Quitting Resources for Teens

When e-cigarettes were first sold, many claimed users would be smokers who wanted to stop smoking regular cigarettes.

But youth oriented marketing, sweet flavors that appeal to kids and the availability of products that are easy to hide has led to an epidemic of use among children who have never tried regular cigarettes.

Up to 25% of high school students say they have vaped within the last 30 days and 10% of middle school students also admit they vape. That is a total of over 5.3 million children.

That’s a problem because most e-cigarettes contain nicotine, which damages young, developing brains.

And the aerosol produced by e-cigarettes has the same harmful toxins found in glue and paint, even if the liquid is labeled as nicotine-free. Researchers are still trying to find out if the toxic chemicals in e-cigarettes have long-term health effects. There have been no long-term studies on the health effects of these chemicals when they are inhaled.

If you suspect your child is vaping, it’s essential you talk to them about quitting.

Is my child using e-cigarettes?

It can be hard to tell if your child is vaping. The e-cigarette aerosol may have a mild sweet smell, but they won’t cause the tell-tale smoke smell on clothes, hair or in the air like regular cigarettes. Also, e-cigarettes like JUUL are often small and easy to conceal.

Maher Karam-Hage, M.D., Medical Director of MD Anderson’s Tobacco Treatment Program, says the first thing to do is find out what your child knows about e-cigarettes.

“You don’t want to come in and blast them with information because they may know more than you,” he says. “Ask them if they see people vaping at school or what their friends are saying about e-cigarettes. Explore and see where the conversation goes.”

You also can look at your child’s behavior.

“Kids who vape talk about feeling irritable,” he says. “They may start to have a short fuse and lose their temper easily.”

Irritability can be a sign that your teen is using nicotine because it’s a stimulant like caffeine.

“Nicotine puts them on hyper drive,” says Karam-Hage.

Withdrawal from nicotine also can cause irritability.

How can I help my child quit vaping?

If your child tells you they are using e-cigarettes or it becomes clear to you they are, approach the issue gently.

“Try to find out where they are with it,” says Karam-Hage. “Are they playing with it because they like the flavors or do they use regularly? Do they know e-cigarettes contain nicotine and flavors, which are both harmful?”

You can explain that it may become difficult for them to quit vaping because nicotine is addictive. It also causes damage to the parts of their brain that regulate mood and attention, and that could have lasting effects.

If they use e-cigarettes, they also may start to feel more anxious or depressed, or have problems concentrating.

Finally, ask your teen if they have tried to quit. If they find they cannot stop, there are support services available that connect with teens through text messaging.

Here are some organizations that specialize in helping children quit vaping:

• Truth Initiative
• Smokefree Teen

Aren’t e-cigarettes illegal for teens?

There are a number of laws that may help protect young people from e-cigarettes.

Tobacco 21. It is now illegal to sell tobacco products to people under 21 in the United States. That includes regular cigarettes, cigars and e-cigarettes.

That means that retailers should check buyers’ ID and refuse to sell vaping products to anyone who is under age 21. It also applies to online sales.

Partial flavor ban. All pod based e-cigarettes with flavors are banned. Only tobacco flavor and menthol flavor are exempt. But disposable e-cigarettes are not included and these one-time use products are becoming more popular. They are also cheap, so they appeal to young users.

FDA pre-approval. Finally, by May 2020 all manufacturers of any tobacco product that want to remain on the market must submit an application to be pre-approved by the Food and Drug Administration. Manufacturers now must prove that their product will not be used by children.

Even with these laws in place, underage users will be able to find a way to access e-cigarettes and other vaping products, so it’s important to stay connected to your teen.

“Try to talk with your children before they try vaping, or before they become addicted,” says Karam-Hage. “The longer they use nicotine, the more difficult it will be for them to quit.”

Cigarette smoking has been on the decline for years. But menthol cigarettes are one segment of the tobacco market that has remained strong.

The Food and Drug Administration (FDA) proposed new rules today to prohibit these products and flavored cigars. These proposed rules are in response to public health concerns about the dangers of menthol cigarettes and their huge popularity among young people and Black, Hispanic and Asian American smokers.

We spoke with Jennifer Cofer, director of the EndTobacco® Program at MD Anderson, about the harms posed by menthol cigarettes and why the FDA's decision matters.

What is menthol, and why do manufacturers add it to cigarettes?

