School-Based E-cigarette Cessation Programs: What do youth want?

Abstract

Purpose:

E-cigarette use is a problem among youth, yet few vaping cessation programs exist. This study aimed to understand what youth want in a school-based vaping cessation program to inform intervention development.

Methods:

We conducted 8 focus groups in Fall 2019 with Connecticut high school youth (N=4–10 adolescents per group, total N=62, 50% female). 6 groups were with youth who were current (i.e., past-month) e-cigarette users and 2 groups were with past users (i.e., lifetime users with no past-month use). Discussions focused on desired features and concerns about a vaping cessation program and analyses used an iterative inductive and deductive approach to identify qualitative themes. We also collected brief survey data assessing skills youth wanted to learn from a vaping cessation program.

Results:

Qualitative themes emerged indicating that youth want a vaping cessation program to include education about health effects of vaping, relatable personal anecdotes from others, and rewards for quitting. Potential concerns include confidentiality (e.g., ensuring teachers/coaches would not know about e-cigarette use), perceptions that youth may not want to participate due to lack of interest/apathy or embarrassment, and needing methods to verify abstinence to limit inaccurate reporting. The most frequently endorsed skills from the survey indicated youth want to learn ways to deal with stress (92%), relax (60%), and deal with poor concentration/attention (55%).

Conclusions:

Findings identified key features to include and issues to address when developing school-based vaping cessation programs. Developing effective vaping cessation programs that appeal to youth is important for addressing youth e-cigarette use.

1. Introduction

E-cigarettes are the most commonly used tobacco product by youth in the U.S.¹ National data indicate that over 3.5 million U.S. youth reported using e-cigarettes in the past month in 2020.² E-cigarette use among youth raises concerns about nicotine exposure and developing nicotine addiction^3–5 and possible transitions to combustible cigarette use.⁶ Importantly, evidence indicates 45% of adolescent e-cigarette users in the U.S. report seriously thinking about quitting vaping and 25% report trying to quit in the past year.^5,7 Youth report many reasons for wanting to quit including health concerns,⁸ yet they also describe many barriers to quitting including social influence, e-cigarette cues at school, stress, and withdrawal symptoms.⁹ Given that e-cigarette use is prevalent among youth and many want to quit but report difficulty doing so, research is critically needed on ways to help youth quit vaping.

Programs to address tobacco use among youth have typically been delivered in school settings, as this is a useful way to reach youth since they spend the majority of their time at school, and there is evidence that these programs are effective for treating adolescent cigarette use.^10–13 Recently, school-based prevention and education programs have been developed to address e-cigarette use among youth, however there are very few e-cigarette cessation programs to help youth stop vaping and more information is needed to inform the development of these programs for youth.^14–16

Developing effective vaping cessation programs that appeal to youth is important for addressing youth e-cigarette use and preventing long-term nicotine addiction. To address this aim and understand what youth want from a school-based vaping cessation program, we conducted focus groups with high school youth who were current and past e-cigarette users. Focus groups are a flexible modality to obtain novel and detailed feedback and to foster discussion about experiences among a diverse group of youth.^17–19This information is an important first step in developing evidence-based interventions that appeal to youth. The focus group discussion centered on two separate topics: 1) understanding youth reasons for e-cigarette use and experiences quitting vaping in the past (these results are reported previously⁹), and 2) what youth want in a school-based vaping cessation program. The current study presents new data about what features of a vaping cessation program youth would find appealing, any concerns they have about a vaping cessation program, and ways to recruit for the program. Additionally, we assessed what specific skills youth would want to learn in a program to help with quitting vaping. This study provides important new information that identifies key features to include and issues to address when developing vaping cessation programs.

