WASHINGTON — When Principal Kimberly Martin sent out the Woodrow Wilson High School weekly newsletter over winter break, she was looking for help.
Martin's school, the largest in the nation's capital, was experiencing the same phenomenon that teachers and principals across the country have described over the last year — an explosion in teen e-cigarette use — but her budget didn't allow for the substance abuse program she'd used at her previous school.
In her newsletter, Martin quoted Surgeon General Jerome Adams, who had just called youth vaping an epidemic, and posted pictures of e-cigarettes that had been confiscated on campus.
"When I got here, I would say there was an issue with it, but I think it's gotten worse, progressively worse, over the last four years," said Martin, who estimates that roughly half of the juniors and seniors are using e-cigarettes.
Struggling to grapple with the epidemic, the Food and Drug Administration is holding a public hearing Friday to solicit ideas on the best interventions to curb youth e-cigarette use.
Among the presenters at the forum in Silver Spring, Maryland, will be Truth Initiative, a nonprofit best known for its envelope-pushing anti-smoking ads aimed at teens and young people. The group has now created a first-of-its kind text messaging program designed to help young people quit vaping.
"We started seeing more and more that people were posting that their New Year's resolution was to leave JUUL and to quit e-cigarettes, but they weren't finding any help," said Megan Jacobs, who works on Truth's innovations team and led the project. "So we said, 'Hey, we've got programs. We could adapt those programs to help people quit e-cigarettes as well as we could help them quit smoking.'"
The program, which officially launches Friday, allows anyone to text "QUIT" to 202-804-9884, anonymously and free of charge. Users are then asked to choose an age bracket so they can start receiving tailored daily text messages of support and tips for quitting. Truth worked with young people who had either quit or were trying to quit, to make the program's messaging more effective.
According to the latest CDC data, 3.05 million high school students and 570,000 middle-schoolers were using e-cigarettes in 2018. That's a total of 3.62 million kids, up from only 280,000 in 2011.
The numbers have spiked since the 2015 introduction of Juul, a cartridge-based e-cigarette that's been wildly popular with kids. Current use among high school students rose 78 percent in a single year, from 2017 to 2018.
In a statement, a Juul Labs spokesperson said the company finds underage use "completely unacceptable" and is "moving full steam ahead" on a plan to limit usage among young people.
Dr. Suchitra Krishnan-Sarin, a professor of psychiatry at the Yale University School of Medicine whose research centers on adolescent addiction and substance use, said there is still a sizable gap in researchers' understanding of e-cigarette use and how drug therapies may affect young vapers.
"We can't say just because you are vaping e-cigarettes I am going to give you a nicotine patch or nicotine gum, because we don't really know how addicted these kids are to the nicotine in e-cigarettes," Krishnan-Sarin said. "We need to need to understand that first before we move to the medication realm."
Krishnan-Sarin said behavioral approaches, on the other hand, have a proven track record when it comes to youth smokers.
"Not telling kids what to do, but educating them about what's bad about the product, these kinds of behavioral techniques have shown to be effective for youth smoking combustible cigarettes," she said. "We have found over time that if you educate kids and make them understand by presenting information to them in a non-judgmental fashion, they come to the conclusion themselves."
The Truth Initiative adopts the same philosophy, offering users messages focused on delivering education and motivation rather than fear.
"You can't frighten people into changing their behavior. It doesn't work in losing weight, it doesn't work in exercise, and it doesn't work here," Truth Initiative CEO Robin Koval said.
Teenage users of the program could get messages like, "Is it hard to not Juul in places you're not supposed to, like school? Reply YES or NO." There's also an option for parents designed to educate them about the devices and help them support children dealing with nicotine addiction.
Truth Initiative used the structure of their quit-smoking programs of the past, but the messages were completely rewritten. The program creators were particularly mindful that the experience of vaping is unique from smoking, Koval said.
"Some of the negative cues from smoking—you know, your hair smells, your clothes smell, your fingers are yellow — all of that sort of thing that makes you want to quit are not as present in vaping," Koval said. "So we have to work with other sorts of messages and cues to help you see even the benefits of your quit process."
Martin, the principal at Wilson High, is hoping many of her students will soon be experiencing those benefits.
After she sent out her e-cigarette-focused newsletter, Martin received grateful messages from several parents, including one who works for Truth Initiative. "I've got an idea," the parent wrote in an email.
Wilson will now serve as a testing ground for Truth Initiative's text message-based quit-vaping program, with a unique phone number so that the organization's researchers can analyze how the Wilson community interacts with it.
"We're going to put it in the newsletter. We're going to put it on our website. We plan to do robocalls and all of the kind of methods that we communicate with parents to get people aware that this campaign is happening," Martin said.
Anya, a senior at Wilson High School who regularly uses e-cigarettes, said she's considering enrolling in the program. "I've always looked at the 'smoke to quit' ads on the metro and I've thought, 'That's a good idea. Maybe I should tell some friends of mine who smoke a lot of cigarettes about that,'" Anya said. "So I think, yeah, there could be one for vaping. There's a niche for that."