Thursday, July 11, 2019

With the National Health Interview Survey, Never Smokers May Have Smoked

Last week I revealed that, based on the 2018 National Health Interview Survey (NHIS), there were about 8.07 million American adult vapers, up from 6.9 million in 2017.  I noted that there were 1.71 million vapers who were never smokers, which is also a substantial increase from the prior year – and potentially troubling.  Let’s take a closer look.

First, it’s important to understand how the NHIS defines never smokers.  They are not necessarily cigarette virgins; they just never smoked 100 cigarettes in their life, which is the cutoff for ever smokers. 

The NHIS never smoker definition includes those who smoked up to five packs.  In contrast, the FDA-funded Population Assessment of Tobacco and Health (PATH) survey asks more detailed questions that allow us to distinguish between people who truly never smoked from those who smoked fewer than 100 cigarettes.  We called the latter group triers in our comprehensive study of e-cigarette users published in Nicotine & Tobacco ResearchWe documented that almost all so-called never smokers were, in fact, current or former cigarette triers.

Further examination of the 2018 NHIS reveals that about three-quarters of the so-called never smoking vapers (1.31 million) used the products some days; the rest were daily users.  About 70% were 18-24 years old, and 20% were age 25-34 years.  Thirty-one percent had smoked a cigar, 3.5% had used smokeless tobacco, and 12% had used both products.  Forty-one percent had at least one episode of binge drinking in the month prior to the survey (that is, 5+ drinks for men, and 4+ for women). 

In summary, many current vapers who never smoked in the 2018 NHIS were young, had used other tobacco products, probably had smoked cigarettes and consumed alcohol.  As I have noted previously, these characteristics refute the claim that vaping is attracting tobacco virgins and creating a new generation of nicotine addicts.

Saturday, July 6, 2019

CDC Data: Vaping Increased in 2018, Particularly Among Former Smokers

Before 2018 even ended (here), federal officials were obsessed with that year’s “teen vaping epidemic,” based on a distorted interpretation of data from the National Youth Tobacco Survey (here).  But what about adult smoking and vaping in 2018?  Our government has had the 2018 National Health Interview Survey (NHIS) data for months, but there has been no public release or discussion.  In all likelihood, the results don’t fit the government’s vision for a tobacco-free society. 

There were about 8.07 million American adult vapers in 2018, up from 6.9 million the year before, according to just-released 2018 NHIS data.  That’s the first increase since the CDC started tracking e-cigarette use in 2014.    

Thirty eight percent of current vapers – over 3 million -- were  were former smokers, also the highest number in five years.

Note that there were 1.71 million vapers in 2018 who were never smokers, and for the second year in a row, over two-thirds were 18-24 years old.  Importantly, this establishes the fact that increased rates of high school vaping (here) are resulting in lower prevalence of smoking among young adults.  In fact, the prevalence of current smoking was 7.8% in this group, which is way down compared to historical levels.  The vaping rate was almost the same (7.6%, with 1.7% currently using both products). 

Tobacco and nicotine prohibitionists in government and elsewhere continue to portray vaping as dangerous and evil.  Despite this, more Americans are moving from cigarettes to this vastly safer smoke-free nicotine delivery system.

Thursday, June 27, 2019

Finally, A Direct Comparison of Smoking and Smokeless Tobacco Use

I have documented how American health authorities refuse to directly compare the health effects of smoking and smokeless tobacco (ST) use.  The results of such an exercise would require them to acknowledge the products’ vast risk differentials.  For years, the American Cancer Society has possessed data that would allow this comparison (here, here, and here), but they refused to run the analysis or provide me with the data (here). I recently explained how FDA officials hid the comparison in a New England Journal of Medicine article (here).

I have spent much of the past 25 years trying to correct this information deficit.  Lacking access to the necessary data, the only comparison I could make was indirect (here), which was less than ideal.

Now, at last, the data are in full view.  Altria scientists in April published the first-ever follow-up mortality study of cigarette smokers and ST users, using national surveys and the National Death Index, all of which are produced by the U.S. Government and publicly available.  The first author of the impressive study, published in Harm Reduction Journal, is Michael T. Fisher. 

The figure at left illustrates the results for all causes of death, all cancers and heart diseases; smokeless tobacco is referenced as SLT.  In each section, hazard ratios – the likelihood of dying compared with never tobacco users – are illustrated for smokers by the first set of black dots/squares in the red circles; former smokers are in the next set; and ST users are in the third set, circled in blue.

Smokers are at more than twice the risk of dying from all causes than never tobacco users.  Former smokers’ odds are about 30% to 50% higher than those of never tobacco users (HR = 1.3 – 1.5).  Current ST users who never smoked died at the same rate as never tobacco users.

Compared with never users, smokers had even higher odds for dying from cancer, from 2.9 to about 4.2.  Former smokers also had higher odds, varying from 1.6 to 2.4.  Once again, ST users died at the same rate as never tobacco users.

Smoking isn’t as big a risk factor for diseases of the heart; other factors, like obesity, diet, physical fitness and diabetes, are also important.  Smokers in this study had odds ranging from 1.2 to 2.2, and not all of these were significant.  ST users had no excess risk.

In summary, this analysis of government data confirms that ST use is vastly safer than smoking.  The FDA and CDC not only had this data, but used it in other mortality studies of smokers and cigar users.  By not publishing the results on ST users, federal officials maintained the illusion that ST “is not a safe alternative to cigarettes.”  It is ironic that cigarette industry researchers produced this pivotal analysis.  Stay tuned to this blog for more results.