2. Methods

2.1. Participants

We conducted eight focus groups with high school youth (age M=16.3, SD=1.2) in Connecticut from September to December 2019. Focus groups had a median of 8 (range 4–10) participants (N=62 total). Among the 62 participants, 50.0% were female, 50.0% identified as non-Hispanic White, 27.4% Hispanic White, 9.8% non-Hispanic Black, 4.8% Hispanic Black, 4.8% Asian, and 3.2% other race. Six groups were comprised of youth who were currently using e-cigarettes (i.e., use in the past month, n=48 youth total) and two groups were comprised of youth who had used e-cigarettes in the past (i.e., reported using e-cigarettes previously but no past month use, n=13 youth total). Youth who were currently using e-cigarettes reported using on average 21 days (SD=10) out of the past 30. All procedures were approved by the Yale IRB.

2.2. Procedure

Participants were recruited from two diverse high schools located in urban/suburban regions of southeastern Connecticut (methods reported previously⁹). Research staff were present during lunch periods in the high schools to recruit for the study. We advertised that we were recruiting participants to discuss perceptions about e-cigarettes regardless of e-cigarette use status to encourage honest reporting and to not single out e-cigarette users. Interested students completed a brief questionnaire reporting their past and current e-cigarette use, age, race/ethnicity, gender, and contact information. To be eligible, participants had to report using e-cigarettes and be willing to participate in a focus group to discuss e-cigarettes. We invited participants to attend focus groups based on their status as current or past e-cigarette users.

Prior to any recruitment, an information sheet regarding the purpose and procedures of the study were sent to all the parents in each school. Parents were instructed to contact the research team if they did not want their child to participate. Parents were also informed that we would not disclose their child’s e-cigarette use status or other information collected as part of the research procedures to them or to any other individuals in the school. Students ≥ 18 years old provided consent while those < 18 years old provided assent prior to participation. All participants were informed of the limits of confidentiality and were instructed to keep all information private and to not share information that was discussed in the focus group. Participants could discontinue at any point if they were not comfortable during the study; no participants dropped out. Focus groups were 60 minutes long and took place at school at the end of the school day. Participants were provided snacks and compensated $25 for their participation.

The focus groups were conducted using a structured guide to facilitate discussions about what youth want in a vaping cessation program. We opened the discussion by telling the youth we were interested in developing a program to help students who vape and want to cut back or quit vaping and we wanted to hear what they thought about this idea. We asked follow-up prompts around topics of what they would want included in a program (e.g., facts about health effects); what would motivate youth to stop vaping; the location, format, and timing of a program (e.g., during school, after school, one-on-one vs. group); who should be involved (e.g., parents, school staff, peers, counselors); and how to advertise or spread the word about a quit vaping program. These questions and themes were generated a priori. When discussing what would make someone want to join a program for vaping, youth also provided information about specific concerns they had about a vaping program and possible barriers that might prevent youth from participating. We asked follow-up questions to understand specific concerns they mentioned (e.g., confidentiality, worry about what others think, not interested in quitting).We also had the youth complete a brief checklist to select what skills they would want to learn in a program that they thought would be helpful for quitting vaping. The list of skills included learning: ways to deal with stress, how to relax, how to deal with poor concentration/attention, ways to deal with anger, getting support from family/friends, how to communicate better, and ways to problem-solve. These were selected because these are key components of skill training used in cognitive-behavioral therapy (CBT), including CBT for smoking cessation, and might apply to e-cigarette cessation as well.^20,21 Youth could select all that apply and we included an “other” option to write in content.

Focus groups were led by two facilitators, a third member of the research team took notes, and all focus groups were audio recorded. The audio recordings were automatically transcribed using NVIVO software (version 12). Research staff reviewed all coded transcripts and made any necessary corrections to ensure accurate transcription.

2.3. Data Analysis

All data coding was conducted in NVIVO. We used an iterative two-stage deductive and inductive approach to identify qualitative themes related to: 1) what youth want in a vaping cessation program, 2) what concerns they have about a vaping cessation program, and 3) how to spread the word about a vaping cessation program. We developed a codebook based on the focus group guide that was used to code the transcripts, consistent with previous qualitative focus group research.^22,23 The deductive approach included identifying major themes a priori from the structured focus group guide. Then, we used an inductive approach to identify any new themes or modify existing themes when reviewing the transcripts.

