Thursday, February 23, 2023

High School Vaping Up Slightly in 2022, But Smoking Rates Remained Vanishingly Low


Reviewing CDC data from the 2022 National Youth Tobacco Survey (NYTS), I have confirmed the agency’s finding that 14.1% of high school students (2.15 million) reported current (past 30 day) e-cigarette use, an increase of 2.9%, or about 430,000 students.  The survey also indicates that high school cigarette smoking was stable at 2%.  

Yet, once again, the CDC’s data, and the agency’s spin on it, raises some critical concerns.

First, about 1.42 million vapers had used other tobacco products and devices, including cigarettes, cigars, pipes, hookahs, smokeless tobacco, nicotine pouches and/or heat-not-burn (HNB) products. 

With respect to HNB, the NYTS has some strange data points.  An estimated 319,000 high schoolers reported that they had ever used HNB, and 114,000 were current users in 2022.  That is simply impossible.  The only HNB ever sold in the U.S., Philip Morris International’s IQOS, was removed from the market in 2021, owing to a patent lawsuit.  In addition, PMI implemented strict controls that made it highly unlikely for teens to have obtained these products.  HNB ever and current usage might be explained by teens confusing those devices with vaping products.  In fact, over three-quarters of high schoolers in NYTS who reported ever using HNBs also were ever users of e-cigarettes.       

Of the 729,000 current “virgin” vapers who had never used another tobacco product, 495,000 vaped infrequently (19 days or fewer in the past month), while 234,000 vaped 20+ days.  This means that only 1.5% of American high school students with no other tobacco use could conceivably be addicted to vaping nicotine.  Although this is cause for concern, it is nowhere near a true “epidemic,” even though anti-tobacco activists use that term incessantly in collusion with the CDC.

As I have noted previously, high school vapers are not just using tobacco/nicotine.  CDC and FDA vaping screeds routinely ignore high rates of marijuana vaping.  The next chart shows that marijuana vaping has become even more popular; for example, a large majority of virgin high school vapers, regardless of frequency, have vaped marijuana.   


Federal officials’ continued profession of moral outrage about nicotine use is entirely misplaced.  They should instead focus on real high school epidemics, including:

39% who text/email while driving

30% who drink alcohol

20% who use marijuana

17% who ride with a driver who had been drinking

17% who considered suicide in the past year

16% who carry a weapon

14% who binge drink

13% who drive after marijuana use

Those teens are at real risk of injury and death.


Wednesday, February 15, 2023

Exposing Defective Research, But Denied Credit for the Effort: Case 1


I have catalogued in this blog numerous instances of deficient research that has been published by respected medical journals.  In some cases, journal editors have published our concerns and authors’ corrections (here). 

It is extremely difficult to get critical letters published.  Editors don’t accept letters that simply complain about debatable issues.  Critics must raise concerns that are irrefutable and likely to affect the study’s results and/or conclusions.  Journal editors are ultimately responsible for failing to detect erroneous research, as they choose the articles and the peer reviewers.  When objecting to an article, the critic carries the burden of proof, often in the face of staunch, even coordinated opposition by all the other parties.

In this and subsequent posts I will describe cases in which editors accepted our criticism as legitimate, but defied medical publishing ethics by failing to publicly acknowledge our concerns, pretending that the errors were discovered by the authors.


Case 1. Mortality Study Among American Smokeless Tobacco Users by staff at the National Cancer Institute.

On May 17, 2019, Maki Inoue-Choi and colleagues at the National Cancer Institute and the University of Minnesota published a study, “Contemporary Associations of Exclusive Cigarette, Cigar, Pipe, and Smokeless Tobacco Use With Overall and Cause-Specific Mortality in the United States,” in the Journal of the National Cancer Institute Cancer Spectrum (here).  It asserted that smokeless tobacco (ST) use was associated with increases in “overall mortality (HR = 1.41, 95% CI = 1.20 to 1.66)” and “higher risk of mortality from heart disease and smoking-related cancer, with strong associations observed for cancers of the oral cavity and bladder.”

Working with the same data, my colleague Nantaporn Plurphanswat and I found that some of the Inoue-Choi results made no sense, with numbers in their tables not adding up, and tobacco use definitions being unclear.  Dr. Plurphanswat emailed Inoue-Choi with our concerns on July 31 (here).  A month passed with no response, so I emailed the senior author of the study on August 28 (here), and again received no response. 

Finally, on December 3, I emailed the editor of JNCI Cancer Spectrum with a summary of our five-month fruitless effort to contact the authors (here).  She responded the same day: “We may suggest you put this together as a letter to the editor that we will ask the authors to respond to.”

A week later, on December 10, an editorial assistant at the journal wrote: “Thank you for bringing this concern to our attention. We are proceeding with a correction to this article. We suggest no other action be taken until we publish the corrigendum.”

In February 2020, the journal published Inoue-Choi’s correction (here), which gives the false impression that they discovered their error.  Dr. Plurphanswat and I were not acknowledged for our weeks of work identifying those mistakes and raising our concerns with the authors.  More importantly, our other questions about the article went unanswered.  Furthermore, the correction itself was bizarre, as it listed the changes line by line in text that ran two pages longer than the original article.  A retraction and republication would have been more appropriate.

When editors allow authors to make mistakes and corrections this egregious, the scientific value of the finished product is seriously compromised. 

Authors and editors may try to evade a full accounting of the errors.  Further evidence of ethical lapses in publishing will be provided in Case 2 next week,


Wednesday, February 8, 2023

U.S. & UK Vaping Rates Similar Among Youth & Young Adults


I have previously commented on the so-called American teen vaping “epidemic”.  Using federal data, I have shown how the CDC and the FDA exaggerate the magnitude of vaping, portraying a fake crisis (here, here, here, here, here, here and here).  This post compares the prevalence of vaping among young people in the United States and the UK.  In the latter country, e-cigarettes have been welcomed and endorsed by the public health establishment as effective quit-smoking, life-saving aids, and there has been a noticeable absence of the U.S.-style crisis scaremongering.

The chart on the left shows the prevalence of vaping in the U.S. and UK among youth and young adults age 16 to 24 years from 2014 to 2019, and 18-24 years in 2020.  Note that prevalence was the same in both countries in 2014, and was higher in the UK over the next three years.  Prevalence spiked in the U.S. in 2018 and 2019, but by 2020 both countries had similar rates. 

The data for the two countries are fairly similar, the biggest difference being how American and British authorities, and the media, have responded.  British authorities have consistently spoken the truth about vaping since 2011 (here, here, here, here and here), and today Britain’s Department of Health helps smokers switch from combustibles to vapor.  Their American counterparts, however, have been on a crusade to eliminate these vastly safer cigarette substitutes, even falsely suggesting that nicotine in e-cigarettes will cause irreversible brain damage in children. Tobacco prohibitionists appear to be ignorant of the fact that their warnings and advertisements might actually spark the “epidemic”.



Notes on the chart’s numbers.  The British annual rates are averaged from four quarterly surveys from the Smoking Toolkit Study (here), which set the age ranges; current vapers were using e-cigarettes at the time of the surveys.  The American rates are a weighted combination of data from National Youth Tobacco Surveys (16-17 year olds) and the National Health Interview Surveys (18-24 year olds).  Current vaping in the former was 20-30 days in the past month; and every day or some days in the latter.