Nicotine use usually starts and is established during adolescence. The prevalence of lifetime adolescent cigarette use has declined from 57% in 1997 (the year before the Master Settlement Agreement of 1998 that prohibited marketing of cigarettes to children) to 16% in 2020. However, e-cigarette use among adolescents may have countered some of this decline in nicotine use and its potential effects on health.
An unsuccessful attempt to stop using nicotine is a central measure of nicotine addiction because it indicates loss of autonomy, a defining characteristic of addiction to any substance, and is also a risk factor for long-term chronic substance use trajectories, distress, and impairment. e-Cigarette and combustible cigarette users may be similarly likely to experience an unsuccessful quit attempt because both products deliver similar levels of nicotine with similar addiction potential.
This study assessed trends in the percentage of adolescents with an unsuccessful cigarette quit attempt between 1997 and 2020 and compares quit attempts for cigarettes and e-cigarettes in 2020.
Respondents were from the 1997-2020 Monitoring the Future study, which each year surveyed nationally representative samples of 8th-, 10th-, and 12th-grade students in person at their schools during school hours. The University of Michigan institutional review board approved the study. Informed consent (active or passive per school policy) was obtained from parents and students. The student response rate averaged 86% over all years.
Analyses centered on the questions “Have you ever tried to stop smoking cigarettes and found that you could not?” among ever smokers (asked between 1997-2020) and “Have you ever tried to stop vaping nicotine and found that you could not?” among ever e-cigarette users (asked in 2020 only). Response categories were “yes” or “no.” Based on responses to these 2 survey questions, a variable was coded identifying a failed quit attempt for either combustible cigarettes or e-cigarettes.
The analyses combined respondent grades and used probability weights and adjusted SEs to take into account clustering within geographic strata and within schools using Stata version 17.0 (StataCorp). The analyses present prevalence levels and 95% CIs using linearized SEs and adjusted Wald tests to test for differences in these levels across years. A 2-sided P < .05 was considered statistically significant.
The analysis pool consisted of 815 690 respondents, including 9065 in 2020. Lifetime cigarette use was reported by 249 663 respondents and lifetime e-cigarette use by 3050 (in 2020 only). Among lifetime users, at least 1 unsuccessful quit attempt was reported by 35 191 respondents for cigarettes and by 365 respondents for e-cigarettes (in 2020 only).
The percentage of all adolescents who reported an unsuccessful quit attempt for cigarettes declined from 9.82% (95% CI, 9.15%-10.53%) in 1997 to 2.23% (95% CI, 1.53%-3.22%) in 2020 (P < .001) (Table and Figure). For e-cigarettes, the percentage of all adolescents who reported an unsuccessful quit attempt was 4.12% (95% CI, 3.25%-5.20%) in 2020. For either type of nicotine use (combustible cigarettes or e-cigarettes), the percentage of all adolescents who reported an unsuccessful quit attempt was 5.74% (95% CI, 4.66%-7.05%) in 2020. Compared with this estimate of 5.74% in 2020, the percentage unsuccessfully attempting to quit cigarettes was significantly higher during each year from 1997 to 2001, was not significantly different from 2002 and 2006, and was significantly lower during each year from 2007 to 2020.
Among adolescents, reported prevalence of an unsuccessful cigarette quit attempt declined between 1997 and 2020. In 2020, the prevalence of unsuccessful quit attempts among adolescents who had used either e-cigarettes or cigarettes was higher than the prevalence of unsuccessful cigarette quit attempts in each of the previous 13 years.
Limitations of this study include absence of high school dropouts, a reliance on self-reported data, only 1 year of information on reported e-cigarette quit attempts, and no analysis of quit attempts among users of low-prevalence tobacco products such as cigars and hookahs.
The contribution of e-cigarettes to unsuccessful nicotine quit attempts among adolescents is substantial and warrants consideration as the US formulates policies to regulate e-cigarettes.