To ensure consistency in coding, two research staff were trained to code the transcripts according to the codebook. Four of the eight focus groups were randomly selected and were coded independently by both coders. Any discrepancies in coding were reviewed and resolved by both coders. Once themes were consistently identified by both coders, one person coded the remaining four transcripts. All transcripts and codes were reviewed by the first author and any changes were reviewed in discussion with both coders.

3. Results

Themes from the focus group are presented below. The main themes, commonly identified subthemes, and example quotations from participants are listed in Table 1. The themes from the focus groups and the survey results reported by the youth who were current or past e-cigarette users were comparable, so the results are presented together.

Table 1.

Focus Group Quotations by Theme

Theme	Example Quotation
Desired Features of a Quit Vaping Program
Information about health effects	Personalized health feedback: Yeah if you showed me my lungs, I would stop if it was so bad, I’d stop like immediately.
	Personal anecdotes: I feel like if people were exposed more to how people are affected by it like the details of what happened to people. We see pictures that like people are in the hospital. But I want to know what happened. Like how did it feel? Why should I be scared of it?
Rewards to motivate quitting	So whoever doesn’t smoke a STIK [e-cigarette brand] or smoke this and this until this period of time gets a prize, gets a gift, gets money something. Because I’m not going to stop for nothing.
Other features to include in a program	Goals to reduce use: Probably cutting down, ‘cause no one can quit right away.
	Participate with a friend: It’s more of like peer pressure though. Like if you could convince your friend group to quit and work on it together then you’ll clown someone for doing it again.
	Start programs early for younger kids: I feel like because most of us we all started in like freshman and sophomore year and because like we met other people that were doing it because you know all these upperclassmen that definitely do it. And so I mean I agree with like starting younger. Like at least the freshmen would benefit from learning what does happen to people who like start vaping and stuff like that.
	Do not want medication: I don’t want to take no medication… that’s like giving them methadone when they’re addicted to opioids, it’s not going to help. It’s just gonna make you addicted to something else.
Format
During school hours	Like a program you could go to during your study hall. Because nobody wants to stay after school to try to quit. That’s a waste of their time.
Face-to-Face	Face to face cause if you call them or something then they’ll probably… Yeah, I feel like a call is not actually as meaningful.
Individual one-on-one	I think individually because most of them are I guess ashamed sometimes or nervous to speak up and tell them they have a problem.
Group	It’s way better in a group. Cause we all have fun talking about our stories and stuff.
Large assembly	I think that like usually assemblies it can get it across better because we have to be quiet and listen. Like they don’t let us be on our phones and we have to pay attention.
Who Should Be Involved
NOT parents or teachers	Most kids are scared because of what their parents will do.
Counselors from outside school	I think with someone outside of school, unless it’s like a recurrent program, you’ll never have to see them again. So all you have is the information they don’t know you. If it’s a teacher, you have to see them every single day.
Relatable peer counselors	Because they’ve been through it. They know what’s going on. They know how you might be, what you might be doing.
Concerns and Barriers Related to a Quit Vaping Program
Confidentiality	The things is it’s not just students it’s just like if a teacher finds out or like an administrator that you talk to. I feel like when you get labeled that stays with you so you really don’t want people knowing.
Concerns about dishonesty	I feel like they would lie, take the money and go buy more stuff [vaping supplies].
Disregard for consequences	Apathy about negative consequences: There’s a lot of excuses for it. Like when you hear all these bad cases you’re just like whatever. That would never really happen.
	Dislike messaging in anti-vaping posters: I feel like a lot of stuff like especially the [anti-vaping] posters we have hanging around our school and stuff are really condescending. There is one that says “Can you look yourself in the eye and say vaping is harmless?” Like I feel like we all know that it’s not good for you. We all get that I think. But for some reason we all still do it.
Embarrassment or feeling too addicted	Embarrassment: It’s like embarrassing to admit that you’re addicted to something. Especially for me because I was so against it, and I was like I’m never going to be addicted to that like I never want to do that. So like actually becoming addicted is like embarrassing even though it’s like a cool thing. It’s like honestly embarrassing.
	Too addicted: I know probably at least seven people that like want to quit and they just can’t do it.
How to Spread the Word About a Quit Vaping Program
In-person sign-ups during lunchtime	I saw prizes then I see a bunch of people signing. I was like what’s going on here?
Flyers or announcements at school	We have announcements but every classroom has a TV that like has like the weekly news going on it. So I feel like if it is up there and someone saw it the word would definitely get around about it.
School social media accounts	Oh yeah. A lot of people follow the [school Twitter account] and that’s where they post like a lot of sports, has like a student section.
Peer ambassadors	Definitely follow the leader kind of thing. But you see people you know or people like that you might look up to that are doing it. It’s definitely something that would happen.
Word of mouth	So you eventually slowly build that trust and they bring more. That’s what happened like more and more people started coming. Oh, it’s confidential I could trust this. Other people have tried it. It’s working.