Menthol is a flavor additive with a minty taste and smell. In addition to tasting good, it has a cooling and painkilling effect. Cigarette manufacturers add it to cigarette filters to cover up the unpleasant taste of tobacco and make cigarettes more appealing.

What does the FDA decision on menthol cigarettes mean?

The FDA has the authority to regulate ingredients, marketing and new products. It banned flavored cigarettes in 2009, but made an exception for menthols. The FDA is essentially catching up by including menthol as a banned flavor now. Last year, the FDA announced that a plan was in the works to catch up, essentially, by including menthol as a banned flavor.

Now, the public will have the opportunity to comment on the proposed rules this summer before the product standards are finalized. It could be several months before menthols and cigars disappear from shelves.

Who smokes menthol cigarettes?

About 18.5 million people in the United States are regular menthol smokers. That’s 37% of the cigarette market. Here’s a breakdown of their use by race in the United States:

• 85% of Black smokers smoke menthols
• 46% of Hispanic smokers smoke menthols
• 39% of Asian American smokers smoke menthols

Why is race important? Because people who smoke menthols tend to inhale more deeply and have a harder time quitting smoking. That means that the health effects of smoking have a disproportionate impact on those communities with a higher rate of menthol use. 

Menthols and mint are also extremely popular among teenage smokers. More than half of cigarette smokers ages 12 to 17 use menthol cigarettes.

The hope is that, once finalized, the rules will help reduce the number of new, young adult nonsmokers and improve the health of people who currently use menthol cigarettes.

What does the research say about the dangers of menthol cigarettes?

Because menthol flavoring masks the harsh taste of cigarette smoke, menthol smokers engage in more intense smoking behaviors than smokers of regular cigarettes. As a result, they suffer greater damage to their health. Here are three reasons menthols are so dangerous:

• People who smoke menthols smoke more. The minty coolness of the menthol covers up the harshness of the cigarette, so smoking is easier to tolerate. As a result, menthol smokers inhale more deeply and they smoke more cigarettes. That means over their smoking lifetime, they take in more of toxic chemicals and tar from cigarettes.
• Menthols are harder to quit. Research by both the FDA and the Tobacco Products Scientific Advisory Committee shows that those who smoke menthol cigarettes are more likely to be dependent and have more trouble quitting. So, while Black smokers are more likely to try to quit smoking than white smokers, they’re less likely to be successful. That’s because of a higher nicotine dependence related to smoking menthol cigarettes. One result: Black men and women have a higher rate of lung cancer than any other race.
• Menthols appeal to young smokers. Studies show that young people who start smoking menthol cigarettes are more likely to become addicted and become long-term daily smokers.

What are the health risks of flavored cigars?

Flavored cigars, or cigarillos, come in flavors like cherry, grape and vanilla. They are typically available at convenience stores and gas stations for a very low price.

Like menthol cigarettes, flavored cigars were not covered by the 2009 flavor ban. Cigars are not regulated in the same way as cigarettes.

Removing these products would be an important step in reducing the overall impact of tobacco on public health, especially in communities where they are popular.

Is there anything else should we know about menthol cigarettes?

There is no safe tobacco product. If you are a smoker or vaper, one of the best things you can do to protect your health and reduce your risk of cancer is to quit. The best way to do that is through a comprehensive program that includes a combination of medications and counseling. MD Anderson offers free research studies for adults in Texas at any stage of smoking cessation. Learn more at SmokeFreeStudy.org.

Youth and young adults who want to quit using tobacco products can text VAPEFREETX to 88709. Parents can text QUIT to 202-899-7550 to get tips and advice for helping their teens and young adults quit using tobacco or vape products.

Request an appointment at MD Anderson online or by calling 1-877-632-6789.

Smoking causes an addiction that can be tough to shake. This is due to nicotine, the addictive ingredient in tobacco.

Thankfully, there are resources that can help you quit smoking. This will lower your risk of tobacco-related cancers, heart disease, stroke and lung disease.

Ahead, we discuss six tobacco-cessation products available in the United States.

Prescription options that can help you quit

Some products used to quit smoking need a doctor’s prescription.

Varenicline 

Medications prescribed by your doctor are very effective quitting tools. Varenicline, formerly produced as Chantix, is the most effective single product to help you quit smoking. Varenicline is a medication taken in pill-form. It cuts cravings by acting like nicotine on the brain without actually containing any. 

