs 6%; aOR, 16.9 [95% CI, 6.2-46.3]) and during weeks 9 through 24 (28% vs 4%; aOR, 11.0 [95% CI, 3.1-38.8]).
- Two varenicline participants (2%) and 1 placebo participant (1%) discontinued study medications due to adverse events.
- No drug-related serious adverse events occurred.
Treatment-emergent adverse events were reported by 76 (86%) in the varenicline group, 68 (79%) in the placebo group, and 68 (79%) in the enhanced usual care group.
Clinical Implications
This is the first clinical trial to examine how varenicline works for youths attempting to quit nicotine vaping. Teens and young adults who took varenicline — an FDA-approved, twice-daily smoking cessation pill for adults — are more than three times as likely to successfully quit vaping compared to those who received only behavioral counseling.
While this study tells us that varenicline is very effective, it also sheds light on the effectiveness of nonpharmacologic interventions we commonly recommend – including counselling and text messaging programs. Unfortunately, these approaches, when used alone, were not very effective, with only 4% to 6% achieving continuous abstinence at 24 weeks. Compared to using the smoking cessation app alone, youth who received a combination of medication, counseling, and app support were 11 times as likely to quit vaping.
The findings of the study are consistent with studies in adults suggesting that using a multipronged approach to nicotine cessation is more likely to be effective than relying on a single intervention. Varenicline was well-tolerated in adolescents and young adults. And good news, varenicline is already on the market. Because varenicline is already approved for smoking cessation in adults, it can be prescribed for anyone aged 16 to 25 wanting to quit nicotine vaping.
Read More
Evins AE, Cather C, Reeder HT, Evohr B, Potter K, Pachas GN, Gray KM, Levy S, Rigotti NA, Iroegbulem V, Dufour J, Casottana K, Costello MA, Gilman JM, Schuster RM. Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial. JAMA. 2025 Jun 3; 333(21):1876-1886.