3.1. Desired characteristics of a quit vaping program:

3.1.1. Important Features

We asked youth what would make a student who vapes want to join a program to help them cut back or quit vaping and the most common themes that emerged were hearing about the health effects of vaping and receiving rewards.

Health effects:

Youth wanted the program to include educational components to learn more about the health effects of vaping, including learning about the chemicals in e-cigarettes and receiving personal health feedback. Some youth referenced hearing about EVALI (E-cigarette or Vaping Product use-Associated Lung Injury) cases in the media which raised concerns about how vaping would be impacting their lungs, but others were uncertain whether the risks of EVALI were relevant to them. Some youth described that if they were able to actually see the specific damage that was being done to their lungs this would motivate them to stop. Furthermore, many youth wanted to hear personal anecdotes directly from people who experienced health problems from vaping because they thought hearing stories from real people they could relate to would be more believable and would motivate them to quit.

Rewards:

When discussing ways to motivate youth to participate, another common response was youth wanted the program to include rewards, with many youth preferring cash or gift cards for quitting. Other commonly mentioned rewards were food, raffles, and prizes for achieving specific milestones. Some youth mentioned that getting school credits or extra credit would be motivating to participate or quit vaping.

Other features:

When asking youth for their ideas about what youth would want in a vaping cessation program, less commonly endorsed themes were that youth wanted the program to include goals to cut down on vaping and not necessarily having to quit right away. Some youth liked the idea of participating with a friend to have someone to challenge and support alongside them. Additionally, some youth mentioned that programs should start at younger ages such as middle school when youth first start vaping. Only a few youth mentioned wanting cessation support like nicotine replacement therapy to help with quitting, while others did not want medication to help with quitting.

3.1.2. Location, Timing, and Format

We prompted youth with questions asking them what they thought would be the best location, format, and timing of a program. Many discussed preferring a program that occurred in school during school hours, such as during a study hall, rather than after school. Responses about the preferences for the format of a quit vaping program were varied. Most youth preferred an individual one-on-one format for ease of openly sharing, although some indicated a group format may be useful to learn from peers and share stories. Some mentioned large school-wide assemblies could be useful for presenting information because this is a format where they have fewer distractions and can pay attention. More youth mentioned preferring communicating face-to-face rather than talking on the phone.

3.1.3. Who should be involved

We asked youth who they would want involved in a quit vaping program. The most commonly identified theme was that youth had specific people they did not want involved, including parents and teachers, because they were worried about getting in trouble and did not think having them involved would be helpful with quitting. However, a small number of individuals expressed that involving parents at some point in the program may be beneficial to support them in quitting vaping. Some youth mentioned they would prefer to have the program run by professional counselors outside of school to help ensure confidentiality. Although mentioned infrequently, some youth mentioned they would like to have the program run by peer counselors who they could relate to.

