The CDC Buries the Lead: Teen E-cigarette Use Rises as More Dangerous Cigarette Use Plummets

According to an April press release from the U.S. Centers for Disease Control, teen e-cigarette use reported in the 2014 National Youth Tobacco Survey was three-fold higher than the previous year, with two million high school students using these products.  FDA Center for Tobacco Products director Mitch Zeller commented that “the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened.”

Not so fast.  The underlying NYTS data, released only last week, reveals that the CDC once again cherry-picked results to demonize e-cigs.

My analysis of the data shows (in the chart) that the prevalence of current e-cigarette use (at least one day in the past 30) increased dramatically in 2014 to 3.9% among middle school students and 13.4% among high school students. 

That spike may be due in part to a change in the survey design.  In previous years, questions about e-cigarette use were bundled with those for “other” tobacco products; in 2014 e-cigs had their own section, behind cigarettes, cigars and smokeless tobacco. 

The 2014 NYTS also documents an astounding 28% decline among high school students in all current cigarette use, from 12.7% to 9.2%.  Exclusive cigarette use dropped from 9.7% to just 4% in 2014, almost a 60% reduction in one year.

Number of High School Students Using E-cigarettes With and Without Other Tobacco Products, NYTS 2014
All Current E-Cigarette Users		1.96 million
Current Cigarette Users	0.76
Current Cigar Users	0.24
Current Smokeless Users	0.11
Current Users Other Products	0.23
All	1.34
Current Exclusive E-Cigarette Users		0.62 million
Ever Cigarette Users	0.33
Ever Cigar Users	0.06
Ever Smokeless Users	0.01
Ever Users Other Products	0.02
All	0.42
Current Exclusive E-Cigarette Users Who Never Used Other Tobacco Products		0.20 million

CDC press releases and reports portray teen e-cigarette use as an independent behavior, when in fact the NYTS data indicate that it is often closely associated with the use of other forms of tobacco.  The table reflects the unpublicized data for the 1.96 million high school students who were current e-cigarette users.  It shows that 1.34 million were also current users of other tobacco products.  Because I generated these numbers in stepwise fashion using the order of the survey (i.e., cigarettes first, then cigars, etc.), they don’t reflect the fact that many students used multiple products.  The bottom line, however, is clear: Almost 70% of current e-cigarette users also use at least one other tobacco product.

The NYTS also collects information about ever use (even one time or one puff) of other tobacco products.  Of the 620,000 high schoolers who were exclusive current users of e-cigarettes, 420,000 had previously used at least one other product. 

The critical fact is that there were 1.96 million current high school e-cigarette users in 2014, 90% of whom were current or previous users of other tobacco products, mostly cigarettes. 

 “CDC” shouldn’t stand for Center for Data Cherry-picking.  The agency ought to provide full and accurate information about tobacco use.  Data in the 2014 NYTS show that while e-cigarette use is on the rise among American teens, they are abandoning far more hazardous cigarettes at an unprecedented rate.