JMIR Publications

ABSTRACT

Background:

E-cigarette use remains prevalent among U.S. adolescents, with many reporting daily use and high nicotine dependence. Few evidence-based mobile health (mHealth) interventions focus specifically on adolescents.

Objective:

To evaluate the feasibility, engagement, and preliminary efficacy of Vaper-to-Vaper (V2V)—a multi-component, mobile, peer-driven texting intervention supporting adolescent e-cigarette cessation.

Methods:

A cluster-randomized pilot study was conducted in five Massachusetts high schools, with schools randomized to either the V2V texting intervention (n=3) or control group (n=2) that received a link to the NCI Smokefree.gov Quit Vaping website. The V2V intervention included four components: 1) Peer-written messages provided motivation, tips, and strategies to support adolescents in quitting vaping, sent daily in the first 30 days; 2) Peer videos featuring adolescents sharing their experiences with e-cigarettes and motivations to quit, sent regularly as links aligned with related peer message topics; 3) Peer coaches—university students under age 22 who had successfully quit vaping— trained to provide support, encouragement, and answers to participants’ questions through the texting platform; and 4) A fictional, gamified mystery story integrated into the texting platform to promote engagement. Each gamified message included a short story segment and a question, with the next segment unlocked after a response or automatically after three days. The intervention was mainly delivered over 30 days, but adolescents could message the peer coach over the three months. Eligible participants (grades 9–12, current e-cigarette users) were followed for three months. We assessed feasibility of recruitment and retention (target: 80 participants, ≥85% retention), engagement with intervention components, and participant satisfaction. Secondary outcomes included improvements from baseline in confidence to quit, self-efficacy to resist vaping in specific high-risk situations , and fewer days vaped. E-cigarette cessation was biochemically verified using the Abbott iScreen cotinine test.

Results:

Seventy-one adolescents enrolled (39 intervention, 32 control), with a 96% follow-up rate at three months. Among intervention participants, engagement was highest with peer messaging (80%), followed by gamification (50%), peer coaching (49%), and peer video (37%). Mean satisfaction scores for the intervention were 25.3 (SD = 4.7, Range = 8-32). The intervention group showed non-significant improvements in confidence to quit (44% vs. 28% moved from not at all/somewhat/moderately confident to very/extremely confident) and in the number of days vaped in the past 30 days (−3.6 vs. −2.9), while self-efficacy scores (adapted smoking self-efficacy scale Range 12-60) were slightly lower compared to the comparison group (−0.21 [SD 1.14] vs. 0.06 [SD 1.39]). Cotinine-validated 7-day point prevalence abstinence was similar between groups (21.6% intervention vs. 22.6% control).

Conclusions:

The V2V intervention demonstrated feasibility and acceptability, with strong engagement and high satisfaction. Although differences between groups were not statistically significant, findings suggest that peer-driven mobile interventions are a promising approach to support adolescent e-cigarette cessation. Clinical Trial: Clinicaltrials.gov NCT05140915 https://clinicaltrials.gov/study/NCT05140915