3.2. Concerns about a quit vaping program:

When talking to youth about what would make someone who vapes want to join a program to cut back or quit vaping, they discussed specific concerns they had about a program and possible barriers that might prevent people from participating and these were categorized into themes of confidentiality, dishonesty, disregard for consequences, embarrassment or feeling too addicted to quit.

Concerns of confidentiality:

When discussing setting up this program at school, the importance of confidentiality was the most commonly discussed theme. Many youth mentioned that they did not want teachers, sports coaches, or other administrators in the school to know that they vape as they are concerned about repercussions and being “labeled”.

Concerns of dishonesty:

Another common concern about a quit vaping program was that the program would need a way to limit dishonesty and verify abstinence. When discussing receiving rewards for quitting, people mentioned concerns that some youth might be dishonest and sign up to earn money to spend on more vaping products.

Disregard for consequences:

Another commonly mentioned theme was that people might not want to participate because of low motivation, including a lack of interest in quitting due to apathy about the consequences of vaping. This was sometimes mentioned when youth described hearing stories about serious consequences people experienced from vaping (e.g., EVALI, collapsed lung) and thinking those negative consequences would not happen to them or they could avoid negative problems by switching to a “safer” e-cigarette device. Relatedly, some youth mentioned the messaging about negative health consequences in the anti-vaping posters in their schools was somewhat condescending and did not motivate them to quit (e.g., posters in the bathroom stating: “vaping is the opposite of freshening up”, “oh you’re worried about pimples? You should be worried about your lungs”).

Embarrassment or too addicted:

Additionally, many youth agreed that people might not sign up to participate because they may have too much pride or embarrassment. They described that youth really do not want to be seen as addicted and it is embarrassing to admit they need help to stop vaping. Additionally, although mentioned infrequently, some youth thought that people would not want to participate because they believe they are too addicted to stop.

3.3. How to spread the word about a quit vaping program:

We asked youth what the best ways would be to recruit people for a quit vaping program. The most common response was recruiting in-person at school, for example during lunchtime at the cafeteria. Furthermore, youth liked the idea of being able to meet members of the treatment team in person during recruitment and thought this would increase the credibility and interest in the program. Other less common responses were recruiting through flyers or announcements at school, posting to school social media accounts, and using peer ambassadors or word of mouth recruitment to spread the word.

3.4. Skills they want to learn:

In total, 97% (n=60) of the youth who participated in the focus group completed the checklist and selected from a list of possible skills they would want to learn to help them stop vaping. Table 2 presents the frequency of endorsing the various skills they wanted to learn. The most commonly selected skill was learning ways to deal with stress, followed by learning how to relax, how to deal with poor concentration and attention, and how to deal with anger. Among the responses written in for ‘other’ (n=16), the most common was learning what to do instead of vaping, such as finding a hobby or alternative (n=4). Although uncommon, some of the write-in responses for skills to use to stop vaping mentioned smoking cannabis instead, so it may be important for programs to address multiple substance use behaviors.

Table 2.

Skills youth want to learn to help them quit vaping (N=60)

SKILLS TO LEARN	N	%
Ways to deal with stress	55	92
How to relax	36	60
How to deal with poor concentration and attention	33	55
Ways to deal with anger	30	50
How to get support from family and friends to stop vaping	24	40
How to communicate better	23	38
Ways to problem-solve	22	37
Other1	16	27

Note: Responses were select all that apply so totals will sum to > 100%.

¹Other responses: learn how to get involved in activities or an alternative to vaping (n=4), smoke weed instead (n=3), learn what you’re doing to your health in the future and show the individual their lungs (n=2), learn to say no (n=2), n=1 responses (“ADHD”, “stop giving a shit”, “accept the process it takes time”, “gradually lower nicotine dose”, “find another addiction like caffeine”).

