Monday, June 1, 2020

Tobacco Prohibitionists Not Letting This Pandemic Go to Waste

Anti-tobacco forces are callously abusing COVID-19-driven anxiety, pain and suffering as they spew their unique brand of science-free propaganda.  A good example is a video interview, titled “The Dangers Of Vaping and Smoking During Coronavirus,” with Matt Myers, head of the Campaign For Tobacco-Free Kids (here).  Following are selected Myers quotes, with my observations (in bold). 

The interview opens with a question on new research suggesting that nicotine might protect smokers from developing COVID-19 illness:

“It is completely false….it is pure and simple bad science.  Last week the World Health Organization convened 29 of the world’s leading scientists, and what they found was two things: First, in fact smoking increases your risk of serious diseases – of serious effects of this disease.  And B, there is no credible evidence that smoking provides any protective effect.  All of the science points that smoking, and potentially vaping, increases your risk of the most serious consequences.”

Myers, a lawyer, is making dogmatic statements on science that legitimate scientists are unwilling to make at this time.  Certainly, a debate about the effects of nicotine and smoking on COVID-19 infection prevalence and illness severity is warranted; here are some articles, pro (here, here, here) and con (here, here).    

“Even if vaping was significantly less hazardous, and we don’t know that for sure, it is still a dangerous product.” 

Even if…?  Extremists are incapable of acknowledging the most incontrovertible facts.  Despite their denials, inhaling vapor has been proven vastly safer than inhaling toxic smoke.  Myers’s denial was a set-up for his major theme – the so-called teen vaping epidemic.

“…in the United States we have over 5 million kids who have become addicted to e-cigarettes.  Many of them would have never smoked in their life…We have a youth e-cigarette epidemic that we need to address…In the last 3 to 4 years we have seen more kids become addicted to e-cigarettes…addicted in a way that’s even more powerful than we’ve seen with cigarettes.”

Myers’ “5 million” is a complete fabrication.  The 2019 National Youth Tobacco Survey, from which the highest estimates are drawn by the CDC, indicates that, at most, 172,000 underage teens might have been addicted to e-cigarettes (evidence here).  There is nothing to suggest that any of these youths have an e-cigarette addiction that is more powerful than cigarettes.

The interviewer asked a leading question about H.R. 2339, a bill approved by the U.S. House of Representatives but languishing in the Senate, that is meant to reverse the youth tobacco epidemic.  “This is one of the most important pieces of legislation Congress could pass.  It would prohibit the sale of all flavored e-cigarettes…it would ban the sale of menthol cigarettes…the tobacco industry has marketed menthol cigarettes to African-American youth and adults with devastating consequences…Eighty-five percent of African-Americans use menthol cigarettes…because the tobacco industry has targeted them.”

Myers wants to ban menthol cigarettes.  Despite a flood of research articles, the FDA has never developed a scientific rationale for such a ban (here and here).   Myers makes a common mistake in claiming menthol is all about race, as a full 68 percent of menthol smokers are not African-American (here).

Tobacco prohibitionists, armed with unfactual talking points, aren’t letting this pandemic go to waste.

Monday, May 11, 2020

First Study of ZYN, A Novel Consumer Nicotine Product

The American Journal on Addictions has just published (here) an analysis by my colleagues and me of the consumer appeal of a new nicotine product, ZYN.

Swedish Match test-marketed ZYN six years ago in Colorado; distribution expanded to 11 states in the western U.S. in 2016, and nationwide in April 2019.  While ZYN marketing was limited to a website and point-of-sale promotions, press reports (here, here and here) indicated remarkable sales success. 

In 2018, the company commissioned from a private contractor two marketing surveys on ZYN perceptions and use.  Last year a research group consisting of Drs. Karl Fagerström from Sweden and John Hughes from the University of Vermont, as well as Nantaporn Plurphanswat and me from the University of Louisville, was granted full access by Swedish Match to that survey data so that we could produce an independent analysis.  Our group previously published a research article describing how proposed changes in Swedish snus warning labels would affect tobacco users’ perceptions and use of the products (here).  Other than providing us with the data, the company had no role in our analysis or reporting of the results.       

In the current study, we assess adult appeal and interest in buying ZYN, and we describe the characteristics of ZYN users and patterns of ZYN use after purchase.

We found that while nearly 90% of never and former tobacco users did not find ZYN to be appealing, one-third of current smokers, more than half of current smokeless tobacco (ST) users, and two-thirds of dual cigarette-ST users did.  More importantly, only 3% of never, and 2% of former users were interested in buying the product.

