Discussion
anxiety
In our experience and according to recent surveys both youth and adults demonstrate a growing interest in quitting ECs [Varenicline was consistently superior to placebo at week-12 and week-24. Among people who use ECs, varenicline more than doubled the chance to quit vaping compared with placebo; cotinine level–verified CAR in the varenicline group combined with vaping cessation counseling was 40.0% at weeks 4 to 12, and 34.3% at weeks 4 to 24. These results are quite remarkable considering that varenicline only alleviates nicotine withdrawal symptoms and cravings, but cannot replace the need for vaping-related rituals. The ORs for the varenicline group in the present trial were similar than the ORs in previous RCTs of smoking cessation [Varenicline is a specific partial agonist and antagonist of the α4β2 nicotinic acetylcholine receptor that has been found to be effective in increasing abstinence rates among cigarette smokers. It is expected to help with the cessation of nicotine vaping in light of its mechanism of action that attenuates nicotine withdrawal symptoms and craving [Presence of cohabitant vapers and high level of anxiety greatly reduced the odds of success for abstinence from vaping, similar to what is observed in cigarette smokers [The safety profile of varenicline in this study was good and similar to that of previous varenicline trials of smokers in the general population [This RCT has several strengths: (1) use of continuous abstinence rate as a robust primary efficacy endpoint of the study; (2) use of salivary cotinine measurements to objectively verify abstinence from vaping; (3) careful verification of compliance with study medications attained by drug adherence checks; (4) detailed characterization of study participants, that include their vaping patterns, details of their vaping products, and their reasons to quit vaping; (5) use of specific vaping cessation counseling and vaping tapering plan for the study.Despite these strengths, the study has several limitations. First, findings in a population of adults who use ECs cannot be extended to young users. Nonetheless, the potential of behavioral interventions for vaping cessation in vapers 18–24 years old has been recently reported [