4. Discussion

This study provides information about youth preferences and concerns about school-based vaping cessation programs that can be used to inform the development of interventions. These analyses of focus group data from high school youth who use e-cigarettes expand on an earlier publication identifying reasons for use and experiences quitting vaping in the past⁹ by identifying key features that youth want in a vaping cessation program that include education and personal health feedback, hearing anecdotes and experiences from others who vape, and rewards to motivate quitting. The most common concerns about a program include maintaining confidentiality, a need to limit dishonesty and verify abstinence, and apprehension about participation due to apathy or to a lack of concern about consequences of vaping and embarrassment about being seen as addicted. Furthermore, we identified important skills that youth want to learn to help with quitting vaping. Developing effective vaping cessation programs that appeal to youth will be critical for addressing youth e-cigarette use and preventing long-term nicotine addiction.

Our data identified features of school-based vaping cessation programs that may be appealing for youth. They discussed wanting an option to participate in a program during school hours, participating with a friend, and using school-based recruitment methods such as providing information and education during lunch periods. Indeed, school settings have been popular for tobacco cessation programs and show promising effects,^12,13,24 and evidence suggests there are effective components to school-based programs that align with the preferences expressed by the youth in our focus groups, including educational information about the health effects of use²⁵ and including peer leaders.²⁶ Furthermore, providing vaping cessation programs in school settings may be important for changing social norms around e-cigarette use and may help address some of the barriers that youth mention when trying to quit, such as peer use and frequent cues of seeing other people vaping at school.⁹

Our focus group data also provide important information about concerns that would need to be addressed to engage youth in a school-based program, notably ensuring confidentiality because youth did not want to be “labeled” and seen negatively by teachers, coaches, or others at school if their vaping status became known. Utilizing counselors from outside the school was appealing to youth for these reasons. Additionally, it is possible that school-wide quit and win programs²⁷ that involve all students regardless of their tobacco use status could be a useful way to address tobacco prevention and cessation without singling anyone out. Additionally, our data suggest there are other important barriers to participating in a vaping cessation program that would need to be addressed. These include related and somewhat contrasting concepts wherein youth reported some people may not want to participate due to apathy or lack of concern about consequences, embarrassment about being addicted, or possibly feeling too addicted to be able to stop. These findings emphasize that it is important to continue providing education on nicotine addiction and vaping in a way that can motivate change while also reducing stigma around seeking help.

In addition, our data suggest that youth want education content and personal health feedback to understand the effects of e-cigarette use. Many youth had the perception that if they could somehow see the damage that vaping is doing to their lungs they would be very motivated to quit. There is some evidence among young smokers that personalized health feedback in the context of motivational interviewing motivates change in tobacco use^28–30, and further research in this area is warranted. While the long-term consequences of e-cigarette use remain to be understood, youth describe experiencing specific health consequences from vaping (e.g., coughing, trouble breathing, chest pain, difficulty participating in sports)⁹ that could be used to enhance motivation to stop vaping by focusing on the observable health consequences they are experiencing now. Interestingly, these focus groups were conducted around the time that reports of EVALI (E-cigarette or Vaping Product use-Associated Lung Injury³¹) were widely publicized in the media which may have intensified the extent to which youth reported concerns about harming their lungs from vaping. Youth described that these reports were concerning but also that they wanted more information about what actually happened to convince them about the potential consequences. A common theme expressed in the focus groups was that hearing relatable personal anecdotes from people who experienced consequences from vaping would be valuable to motivate them to quit, in line with research on peer recovery support³² and studies indicating that messages conveying the harms of vaping may be useful for reducing vaping among young people.³³ Furthermore, data suggest some youth have experienced negative health consequences from vaping such as coughing, chest pain, sore throat, and trouble breathing, and this can often motivate quit attempts,⁹ and there may be other domains of consequences such as financial, social, and wanting to be free from addiction⁸ that can be important for motivating youth to stop vaping. Taken together, these findings suggest that youth may be motivated by tangible, concrete information about the effects of vaping.

