Monday, December 19, 2022

2022 High School Seniors: Little Change in Tobacco Use, But Significant Increases in Current Marijuana Vaping & Flavored Alcohol Consumption


As my readers know, I have been following the results of the annual Monitoring the Future Survey for many years, focusing on alcohol, marijuana and tobacco use among high school seniors.  Just-released 2022 MTF results (here) indicate that past 30-day (i.e., current) use of these products was fairly stable from the prior year (as seen in chart at left), with the exception of vaping marijuana, which significantly increased.    

While current smoking bottomed out at 4%, past-month alcohol drinking remained at the top of this list at 28%, with 17% having been drunk.  Marijuana use comes in at 20%, with 15% of seniors vaping that substance in the past 30 days. 

Two other MTF topics not in my chart deserve attention: JUUL and flavored alcohol.  MTF reported current JUUL use for the first time in 2019, noting that it was used by 21% of high school seniors.  By 2021, the rate was 6.8%.  This year, MTF dropped JUUL from the survey, which is strange because they kept many other drugs with less than 1% current use.  The reason may be that the sharp decline in JUUL use conflicted with the MTF narrative, highlighted in this year’s press release header: “Nicotine vaping now one of the top forms of substance use among teens.” 

Current drinking of flavored alcohol was another fascinating finding; it significantly increased from 15% in 2021 to 21% this year, identical to vaping nicotine and eclipsing vaping flavors (8.3%).  The FDA Tobacco Center supports the banning all flavored vapes, even in the absence of a scientific rationale.  These products are being banned in jurisdictions across the country.  While it’s hard to conceive a scenario in which flavored alcohol comes under the same attack, one shouldn’t underestimate the power of American prohibitionist thinking. 



Monday, December 12, 2022

American Cancer Society, Which De-Listed Smokeless Tobacco as a Cancer Risk, Now Targets Nicotine Pouches


The journal JAMA Network Open last month published a short report by American Cancer Society and University of Georgia researchers who used Nielsen retail scanner point-of-purchase sales data to estimate U.S. sales of four nicotine pouch brands: Zyn, Rogue, On! and Velo.  While the authors acknowledged that their “data did not represent all nicotine pouch products and online sales,” they still reported a whopping increase in consumption: “Overall sales [of nicotine pouches] increased from 126.06 million units from August to December 2019 to 808.14 million units from January to March 2022.”

This raised a red flag at the American Cancer Society, which issued a press release subtitled, “Researchers at the American Cancer Society stress health interventions to continue reducing nicotine pouch use.”  What health concerns did they cite?  The press release mentions “flavorings, sweeteners”, “colorful packaging that looks like mint containers,” and the usual culprit, “addictive chemical nicotine, which can negatively impact your learning, attention span, and proneness to addiction.”

The closing line of the report reflects the real intent of the authors and the Society: “Health campaigns warning of potential adverse health outcomes of nicotine pouches are needed.”

The question remains: What are those “adverse health outcomes”?  Four years ago, the Society issued a policy paper identifying the top 17 causes of cancer (here).  Smokeless tobacco products were not on the list, as the Society promised to “focus on the primary goal of ending deadly combustible tobacco use.”

Today, the Society has apparently shifted its focus to nicotine pouches.

The American Cancer Society has for decades opposed all nicotine/tobacco products.  Since smokeless products are vastly safer quit-smoking options, the organization has betrayed its “vision to end cancer as we know it for everyone.”  Rather than ensuring “that everyone has an opportunity to prevent…cancer,” the Society ensures that smokers and their families continue to suffer. 

Seven years ago I wrote, “It is time for tobacco users, their families and friends to send a message to the American Cancer Society: ‘Say goodbye to our donations.’  Tell ACS volunteers in your community that the society must acknowledge scientific facts and abandon its tobacco prohibition stance.  Until the ACS tells the truth about tobacco harm reduction, charitable contributions should be directed elsewhere.”

Friday, December 2, 2022

Deficient and Unreliable Studies of Vaping and Disease


At least a dozen medical studies over the past few years have found that vaping is associated with heart attack, stroke, hypertension, emphysema and other lung disease, as well as diabetes (see the list at the end of this entry).  The studies are cross-sectional; they are drawn from population samples at one point in time.  They only produce associations, but those are then inflated to imply or outright claim that vaping causes those disease conditions.  The studies appeared in respected medical journals and, together, form a powerful disincentive for smokers to switch to vaping.  They also add fuel to the regulatory fire to suppress vape products, which are actually vastly safer than cigarettes. 

My research group has published a new analysis entitled, “Cross‑sectional e‑cigarette studies are unreliable without timing of exposure and disease diagnosis,” in the journal Internal and Emergency Medicine.

