New study: Teen e-cigarette users with childhood trauma need increased support to quit

Adolescent e-cigarette users who reported a higher number of adverse childhood experiences (ACEs) - potentially traumatic events such as abuse, neglect, and household dysfunction - were 20% less likely to successfully quit vaping compared to those with fewer ACEs, according to new research from a randomized clinical trial published in the Journal of Adolescent Health.

The clinical trial, the first of its kind to examine the relationship between ACEs and e-cigarette cessation among adolescents, found that 90% of participants reported at least one ACE and 56% were classified as "high risk" with four or more ACEs. High risk participants were 20% less likely to quit after seven months compared to those with fewer ACEs. Each additional experience of abuse was associated with a 7% decrease in abstinence from vaping. 

Extensive research demonstrates that ACEs dramatically increase lifelong risk for chronic disease, substance use, and mental illness. For adolescents, nicotine can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction, while a trauma history makes quitting exponentially harder.

Childhood trauma impacts vaping cessation outcomes

The study analyzed data from 1,248 adolescent (13-17 years) e-cigarette users from across the U.S. who participated in a randomized clinical trial for vaping cessation. All participants were interested in quitting. As part of the baseline survey, teens reported lifetime exposure to adverse childhood experiences. The most commonly reported ACEs were feeling unloved or unsupported (68% of respondents); being insulted or put down by a parent or caregiver (63%); and living with a parent or caregiver with mental health issues (60%). 

Compared to teens in both the low and intermediate risk groups, high risk adolescents were more likely to be female or LGBQ (lesbian, gay, bisexual, or queer; transgender status was not assessed), had higher scores on measures of nicotine or e-cigarette dependence, psychological distress, substance use, and loneliness, and reported lower confidence in quitting vaping. 

The remarkably high prevalence of ACEs among adolescent vapers - with no trauma-related recruitment criteria - suggests that nicotine e-cigarette use may be particularly appealing to trauma-exposed youth as a form of emotion regulation or self-medication.

Addressing trauma in quit vaping programs for teens

The association of childhood trauma with difficulty quitting demonstrated in this study points to opportunities to strengthen youth vaping cessation programs. Incorporating principles of trauma-informed care, including establishing a safe and trustworthy environment, emphasizing individual choice, and offering non-judgmental support, may significantly improve cessation outcomes for adolescent vapers who have experienced childhood adversity.