Wednesday, October 21, 2020

Good News: Young Adults Sustain the High School Smoking Decline!


In January, I discussed results from the 2019 National Youth Tobacco Survey (NYTS) showing that vaping among high school students increased considerably over the past five years, as use of cigarettes declined at a rapid rate (here).  With the release of 2019 data from the National Health Interview Survey (NHIS), which I summarized a week ago (here), it is useful to compare high school vaping and smoking rates with those among young adults 18-24 years old, as seen in the chart at left.

The prevalence of smoking in 2014 – the first year that the NHIS collected vaping information – was 16.6%; it had fallen by over one-half by 2019, to 7.7%.  That was even better than the decline in smoking among high schoolers, which fell from 9.2% in 2014, to 5.7% in 2019 (in the chart below, for easy comparison). 

Vaping surpassed smoking among young adults in 2019 for the first time at 9%, only a modest increase from 5.1% in 2014.  Note that all NHIS vaping and smoking figures include about two percentage points of dual use; high schoolers showed about five percentage points of dual use during the same period.

It is noteworthy that the prevalence of vaping in young adults never reflects the high prevalence in high school students.  Take 2019, when high school vaping reached 27%, but registered 9% among young adults.  There are several reasons for this.  First, NYTS high school vaping rates are hyperinflated compared with other federal surveys, as I demonstrated here.  That is not the case with smoking rates, which in 2019 were 5.7% among high schoolers (NYTS) and 7.7% among young adults (NHIS).  Second, current use of these products among teens is “once in the past month,” whereas current use among adults is “every day or some days.”  Third, a small increase in tobacco use after high school is expected, as 18-year-olds escape parental and school supervision, and tobacco can be purchased legally.  It is likely that national adoption of Tobacco 21 will make further inroads into smoking and vaping.

One final impressive trend: Contrary to the scaremongering about a purported teen vaping epidemic, total vaping and smoking is down among young adults.  This is news featured only at Tobacco Truth.



Wednesday, October 14, 2020

Swedish Research Proving HPV Vaccine Prevents Cancer Mirrors that Country’s Life-Saving Snus Experience


Research from the Karolinska Institute in Stockholm and Lund University, published in the New England Journal of Medicine, proves beyond a shadow of a doubt that the human papillomavirus (HPV) vaccine protects women from cervical cancer.  It showed that vaccinated women had only 37% of the risk of contracting that cancer compared with women who weren’t vaccinated (incidence rate ratio [IRR] = 0.37, 95% confidence interval [CI] = 0.21 – 0.57).

Earlier vaccination was even better.  Girls younger than 17 years were 88% less likely to get cervical cancer (IRR = 0.12, CI = 0.00 – 0.34), while protection among women age 17 to 30 was over 50% (IRR = 0.47, CI = 0.27 – 0.75).

These critical findings mirror the Swedish tobacco experience: Snus use helps Swedes avoid the deadly consequences of smoking, acting to some extent as a “vaccine.”  I began chronicling the Swedish experience in 2002, with a series of published studies and, in 2003, Congressional testimony in which I demonstrated how use of snus protected Swedish men from smoking-related lung cancer.

Here is a full list of my published work on the Swedish snus experience, with PubMed links.  Proof of the Swedish snus vaccine is documented in # 10.

Rodu B, Stegmayr B, Nasic S, Asplund K.  Impact of smokeless tobacco use on smoking in northern Sweden.  Journal of Internal Medicine 252: 398-404-2002. 


Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K.  Evolving patterns of tobacco use in northern Sweden.  Journal of Internal Medicine 253: 660-665, 2003.


Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K.  The influence of smoking and smokeless tobacco use on weight among men.  Journal of Internal Medicine 255:102-107, 2004.

Rodu B, Cole P.  The burden of mortality from smoking: comparing Sweden with other countries in the European Union.  European Journal of Epidemiology 19: 129-131, 2004.  


Eliasson M, Asplund K, Nasic S, Rodu B.  Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study.  Journal of Internal Medicine 256: 101-110, 2004.

 Rodu B, Jansson C. Smokeless tobacco and oral cancer: a review of the risks and determinants.  Critical Reviews in Oral Biology and Medicine 15: 252-263, 2004. 


Stegmayr B, Eliasson M, Rodu B.  The decline of smoking in northern Sweden.  Scandinavian Journal of Public Health 33: 321-324, 2005.


Rodu B, Nasic S, Cole P.  Tobacco use among Swedish schoolchildren.  Tobacco Control 14: 405-408, 2005.


Rodu B.  Snus and the risk of cancer of the mouth, lung, and pancreas.  Lancet 370:1207-1208, 2007.


Rodu B, Cole P.  Lung cancer mortality: comparing Sweden with other countries in the European Union.  Scandinavian Journal of Public Health 37: 481-486, 2009.


Rodu B, Heavner KK, Phillips CV.  Snuff use and stroke. Epidemiology 20(3):468-469, 2009.


Rodu B, Heavner KK.  Errors and omissions in the study of snuff use and hypertension.  Journal of Internal Medicine 265: 207-208, 2009.  


Rodu B, Jansson J-H, Eliasson M.  The low prevalence of smoking in the northern Sweden MONICA Study, 2009.  Scandinavian Journal of Public Health 41: 808-811, 2013.  

I have also explored the Swedish experience in my blog (examples herehere, here, here, and here).

The new Karolinska/Lund publication also indirectly addresses a topic I’ve discussed: why randomized clinical trials don’t work well for harm reduction.  The NEJM authors underscore the key deficiencies: “Randomized, controlled trials cannot readily evaluate vaccine effectiveness against invasive cervical cancer because of the long lead time (the time from HPV infection to the clinical detection of cervical cancer) and the low risk of cervical lesions after vaccination.”

The long lead times for smoking-attributable diseases and the minuscule risks of vastly safer smoke-free products make population-based studies far more informative for analysis of tobacco harm reduction.