Our analysis shows that the dozen are irrevocably deficient and unreliable.  Some used data from National Health Interview Surveys (NHIS), the Behavioral Risk Factor Surveillance System (BRFSS), or the FDA’s Population Assessment of Tobacco and Health (PATH) surveys, all of which profile participants who smoked and/or vaped and who had ever been diagnosed with numerous diseases.  However, there is absolutely no information in the NHIS or BRFSS about when participants started to smoke or vape, or when they were first diagnosed with a disease. Absent this critical data, it is impossible to demonstrate that smoking or vaping preceded the disease, and therefore had any role in causing it.

While authors of some of the studies tried to use a statistical sleight of hand by claiming that their results were “adjusted” for smoking, that is not a legitimate work-around for the missing cause-and-effect information.

Some studies used PATH data, which does contain all of the information needed to analyze whether smoking and vaping preceded the diseases and therefore might have caused them.  Readers of my blog know that my research group in 2019 used PATH data to demonstrate that a heart attack study published in the flagship journal of the American Heart Association was pure fiction, resulting in its retraction by journal editors.  Now we have analyzed PATH data to demonstrate that none of the vaping-caused-disease claims in the recent studies are valid.

Our design was simple: We started by determining at what age participants were diagnosed with smoking-attributable diseases – chronic obstructive pulmonary disease (COPD), emphysema, myocardial infarction (MI, or heart attack) and stroke.  We then noted when participants started smoking or vaping.  The results were crystal clear.  As we reported in our study, “Only 4% of COPD and emphysema cases, 6% of MIs and 11% of stroke had occurred in PATH participants who had used e-cigarettes prior to the diagnoses. In contrast, over 94% of all cases occurred after smoking cigarettes fairly regularly.” 

In summary, the cited studies’ claims that vaping is related to or causes airway and circulatory diseases are not valid, as the authors lacked or ignored causative pathway information.  As for those few cases in which vaping preceded the disease, we note in our article, this may indicate “a potential reverse association between e-cigarette use and these diseases. In other words, having a diagnosis for respiratory and cardiovascular diseases leads smokers to use e-cigarettes.”


   Deficient and Unreliable Studies of Vaping and Disease

   Alzahrani T, Pena I, Temesgen N, Glantz SA (2018).  Association between electronic cigarette use and myocardial infarction.  Am J Prev Med 55(4):455-461.   

Vindhyal MR, Okut H, Ablah E, Ndunda PM, Kallail KJ, Choi WS (2020).  Cardiovascular outcomes associated with adult electronic cigarette use.  Cureus 12(8): e9618. 

Wills TA, Pagano I, Williams RJ, Tam EK (2019).  E-cigarette use and respiratory disorder in an adult sample.  Drug Alc Depend 194:363-370. 

Osei AD, Mirbolouk M, Orimoloye OA, et al (2019).  Association between e-cigarette use and cardiovascular disease among never and current combustible-cigarette smokers.  Am J Med 132:949-954. 

Parekh T, Pemmasani S, Desai R (2020).  Risk of stroke with e-cigarette and combustible cigarette use in young adults.  Am J Prev Med 58(3):446-452.

   Bircan E, Bezirhan U, Porter A, Fagan P, Orloff MS (2021).  Electronic cigarette use and its association with asthma, chronic obstructive pulmonary disease (COPD) and asthma-COPD overlap syndrome among never cigarette smokers.  Tob Ind Dis 19:23. 

   Wills TA, Choi K, Pokhrel P, Pagano I (2022).  Tests for confounding with cigarette smoking in the association of e-cigarette use with respiratory disorder: 2020 national-sample data. Prev Med

Perez MF, Atuegwu N, Mead E, Oncken C, Mortensen EM (2018).  E-cigarette use is associated with emphysema, chronic bronchitis and COPD.  Am J Respir Crit Care Med 197:A6245.  

Zhang Z, Jiao Z, Blaha MJ, et al (2022).  The association between e-cigarette use and prediabetes: results from the Behavioral Risk Factor Surveillance System, 2016-2018.  Am J Prev Med 62(6):872-877. 

Atuegwu NC, Perez MF, Oncken C, Mead EL, Maheshwari N, Mortensen EM (2019).  E-cigarette use is associated with a self-reported diagnosis of prediabetes in never cigarette smokers: results from the Behavioral Risk Factor Surveillance System Survey.  Drug Alc Depend 205: 107692. doi:10.1016/j.drugalcdep.2019.10769

Miller CR, Shi H, Li D, Goniewicz ML (2021).  Cross-sectional associations of smoking and e-cigarette use with self-reported diagnosed hypertension: findings from Wave 3 of the Population Assessment of Tobacco and Health Study.  Toxics 9:52 

Osei AD, Mirbolouk M, Orimoloye OA et al. Association between e-cigarette use and chronic obstructive pulmonary disease by smoking status: Behavioral Risk Factor Surveillance System 2016 and 2017.  Am J Prev Med 58, ISSUE 3, P336-342, March 01, 2020.  

Osei AD, Mirbolouk M, Orimoloye, OA et al. The association between e-cigarette use and asthma among never combustible cigarette smokers: Behavioral Risk Factor Surveillance System (BRFSS) 2016 & 2017. BMC Pulm Med 19, 180 (2019).