Importantly, some of the key components that youth want in a vaping cessation program have been successfully included in youth interventions treating combustible tobacco use^11,13 and could be adapted for e-cigarettes. For example, CBT is a behavioral intervention that helps teach coping skills to support abstinence that has been shown to be effective for smoking cessation.^34,35 CBT skills training could be incorporated into vaping cessation programs to address the areas the youth said they needed help with, including learning ways to deal with stress, how to relax, how to deal with poor concentration, how to manage negative moods, and finding alternative behaviors instead of vaping. Notably, almost all youth (92%) reported wanting to learn skills to manage stress and said that this would be important for quitting vaping. Stress is commonly reported as a reason for vaping,⁹ and these data suggest it will be essential for treatment programs to directly address stress management as many youth may be using e-cigarettes to cope with stress or manage other mental health problems.³⁶ Additionally, contingency management (CM) is a behavioral intervention that provides rewards or incentives for making positive changes and can be used to reward abstinence that is verified with biochemical measures.³⁷ CM has been used to help youth quit smoking cigarettes^38,39 and could be incorporated into programs to help increase motivation and help youth stop vaping. Furthermore, there is evidence that combining CM and CBT approaches improves cessation outcomes among youth.⁴⁰ Also, behavioral interventions such as these may be more appealing to youth, as very few youth reported any interest in pharmacotherapy such as nicotine replacement therapy and there is limited information on the effectiveness of tobacco treatment medications among youth.²⁴

While it is possible that these components from prior studies addressing youth cigarette use could be adapted for e-cigarette use, it is important to note that social norms and perceived health risks of e-cigarettes differ compared to traditional tobacco products,⁴¹ so it is unclear whether methods that have historically worked to address tobacco use will be effective for e-cigarette use, and future research is warranted to evaluate what adaptations are necessary to effectively treat e-cigarette use.¹⁶ Work in this area is ongoing, with promising findings from text-message vaping cessation programs like This is Quitting, for instance.⁴² Additionally, while a meta-analysis of evidence from youth smoking cessation interventions indicates further work is needed, including conducting research using well-powered studies with longer follow-up periods and strong control groups,²⁴ there are opportunities to enhance the effectiveness of these interventions in the developmental phase by engaging youth to understand what components of the intervention appeal to them and to consider relevant issues like parent and teacher involvement.It is also important to note that although studies have evaluated the overall efficacy of treatment programs for youth smoking or vaping cessation,^24,34,35,42 more work is needed to understand what key components or aspects of the programs most contribute to successful outcomes.

There are limitations to consider when interpreting the study results. Specifically, our results are drawn from focus group data using local youth from public high schools in Connecticut. The specific content youth want included in a school-based program, possible concerns and barriers to participating, and recruitment methods may differ by region or school setting, so it would be important to assess these themes in a larger more representative sample to ensure that the themes are generalizable. Although data were drawn from a local convenience sample, rates of youth e-cigarette use in our Connecticut samples are comparable to national estimates (e.g.,⁴³). We did not specifically recruit youth who were treatment-seeking because we wanted to obtain broad perspectives from a diverse group of high school students with e-cigarette experience, although it was clear from the discussion that many of the youth were interested in quitting and had prior experience quitting vaping.⁹ We did not assess youth preferences for specific format of intervention materials (e.g., videos, brochures, apps) and future studies should examine these areas. Despite these limitations, the current study provides valuable information about what youth want in a vaping cessation program that can be used to inform intervention development.

4.1. Conclusions

In conclusion, focus group data from high school youth who use e-cigarettes provided valuable information about key features to include and issues to address when developing school-based vaping cessation programs. Developing effective vaping cessation programs that appeal to youth is important for addressing youth e-cigarette use.

Highlights.

• Focus groups were conducted with youth who had past or current e-cigarette use

• Youth discussed important features they want in a vaping cessation program

• Confidentiality and information about health effects of vaping were very important

• Youth want to learn skills to help them quit vaping, such as ways to manage stress