STEPHANIE SY: There is new evidence that a free texting program may help teens quit e-cigarettes, also known as vaping, more than 2 million American middle and high school students now use e-cigarettes.

A clinical trial has found teens enrolled in the This is Quitting anonymous text message program where 35 percent more likely to report giving up vaping after seven months.

Doctor Amanda Graham is the principal investigator of the study and the Chief Health Officer at Truth Initiative, a nonprofit aimed at preventing youth nicotine addiction.

Dr. Graham, thank you so much for joining us.

So this program has been up and running for several years.

How many teens have enrolled, and how did you reach them?

D. AMANDA GRAHAM, Chief Health Officer, Truth Initiative: We launched the program in January of 2019 and since that time over 780,000 young people have enrolled.

This is a program that serves 13 to 24 year olds, and we consistently see tens of thousands of young people enrolling every month of the program is promoted through the Truth campaign the national public education -- public education campaign that we've run here at Truth Initiative since 1999 and that reaches young people where we know they're spending the majority of their day, which is on social media.

STEPHANIE SY: Briefly describe for us how this texting program works, and how did you design it specifically for the target audience here, which is young people.

AMANDA GRAHAM: So this is a quit vaping program that we specifically designed to meet the needs of young people.

It delivers proven behavior change techniques, things that we know are effective for helping people to break a nicotine addiction, and delivered through text messaging, which we know is the way that young people prefer to communicate.

The program is tailored by age, by the device type that they're using, and by their quit date, which ensures that we're delivering relevant support all throughout their quitting journey.

It's a very interactive program.

We deliver open ended questions, true, false questions, yes, no, things that are designed to engage young people throughout the process of using the program, and it's highly tailored.

One of the things I'll say that's unique to this program is that we've received tens of thousands of submissions from other program users wanting to support young people, and we folded their tips and advice and encouragement back into the program to convey that lots of other young people are quitting and that quitting successfully is possible.

STEPHANIE SY: You know, teen smoking, as you know, Dr, Graham, has been a problem for decades.

How do e cigarettes present a different challenge than traditional cigarettes in trying to get teens to stop?

AMANDA GRAHAM: You know, one of the challenges has been the very rapid evolution of these devices over the past five or six years.

We know that disposable devices in particular, have evolved to deliver much larger doses of nicotine, much stronger doses of nicotine, and they're relatively inexpensive.

And we know that disposable e-cigarettes are the products that young people are using most.

You know, with cigarettes, there was always a clear signal to the end of a smoking episode when you got to the end of a cigarette.

And with these big, chunky devices, some of them contain the average amount of nicotine that you would find in seven to 14 packs of cigarettes, that massive amount of nicotine is really what has changed the game for young people today.

STEPHANIE SY: And these were originally marketed as somehow safer than cigarettes, right?

And now you have governments and bans on the flavorings, and yet they still seem to be so prevalent.

AMANDA GRAHAM: They're very popular among young people.

Flavors are something that we know attract adolescents to using e-cigarettes, and they often don't know that most e-cigarettes do contain nicotine and that nicotine is highly addictive.

We also know that nicotine and these products are things that young people turn to, thinking that it will help alleviate stress, it will help alleviate anxiety and boredom.

And so there's really important to get information out specifically to young people that there is no safe level of nicotine use.

You know, there's a different story when it comes to adult smokers, and where there may be evidence emerging that e-cigarettes may help some smokers to quit, and so there's a very fine line to tread in public health about how to craft the right message that warns young people about the dangers, but that leaves open the opportunity for smokers.

STEPHANIE SY: How effective is something like this texting program compared to something like nicotine replacement therapy, which you would see a full on nicotine addict that was an adult turning to?

AMANDA GRAHAM: So this is the first study of its kind.

It's the first evidence that we have about what works for adolescents to help them quit vaping.

What we saw was about a 10 percent percentage point difference between participants randomized to this text message intervention, about 38 percent of them quit, compared to about 28 percent in the control arm.

What I'll say is that many clinicians are prescribing nicotine replacement therapy for adolescents off label their support from some of the national bodies for doing this, because we know that a combination of medication and behavioral support can be most effective.

STEPHANIE SY: That is Dr. Amanda Graham with the nonprofit Truth Initiative.

Doctor Graham, thanks so much for joining us.

AMANDA GRAHAM: Thank you.