Tuesday, October 13, 2015

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 Users1.96 million
Current Cigarette Users0.76
Current Cigar Users0.24
Current Smokeless Users0.11
Current Users Other Products0.23
Current Exclusive E-Cigarette Users0.62 million
Ever Cigarette Users0.33
Ever Cigar Users0.06
Ever Smokeless Users0.01
Ever Users Other Products0.02
Current Exclusive E-Cigarette Users Who Never Used Other Tobacco Products0.20 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.         


Unknown said...

Nice summation, graph says it all.

Unknown said...

Well done. A fair analysis.

Anonymous said...

Your graphic chart showing "past 30 day" cigarette and e-cig use by teens from 2011 to 2014 NYTS is phenomenal.

That and the 2014 NYTS data delineating tobacco usage patterns of e-cig users clearly show that e-cigs have been the key force driving down teen cigarette smoking rates to new record lows during the past several years.

Since the NYTS doesn't ask students if they were vaping nicotine (or something else), I suspect that a majority (and perhaps a large majority) of "never tobacco users" who reported exclusive vaping were not vaping nicotine (but the CDC inaccurately classified them as tobacco users simply because they said they had used an e-cig).

The only two surveys that inquired if the e-cig(s) used contained nicotine both found that most nonsmokers who reported past use of an e-cig reported using a no-nicotine e-cig.

Bill Godshall