Monday, March 28, 2022

Home Schooling Suppresses High School Vaping & Smoking


Following my blog post last week about the 2021 National Youth Tobacco Survey (NYTS), there was a lot of discussion among colleagues about the fact that roughly half of the students responded to the survey from home due to the Covid pandemic, while the other half filled it out at school.  According to the CDC (here), “Youths who reported participating in the 2021 NYTS in a school building or classroom reported a higher prevalence of e-cigarette use compared with youths participating at home or at some other place.”  That makes sense.  Teens restricted to their homes were probably not using any drugs as frequently as teens at school.  The bottom line is that this change in survey location during 2021 might have affected prevalence estimates.

Note that while the first two columns in the chart are identical to those in last week’s chart, the last two columns underscore the importance of where the survey was completed.  Students who took the survey at school reported prevalence rates for smoking, vaping and dual use that were twice those for students who responded from home.

There is still good news here.  Even the higher smoking and vaping rates among school survey takers are lower than the rates in 2020, so the decline in both behaviors is real.

In all seriousness, I want to add this cautionary note.  Given that there is no limit to the legislation, regulation and litigation that anti-tobacco zealots will employ, I would not be surprised to see Campaign For Tobacco Free Kids, Truth Initiative and others start lobbying for all American teens to be home-schooled in the months ahead.


Thursday, March 24, 2022

Sharp Decline in High School Vaping as Smoking Is Almost Eliminated


Last week, five and a half months after the CDC and FDA published selective information on 2021 teen vaping (generating frightening “epidemic” headlines in major news media), the CDC finally released data from the 2021 National Youth Tobacco Survey (NYTS).  I have confirmed the CDC finding that “11.3% of high school students (1.72 million) … reported current (past 30 day) e-cigarette use” (here).  However, the CDC failed to mention that this is a 58% reduction in high school vaping from peak prevalence of 27.5% (or 4.1 million) in 2019.  The survey also indicates that high school cigarette smoking declined to 1.9%.  


As indicated in the chart, this represents a profound alteration from 2018, when the vaping rate among high schoolers increased substantially.  The vaping rate rose again in 2019, but plummeted the next two years.  Importantly, during that period the smoking rate fell 77%, from 8.3% to 1.9%.  Tobacco prohibitionists’ claim that vaping would prove a gateway to smoking was without merit.  In fact, it is now clear that vaping helped cancel smoking.

Let’s explore some gaps in the government’s representation of the 1.72 million high school vapers.  First, about 519,000 of those vapers had also used other tobacco products, including cigarettes, cigars, pipes, hookah, smokeless tobacco, nicotine pouches and/or heat-not-burn (HNB) products.  With respect to HNB, the NYTS has some odd data points.  Roughly 316,000 high schoolers reported that they had ever used HNB, and 123,000 said they were current users.  That is simply impossible.  The only HNB sold in the United States was IQOS, but that product was taken off the market by a patent lawsuit.  Additionally, Philip Morris International implemented strict controls that limited teens’ ability to obtain the products.      

Of the 1.2 million “virgin” vapers with no other tobacco use, 732,000 used the products infrequently (19 days or fewer in the past month), and 467,000 vaped 20+ days.  This means that up to 3% of American high school students with no other tobacco use could have become addicted to vaping nicotine, a drug that is not associated with any smoking-related disease.  That number, while of concern, does not constitute an “epidemic,” even though anti-tobacco activists constantly use that term (here).

As I have noted previously, high school vapers are not just using tobacco/nicotine; they are  vaping marijuana at high rates as well. The next chart shows a large majority of high school vapers, regardless of frequency, have vaped marijuana. 



Government public health officials express moral outrage about youth nicotine use, but their concern ought to be directed at the real high school epidemics, evidenced by these statistics from the CDC:

39% text/email while driving

30% drink alcohol

20% use marijuana

17% ride with a driver who had been drinking

17% considered suicide in the past year

16% carry a weapon

14% binge drink

13% drive after marijuana use

Note to activists: Prioritize the activities putting teens at actual risk of injury and death.



Wednesday, March 9, 2022

Massachusetts Department of Public Health Boasts About Its 2019 Vaping Ban That Pushed Vapers to Smoke


Officials at the Massachusetts Department of Public Health have published a report about the “implementation and evaluation of the public health emergency response to the 2019 outbreak of e-cigarette and vaping product use-associated lung injury [abbreviated EVALI]” in that state.  The first author was Lindsay Kephart and the senior author was Dr. Monica Bharel, who served as Commissioner of the department from 2015 to 2021. 

After the state received 38 EVALI case reports, Massachusetts Governor Charlie Baker on September 24, 2019 announced a “public health emergency response” which included a complete ban on “the sale or display of all vaping products…for 4 months.” 

Kephart and colleagues celebrate the results in their report: “Massachusetts residents indicated high awareness of the EVALI outbreak and the corresponding public health response. Tobacco retailers were compliant with the temporary state prohibition on the sale of e-cigarettes. In response to reduced access to vaping products in stores, both adult and youth survey respondents reported reduced use, increased quit attempts, or complete e-cigarette cessation.”

What do these results indicate?  First, tobacco retailers largely cooperated, despite the fact that by early September many, including me (here) and Boston University’s Dr. Michael Siegel (here), were noting that the lung injuries were unrelated to nicotine-based e-cigarettes and vaping products which had been used by tens of millions of consumers for a decade with no serious lung problems.  Second, “high awareness” actually means the public had been seduced into believing, wrongly, that nicotine e-cigarettes and vapes caused EVALI. 

The Kephart report didn’t mention a hugely significant response by vapers to the ban. 

Table 3 provides information from a survey of 602 adult vapers, which asked: “did you switch to using or increase your use of any conventional tobacco products?”  (A technical note: The total number of yes/no responses to that question in Table 3 is 609, which is greater than the 602 respondents.  Kephart has not yet responded to my inquiry about this anomaly.)

In response, 231 vapers – nearly 40 percent -- said they switched or increased use of other products as a result of the ban.  Since there is minimal smokeless tobacco use in Massachusetts, it is likely that the “other products” were cigarettes.

Converting 40 percent of smoke-free product users to smokers is an important and unfortunate result, for which ban architects must be held partially responsible.  This was predictable and predicted.  When will tobacco control activists ever own the foreseeable harmful consequences of their actions?