Varenicline works in two ways. First, it binds to and blocks the brain’s nicotine receptors. This makes smoking a cigarette feel less satisfying. Second, it partially stimulates the brain’s nicotine receptors. This helps reduce withdrawal symptoms and cravings. 

Potential side effects include:

• Nausea
• Vivid dreams
• Constipation
• Intestinal gas

Bupropion

Bupropion, also known as Wellbutrin or Zyban, is a medication taken as a pill. Like Varenicline, it doesn’t contain nicotine. It works by blocking nicotine receptors in your brain.

Potential side effects include:

• Insomnia
• Dry mouth
• Mild hand tremors

Nicotine nasal spray

Nicotine nasal spray is similar in size and shape to allergy or congestion nasal sprays but is used very differently. Instead of inhaling the spray into the sinus cavities, users let the spray sit in their nostril, allowing nicotine to be absorbed into the lining of the nose and into the bloodstream.

Potential side effects include:

• Nasal irritation 
• Runny nose
• Watery eyes

Over-the-counter options

Nicotine replacement therapy provides nicotine without the harmful components of cigarettes. This can help you curb cravings and wean off tobacco with fewer withdrawal side effects. 

You can buy the following nicotine replacement therapies over-the-counter at most pharmacies.

Nicotine patches

Nicotine patches are usually 3 to 4 inches wide and typically made of latex. These patches provide a steady dose of nicotine. They are applied to the upper body, such as the arm, shoulder or back, and changed once a day. Nicotine patches come in three doses — 7 mg, 14 mg, 21 mg — which can be reduced over time.

A hypoallergenic, latex-free brand name version of the patch is also sold for those with latex allergies. 

Potential side effects include:

• Skin redness under the patch
• Allergy or rash
• Sleep problems or unusual dreams 
• Racing heartbeat

Lozenges

Candy-like lozenges provide a dose of nicotine while they dissolve. They also keep your mouth busy, which can reduce the temptation to smoke.

Lozenges are available in 2 mg and 4 mg doses and come in mini and regular sizes. For mini lozenges, it may take between 10 and 15 minutes to feel the effect. For regular-sized lozenges, it may take between 15 and 20 minutes to feel the effect. 

Potential side effects include:

• Nausea
• Hiccups

Nicotine gum 

To use nicotine gum correctly, follow the ‘chew and park’ technique. Chew the gum for about 5 to 10 seconds or until you feel the effects of nicotine — a tingling sensation. Next, move the gum and hold it between your teeth or between your teeth and cheek where it will stay ‘parked’ for 5 to 10 seconds. Repeat the process, chewing then parking the gum in different parts of your mouth for a total of 20 to 30 minutes. 

Nicotine gum starts to work within 10 to 15 minutes if used correctly. It comes in different flavors and 2 and 4 mg doses.

Potential side effects include:

• Hiccups 
• Nausea
• May stick to dentures

Can e-cigarettes or vapes be used to quit smoking?

E-cigarettes are considered a harm reduction tool for those who have made serious attempts to quit smoking and were not able to quit, or those who are not interested in quitting.

While e-cigarettes can help you quit smoking cigarettes, they still contain nicotine. Being a 'dual user’ — that is, someone who smokes both cigarettes and e-cigarettes — is more harmful than using either alone.

Here are three additional reasons e-cigarettes aren’t recommended as a first-line strategy to help smokers quit.

• While considered less harmful than cigarettes, the exact long-term effects and harm from e-cigarette use is unknown.
• E-cigarettes lead to continued dependence on nicotine. 
• E-cigarette users have the potential to return to smoking.

How to choose the product that is right for you

Talk to your health care providers about your plans to quit. Working with your care team is especially important if you’re considering medication, using more than one nicotine replacement product or experiencing other health problems.

Therapy or counseling in combination with the medications or nicotine replacement products on this list is highly recommended and doubles the success rate compared with one or the other. Free counseling is offered through the National Institutes of Health Quitline and the Texas Tobacco Quitline. 

Remember, quitting smoking offers significant health benefits — no matter how long you’ve been smoking. Within hours of quitting smoking or tobacco use, your circulation starts improving. And your lung function starts improving within weeks of quitting. Keep it up, and within one year, your heart disease risk is 50% less; by five years, the risk of lung cancer is 50% less.

Learn more about smoking cessation studies at MD Anderson.

Many people are curious as to how vaping impacts the brain. As a researcher who studies the psychology behind smoking, I share that curiosity.

