Wednesday, November 13, 2019

Opportunity For the World-Wide Research Community: Spend 15 Minutes to Counter Falsified Research in the Journal of the American Heart Association

The Journal of the American Heart Association on June 5, 2019, published a bogus research article, “Electronic cigarette use and myocardial infarction among adults in the US Population Assessment of Tobacco and Health [PATH],” by Dharma N. Bhatta and Stanton A. Glantz (here). 

Drs. Bhatta and Glantz used PATH Wave 1 survey data to claim that e-cigarette use caused heart attacks. However, the public use data shows that 11 of the 38 current e-cigarette users in their study had a heart attack years before they first started using e-cigarettes.

The article misrepresents the research record; presents a demonstrably inaccurate analysis; and omits critical information with respect to (a) when survey participants were first told that they had a heart attack, and (b) when participants first started using e-cigarettes.  The article represents a significant departure from accepted research practices. 

I provided the JAHA editors with details about the false results on July 11 and July 18, and I urged them to consider an investigation and retraction.  They failed to provide a substantive response (here).

As the JAHA editors apparently need further encouragement to retract this article, I invite researchers at 776 ICPSR-member universities, government agencies and other institutions to conduct their own investigation of the article’s false claims. 

Investigate and Take Action on the Bhatta-Glantz False Findings in Three Easy Steps

1.  Download the PATH Wave 1 public use dataset from ICPSR (here) using your preferred software (5 minutes).  The data is available in the popular programs SPSS, SAS, STATA or R.

2. Identify participants who are current users of e-cigarettes and who report having had a heart attack, then run a simple crosstabulation of the age range at which they had the heart attack and the age range at which they first used e-cigs (5 minutes).  Here are easy-to-follow programming codes for SPSS, SAS, STATA and R.* 

The resulting table will reveal that 11 of the 38 current e-cigarette users were first told that they had a heart attack years before they started using e-cigarettes.

3. Send an email to the JAHA editors, asking them to retract the article (5 minutes).  Here are their email addresses:

Barry London, Editor-in-Chief 
Daniel T. Eitzman, Deputy Editor 
Janice Weinberg, Statistical Editor

Thank you for your assistance in correcting the scientific record on e-cigarettes and heart attacks.

*You can download these programs with confidence.  I developed them with trusted colleagues.

Monday, November 11, 2019

High School Vaping Estimates Are Hyperinflated Via Reliance on National Youth Tobacco Survey

The federal government bases its assessment of a so-called teen vaping epidemic on data from the National Youth Tobacco Survey (NYTS).  Health officials typically advance the epidemic narrative by selectively releasing NYTS details before complete data sets are made available to external researchers.  This was the case with last week’s article in the Journal of the American Medical Association, in which it was reported that over four million high school students were current (past-30-day) users of e-cigarettes this year.  That’s 28%, up from 21% in 2018.  Unfortunately, we’ll have to wait until mid-2020 for access to all the underlying data; at that time, I will provide an analysis, much as I did for the 2018 survey here and here.

Given that state and national tobacco policies are being driven by the NYTS, it’s fair to ask: How accurate is this survey?

I have had a long-term research interest in the differences in tobacco use data reported in federal surveys.  For example, I published a study 10 years ago comparing smoking rates in the National Health Interview Survey and the National Survey on Drug Use and Health.  I found that NSDUH’s 4.5% higher estimate in 2005 amounted to 9.1 million more smokers than the NHIS estimate. 

NYTS is not immune to this problem.  Earlier this year I showed that its estimate of high school vapers was double that of the KnowledgePanel, another nationwide federal survey.

Now I provide further evidence that NYTS vaping rates may be hyperinflated.  I analyzed public use files from the Population Assessment of Tobacco and Health (PATH) study, which is sponsored by the FDA and considered an authoritative resource on tobacco use among American youth and adults.  I compared the first three waves of the PATH survey with the 2014, ’15 and ‘16 NYTS, using matching age groups (15-17 years).

The chart shows that PATH and NYTS have similar estimates of current smoking for all three years, but NYTS estimates of current e-cigarette use are much higher than those generated by PATH.  In fact, current e-cigarette use in NYTS was almost double that in PATH for all three years.

There is no way to determine which federal survey more accurately reports high school vaping rates.  But NYTS vaping prevalence estimates were twice as high as PATH and KnowledgePanel, in four separate years.  What is clear is that students participating in the NYTS are different from those participating in the other surveys. 

Despite these critical issues, federal health officials and their allies rely solely on the NYTS to argue for the existence of a teen vaping epidemic.  This is unacceptable.  While the FDA recently praised the PATH study -- “The data from the PATH Study gives us critical insights into adult and youth tobacco use of flavored tobacco products…” – federal officials never cite PATH when they discuss youth vaping prevalence.  The FDA has actually supplied the reason for this contradiction, advising that “…estimates of youth tobacco use from the household-based PATH Study were generally lower than those from school-based national surveys such as the NYTS and Monitoring the Future…”  The government intentionally uses the highest numbers to make its case. 

No one doubts that American youth are using e-cigarettes, but teen vaping is mischaracterized as an epidemic by federal public health officials, politicians and tobacco prohibitionists.  The drastic measures they champion will make harm-reduction products less accessible to millions of current and former smokers.  Public health would be better served with the British approach including accurate use assessments and the promotion of a full range of cigarette substitutes.