Federal Officials, Please Pay Attention to Federal Surveys: E-Cigarettes Are Not Gateway Products

I noted in 2013 that the CDC director’s claim – that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes” – was pure gateway speculation (here).  Youth surveys had just started collecting information that teens were using e-cigarettes, but there was zero evidence that they were “going on to smoke.”

In January I presented data from the CDC’s National Youth Tobacco Survey showing that e-cigarette experimentation since 2011 did not produce an epidemic of teen smoking (here).  The 2017 Monitoring the Future survey, illustrated in the chart at left, provides further evidence of a steady decline in cigarette smoking among high school seniors.  In 2017, the smoking rate in MTF dropped below 10% for the first time in history.  At 9.7%, the rate is almost half that of 2011 (18.7%), while the vaping rate remained at 16-17%.  Meanwhile, high school seniors used alcohol and marijuana at far higher rates than cigarettes (33% and 23% respectively).  Nineteen percent of seniors reported being drunk in the past month.

MTF vaping data in 2014-2016 didn’t specify the liquids used; in 2017 MTF collected information on non-specific vaping and vaping nicotine and marijuana in the past month.  Nonspecific vaping, illustrated by the green line in the chart, was around 16%, nicotine vaping was 11%, and marijuana vaping was 4.9% in the past month.

Federal officials are still obsessed with the vape-to-smoke gateway, despite virtually no evidence.  FDA Commissioner Scott Gottlieb recently tweeted a warning: “The [e-cigarette] industry isn’t sustainable if it leads to a whole generation of youth initiation on tobacco.” (here) 

I tweeted a reply urging Dr. Gottlieb to look at his agency’s data from the “…PATH survey of 9,909 never-smoking teens. One year later, 219 (2.2%) had smoked in past 30 days. All awful, but 175 (80%) had no prior tobacco product use; only 11 had used e-cigs. FDA data shows vaping not major gateway to teen smoking [here].” (emphasis added)

Federal officials should stop claiming that vaping is a gateway to smoking, because evidence is absent in all federal surveys.

Tobacco Harm Reduction Research & Funding Draw Ad Hominem Attack

The influential journal Science recently posted on its website an article (here) on the Foundation for a Smoke-Free World, an organization funded by a pledge of almost $1 billion from Philip Morris International.  The Foundation supports tobacco harm reduction research with a stated goal of “end[ing] the production and use of combustible cigarettes and help[ing] smokers switch to less dangerous alternatives.”  Asking, should scientists take the funding, the article clearly leans toward “no”.

The only affirmative comments included in the piece are from the Foundation’s director and me, with my response truncated by the author to this: “But public funding to help settle those questions is in short supply, says Brad Rodu, a harm reduction advocate at the University of Louisville in Kentucky who for years has relied on tobacco money.”

As I have written, government funding, predominantly from the National Institutes of Health, keeps academic research aligned with a vision of a tobacco-free society (here).  NIH’s opposition to tobacco harm reduction dates back to the mid-1990s, as seen in the agency’s efforts to undermine my research and reputation (detailed in Jacob Sullum’s book, For Your Own Good, here).

The Science writer casts me as “a harm reduction advocate…who for years has relied on tobacco money,” despite my record of 65 published professional articles (available here, with PubMed links) and 24 years of scientific endeavor, 19 of which were supported by unrestricted grants from tobacco companies to, and administered by, two universities.

Elsewhere in the story, an individual with half as many published articles is respectfully described as a “tobacco control researcher” as he terms the Foundation a “scam”.

I support academic freedom, including the right to use research funding from any lawful source, accompanied by total transparency and full disclosure.  Research ought to be judged on its merits, using objective standards of quality and accuracy.       

The Foundation director is, regrettably, prescient in anticipating “harassment of grantees and staff” and “ad hominem attacks”.  Such behavior is, as he notes, unacceptable.

American Smokers’ Misperception of E-Cigarettes’ Relative Harm: A National Disgrace

Clive Bates recently commented on Americans’ perception of the relative harm of e-cigarettes versus cigarettes, as measured by the National Cancer Institute’s Health Information National Trends Survey (HINTS).  After looking at numbers from 2013 and 2017 (available here), he asked:

“So what difference did four years of better products, academic studies, journal articles and commentaries, conferences and publicly funded risk communication make? Yes, it caused a deterioration in these already very bad numbers…those incorrectly believing e-cigs were just as harmful or worse than cigarettes had risen from 39.8% to 55.4%.”

These numbers, while unfortunate, pale in comparison to growing misperception among American smokers.  These are the people whose lives will be shortened if they don’t quit.  In the chart I summarize a disheartening trend.

In 2012, 38% of smokers correctly believed that vaping was safer than smoking (the green zone on the chart); the percentage increased to 57% a year later.  In contrast, about 37% and 34% of smokers thought e-cigs were equally or more harmful in those years (the red zone). 

A slight decrease in accurate perceptions (green, at 55%) was seen in 2014, while those with misperceptions grew to 41% (red).  HINTS did not survey smokers again about the comparison until 2017; at that time, accuracy dropped to 38% (green), and misperception rose to 53% (red).       

The sharp increase in misperceptions coincides with a sharp decline in smokers who vaped, from 6.3 million in 2014 to 4.1 million in 2016, according data from the CDC (here).      

This is a national disgrace, driven by hundreds of millions of taxpayer dollars spent on anti-tobacco, anti-tobacco-harm-reduction research (here), with fawning complicity by the media and ill-advised endorsement by public health officials and major medical organizations.  Smokers are the unfortunate victims of this irresponsible crusade.