Vaping is the process of inhaling an aerosol that contains nicotine, flavoring and other chemicals. Vaping is relatively new compared to smoking, so there's a lot we're still learning. However, vapes often contain an ingredient we know plenty about: nicotine. We can use this information to help us understand how vaping impacts the brain.

Here is what my team is learning about vaping and how it affects brain health and development.

How does vaping impact the brain? 

Nicotine is a highly addictive substance. When you vape, the nicotine you inhale can dysregulate activity in several parts of the brain. This can make nicotine more desirable. 

The brain functions that nicotine affects include:

• Reward processes: These are a central component of the brain’s motivational systems. The motivational systems guide behavior toward positive outcomes or away from negative ones.
• Executive function: This set of cognitive processes is essential for controlling and managing thoughts, actions and emotions.

When nicotine hits the brain, it produces effects that are similar to those produced by other rewards like food, sex and social connection. Nicotine can “hijack” the brain mechanisms that support reward and executive functions and bias them toward nicotine and nicotine-associated cues. This means that through repeated exposures, the brain learns that certain cues, such as vape logos and even the shape of a vape device, are associated with nicotine.   

The associations between these cues and nicotine can be so strong that they lead to addiction. 

My team is using brain imaging to study why some people are more affected by drug cues – like pictures of vapes or people vaping – than others.

What parts of the brain are affected by nicotine?

Nicotine primarily impacts the brain regions involved in reward processing and cognitive control. These areas are crucial for regulating emotion, motivation and impulses.

In our studies, we showed that there are large individual differences in the effects of nicotine on the brain. Some individuals have stronger brain responses to these nicotine-related cues than to non-drug-related rewards. For them, resisting the lure of nicotine is more difficult. These individuals tend to compulsively use nicotine when exposed to nicotine-related cues. They are also more likely to relapse when they try to quit.

Our team is developing tools to identify people who are sensitive to nicotine-related cues. These screening tools will help us develop more successful, personalized smoking cessation treatments.

Does vaping impact mental health? 

There is a complex relationship between nicotine use and mental health.

Nicotine addiction is often seen in those with other behavioral or mental health conditions such as:

• attention-deficit/hyperactivity disorder (ADHD)
• anxiety disorders
• depression 
• other substance use disorders

Some individuals with mental health concerns might use nicotine as a form of “self-medication” to find temporary relief from their symptoms. However, nicotine withdrawal can worsen anxiety and depression symptoms. 

Our studies and clinical trials show that quitting smoking improves mental health symptoms.

Are there any brain development risks specific to youth and young adults who vape? 

The human brain continues to mature until a person is in their mid-20s. The prefrontal cortex – the part of the brain responsible for functions like impulse control – develops significantly during adolescence and young adulthood. 

Using nicotine while the brain is still developing can have long-lasting effects because it dysregulates activity in the brain’s neuronal circuits. These circuits control: 

• attention 
• impulse control 
• mood   
• reward sensitivity

Youth and young adults who use nicotine products may also be more vulnerable to:

• nicotine dependence
• mental health problems
• use of other addictive substances  

For these reasons, youth and young adults should avoid using nicotine, including vape products.

In late 2019, the legal age for purchasing nicotine products increased from 18 to 21 to reduce nicotine use among young adults.

Can quitting vaping improve brain function, or is the damage permanent?

Our team studied this by showing nicotine-related photos to people who currently smoke, used to smoke and have never smoked. Then, we measured their brain response to these images. Our results found that neither non-smokers nor former smokers felt motivated to smoke after viewing these images compared to current smokers.

This means it is possible to reverse nicotine’s effects on the brain. However, it is common for former smokers to relapse even after long periods of not smoking. Specific environments, emotional states or cues can suddenly trigger a craving that, if not managed, can lead to relapse. That is why nicotine addiction is considered a chronic relapsing disease that often requires multiple quit attempts. 

What resources can help you quit vaping?

If you want to quit smoking or vaping, you don’t need to do it alone.

MD Anderson’s Tobacco Research and Treatment Program provides evidence-based smoking cessation treatments to every MD Anderson patient and employee.

Additionally, This is Quitting provides free, anonymous text support for people ages 13-24 who want to quit vaping.

Request an appointment at MD Anderson online or call 1-877-632-6789.

Jason Robinson, Ph.D., a professor in the Department of Behavioral Science, and Jennifer Cofer, executive director of MD Anderson’s EndTobacco® program, also contributed reporting to this story.