In addition, we found that the likelihood of buying ZYN compared with other tobacco products was highest among exclusive ST users.  That cohort may be more inclined to buy ZYN because its manner of use is similar to that of other ST products, i.e., placing the product between the lip and gum; additionally, Swedish Match was offering the product on stores’ ST shelves.

The vast majority of ZYN users were white men, which is consistent with ST use. About 90% used the pouches every day, and most chose the 6 mg nicotine pouch, rather than the 3 mg version.  More than one-third had used ZYN about 3-6 months.

When offered a variety of reasons for using ZYN, participants frequently chose options such as “less harmful…”, “no one can tell when using”, and “to avoid spitting”.  Among current smokers, the top answers were, “less harmful for my health than cigarettes” and “do not cause me to smell like smoke/tobacco.”

There was no information about tobacco cessation due to ZYN, and time since quitting tobacco, so we cannot know if participants used ZYN to quit other products.  We also had no information about how frequently and how many pouches were used.

ZYN’s striking entry was quickly followed by similar products DRYFT ( and On! ( ).  None of these brands contain tobacco, only pharmaceutical-grade nicotine at different levels: ZYN pouches contain either 3 or 6 mg; On! is available in 2, 4 and 8 mg strengths; and DRYFT pouches have 2 or 7 mg. The highest nicotine dose approved by the FDA for medicinal nicotine gum and lozenges is 4 mg. Higher nicotine doses in the new pouch products may explain their popularity, since medicinal nicotine offerings have proven unsatisfying to consumers who can’t or don’t want to achieve nicotine abstinence.

Our study was the first to assess interest in and actual usage of a new tobacco product, ZYN nicotine pouches.  Non-users of tobacco had little interest, and ST users constituted the majority of ZYN regular users.




Monday, April 20, 2020

CDC’s Misuse of EVALI Misleads Americans That Smoking Safer Than Vaping

In a campaign of disinformation, culminating in the prolonged mischaracterization of the EVALI (e-cigarette, or vaping, associated lung injuries) crisis, the Centers for Disease Control and Prevention has caused more Americans to believe the untruth that vaping is more dangerous than cigarette smoking.

Bentley University economist Dhaval Dave and colleagues at the City University of New York and Cornell have authored an article titled “News That Takes Your Breath Away: Risk Perceptions During an Outbreak of Vaping-Related Lung Injuries,” published by the National Bureau of Economic Research.  It analyzes the effect of actions taken by the CDC.

Dave et al. describe the federal response to EVALI: “Statements issued by the CDC during the early ‘crisis’ period were direct and clear suggesting that individuals should stop using all vaping products in the late summer of 2019.” (emphasis added). 

The CDC was silent on marijuana until December 10, 2019, when it acknowledged in a tweet that “products that contain THC, particularly from informal sources…play a major role in the current lung injury outbreak.”  The agency had delayed focusing public attention on cannabis products for over three months, as it was clear by early September to many observers, including me (here) and Boston University’s Dr. Michael Siegel (here), that the lung injuries were unrelated to nicotine-based e-cigarettes and vaping products which had been used by tens of millions of consumers for some 10 years with no serious lung problems.    

Figure 5 in Dave’s article, seen above, shows the effect of the anti-vaping misinformation campaign that has been supported since 2012 by the transfer of hundreds of millions of dollars from the FDA to the National Institutes of Health to cooperating university researchers.  This scheme has generated hundreds of laboratory and epidemiologic studies reporting exaggerated or downright false vaping harm. 

The chart shows the success of the misinformation campaign from 2012 to 2019.  The percentage of Americans viewing e-cigarettes as more harmful than cigarettes grew at a consistent rate of about two percentage points per year. 

The 2019 EVALI debacle took the public’s fear of nicotine e-cigarettes and vaping products to new heights.  As Dave et al. write, “the immediate impact…was to increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking by about 16 percentage points.”  After the CDC issued its December 10 tweet emphasizing “the role of THC e-cigarette products, e-cigarette risk perceptions were partially revised downwards.”

That downward movement was minimal, as Figure 6 from the analysis illustrates:

Dave et al. generously refer to the CDC’s delayed identification of marijuana as the cause of EVALI as “precautionary” but they suggest that it may have had “unintended consequences. More targeted advice about the risks of THC e-cigarettes might have more effectively reduced the use of those products, potentially preventing EVALI cases. Moreover, the increase in e-cigarette risk perceptions might discourage adult smokers from using e-cigarettes…the increase in e-cigarette risk perceptions might slow the downward trend in youth smoking.”

By not announcing early on that contaminated marijuana products cause EVALI, the CDC increased the number of injuries and deaths.  The agency inaction also discouraged smokers from switching and might have even encouraged teens to smoke.