# Adolescent Vaping & Substance Use: Drivers, Deeper Issues, and How Digital Phenotyping Can Help - ==Don't get distracted by the noise/symptoms/smoke, what is the bigger picture/patterns/underlying issues?== ## 1 Why Adolescents Vape or Use Substances |Evidence-based driver|Illustrative findings|Key sources| |---|---|---| |Peer and sibling influence|- 60% of first vape products obtained from friends; initiation commonly occurs while “hanging out” with peers [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/) <br>- Having friends who vape raises odds of use 15-fold [2](https://www.uq.edu.au/news/article/2025/06/peer-influence-drives-youth-vaping-epidemic)|[3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/)[4](https://www.zeptive.com/post/peer-pressure-and-vaping)[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC11747700/)[2](https://www.uq.edu.au/news/article/2025/06/peer-influence-drives-youth-vaping-epidemic)| |Appealing flavours & sensory rewards|Fruit, candy and mint flavours cited as a top-10 reason for first use; 9 in 10 current youth vapers use flavoured pods [3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)|[3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)[6](https://academic.oup.com/heapro/article/40/2/daaf007/8086853)[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC4939118/)[8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)| |Curiosity & experimentation|“Just to try” ranked the single most common motive (53%) in the U.S. Monitoring the Future survey [7](https://pmc.ncbi.nlm.nih.gov/articles/PMC4939118/)|[7](https://pmc.ncbi.nlm.nih.gov/articles/PMC4939118/)[8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)[9](https://pubmed.ncbi.nlm.nih.gov/39256933/)| |Perception that vaping is “safer” than cigarettes|Lower harm perception strongly predicts initiation and continued use [8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)|[3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)[8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)[10](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(22\)00353-4/fulltext)| |Stress relief / mood regulation|Teens report vaping “to relax,” to manage anxiety before social events, or to “cheer up” when depressed [11](https://childmind.org/article/mental-health-disorders-and-substance-use/)|[11](https://childmind.org/article/mental-health-disorders-and-substance-use/)[12](https://norcalbehavioral.com/why-is-my-teen-vaping/)[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC9673242/)[14](https://pmc.ncbi.nlm.nih.gov/articles/PMC11100307/)| |Marketing & social media exposure|7 in 10 U.S. students report seeing e-cigarette ads; social media ads double the odds that friends provide the first vape [3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/)|[3](https://www.cdc.gov/tobacco/e-cigarettes/why-youth-vape.html)[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/)[15](https://www.straitstimes.com/world/use-of-alcohol-and-e-cigarettes-among-youth-alarming-who)[16](https://www.channelnewsasia.com/singapore/vape-vaping-cna-explains-hsa-moe-moh-4519186)| |Easy access & low price|Online marketplaces and peers circumvent age restrictions; cost is one-third of cigarettes in regional reports [17](https://www.myheart.org.sg/heart-news/public-health-at-risk-as-e-cigarettes-gain-popularity-among-youth/)|[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC10001692/)[17](https://www.myheart.org.sg/heart-news/public-health-at-risk-as-e-cigarettes-gain-popularity-among-youth/)[16](https://www.channelnewsasia.com/singapore/vape-vaping-cna-explains-hsa-moe-moh-4519186)| |Sensation seeking / impulsivity|Higher Behavioral Activation (fun-seeking) predicts nicotine and cannabis vaping [19](https://www.sciencedirect.com/science/article/pii/S0306460322002027)|[19](https://www.sciencedirect.com/science/article/pii/S0306460322002027)[5](https://pmc.ncbi.nlm.nih.gov/articles/PMC11747700/)| ## 2 When Use Is a Symptom: Underlying Issues to Address - [[202111201319 Symptoms of Latchkey Kids through life]] - [[020.200 Systemic Perspective MOC]] - [[BioPsychosocial Formulation]] - [[202209081204 if behaviour works for the person is that abnormal]] - [[Function of illness]] |Domain|Examples of underlying factors|Supporting evidence| |---|---|---| |Mental-health disorders|Anxiety, depression, ADHD, PTSD increase odds of substance use two- to four-fold; almost half of untreated youth with mental illness develop a use disorder [11](https://childmind.org/article/mental-health-disorders-and-substance-use/)[20](https://www.ccsa.ca/sites/default/files/2019-05/CCSA-Mental-Health-and-Substance-Abuse-2013-en.pdf)[21](https://pmc.ncbi.nlm.nih.gov/articles/PMC6788757/)|[11](https://childmind.org/article/mental-health-disorders-and-substance-use/)[20](https://www.ccsa.ca/sites/default/files/2019-05/CCSA-Mental-Health-and-Substance-Abuse-2013-en.pdf)[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC9673242/)[14](https://pmc.ncbi.nlm.nih.gov/articles/PMC11100307/)| |Emotional dysregulation & stress|Nicotine or THC used for self-medication when coping skills are weak; heart-rate variability studies show blunted autonomic regulation in stressed adolescent users [11](https://childmind.org/article/mental-health-disorders-and-substance-use/)|[11](https://childmind.org/article/mental-health-disorders-and-substance-use/)[13](https://pmc.ncbi.nlm.nih.gov/articles/PMC9673242/)| |Adverse childhood experiences & trauma|Traumatic events, family conflict, neglect linked to earlier initiation and heavier use [18](https://pmc.ncbi.nlm.nih.gov/articles/PMC10001692/)|[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC10001692/)| |Family modelling & permissive norms|Living with an e-cigarette user raises likelihood youth will vape; parental use shapes attitudes [1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/)[8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)|[1](https://pmc.ncbi.nlm.nih.gov/articles/PMC8296881/)[8](https://www.tobaccoinduceddiseases.org/A-systematic-review-on-risk-factors-and-reasons-for-e-cigarette-use-in-adolescents,196679,0,2.html)[22](https://journals.sagepub.com/doi/full/10.1177/10105395241275226)| |Low peer-network health / social exclusion|Depression predicts higher use only when peer supports are weak; protective peer networks buffer risk [21](https://pmc.ncbi.nlm.nih.gov/articles/PMC6788757/)|[21](https://pmc.ncbi.nlm.nih.gov/articles/PMC6788757/)[6](https://academic.oup.com/heapro/article/40/2/daaf007/8086853)| |Socio-economic & environmental factors|Urban residence, higher disposable income, and retailer density correlate with early vaping [5](https://pmc.ncbi.nlm.nih.gov/articles/PMC11747700/)[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC10001692/)|[18](https://pmc.ncbi.nlm.nih.gov/articles/PMC10001692/)[16](https://www.channelnewsasia.com/singapore/vape-vaping-cna-explains-hsa-moe-moh-4519186)| |Developmental neurobiology|Adolescent reward circuits heighten novelty-seeking and reduce harm sensitivity, accelerating nicotine dependence [10](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(22\)00353-4/fulltext)|[10](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370\(22\)00353-4/fulltext)| ## 3 Leveraging Digital Phenotyping & Health Apps for Recovery Support [[Digital Phenotyping]] ## 3.1 What Digital Phenotyping Can Detect in Youth |Passive data stream|Inferred construct|Clinical value| |---|---|---| |GPS trajectories, geofencing|Exposure to cue-rich environments (malls, vape shops)|Predict craving episodes; trigger location-specific nudges [23](https://bmjopen.bmj.com/content/9/9/e028284)| |Phone-use patterns (screen-on time, nocturnal use)|Sleep disruption, boredom|Identify relapse-prone fatigue states [24](https://pmc.ncbi.nlm.nih.gov/articles/PMC8579216/)| |Accelerometer / gyroscope (wearable or phone)|Hand-to-mouth gestures, sedentary bouts|Real-time smoking/vaping detection; prompt coping action [23](https://bmjopen.bmj.com/content/9/9/e028284)| |Heart-rate variability, EDA|Stress, autonomic arousal|Anticipate stress-induced lapses; deliver breathing exercises [11](https://childmind.org/article/mental-health-disorders-and-substance-use/)[25](https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2023.1103703/full)| |Ecological Momentary Assessment (EMA) pop-ups|Self-reported craving, mood|Update personalised risk model; refine interventions [26](https://journals.plos.org/digitalhealth/article?id=10.1371%2Fjournal.pdig.0000594)| ## 3.2 Designing a Youth-Centric Digital Intervention 1 **Data-driven risk model** - Collect 2–3 weeks of passive and EMA data to train individualised lapse-prediction algorithms (AUC > 0.9 in adult pilots) [26](https://journals.plos.org/digitalhealth/article?id=10.1371%2Fjournal.pdig.0000594). - Combine peer-context variables (Bluetooth proximity) with stress physiology for richer predictions in adolescents. 2 **Just-in-Time Adaptive Interventions (JITAIs)** - When model detects a high-risk state (e.g., 30 min before usual school-break vaping), push tailored coping strategies: paced-breathing audio, quick CBT reframe, or “text a buddy” prompt [27](https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2025.1460167/full)[28](https://www.sciencedirect.com/science/article/abs/pii/S2452310020300081). - Use gamified micro-goals (e.g., “skip 3 cravings to level-up”) to suit adolescent motivation styles. 3 **Positive social loops** - In-app peer-support channels moderated by clinicians; real-time “streak” sharing to leverage pro-social norms. - Parental dashboards (opt-in) showing aggregate stress and sleep trends rather than precise locations to respect privacy. 4 **Clinician integration** - Weekly risk summaries auto-flag sudden spikes in cravings or missed school events, allowing case managers to triage contact quickly [29](https://journals.plos.org/digitalhealth/article?id=10.1371%2Fjournal.pdig.0000883). - Dashboard embeds motivational interviewing scripts linked to sensed triggers. 5 **Data governance & ethics** - Adopt Singapore PDPA-compliant encryption; youth-friendly consent with clear opt-out. - Edge processing for geolocation to minimise raw data transfer. ## 3.3 Implementation Roadmap for a Singapore / Asia Context |Phase (6-12 months each)|Key activities| |---|---| |Pilot sensing study|Recruit 60 adolescents via school counsellors; validate vape-gesture algorithm with inertial wearables; co-design app language in English-Mandarin-Malay.| |Algorithm refinement|Integrate contextual factors unique to Singapore (HDB void-deck hotspots, convenience-store density).| |Randomised JITAI trial|Compare app-plus-counselling vs counselling-only on 6-month abstinence and stress scores.| |Scale-up & policy linkage|Partner with Health Promotion Board’s HealthHub to embed digital-phenotype modules into existing parental education campaigns [30](https://www.healthhub.sg/live-healthy/smoke-free-teens)[31](https://www.healthhub.sg/live-healthy/lets-get-real-about-vaping).| ## Key Take-away Adolescent vaping is rarely “just nicotine.” It is entwined with peer belonging, stress relief, low perceived harm and savvy marketing. 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