Thursday, February 22, 2024

Further Evidence That CDC’s National Youth Tobacco Survey Exaggerates Teen Vaping Rates


The National Survey on Drug Use and Health (NSDUH) is a valuable federal resource for population-level research on tobacco and other substance use.  Analyzing its data, I have published research on how many Americans smoke (here, here, here and here), the illegitimacy of the gateway claim (here), and the role of smoking and smokeless tobacco (ST) use in past-year psychiatric disorders (here).  I have shared in this blog other important NSDUH insights into how many Americans use ST (here), who smokes menthols (here and here), and teen smoking declines before and during the e-cigarette era (here and here).  I have also noted that federal officials use NSDUH to spin their prohibition narratives (here).

Today I report an important development: In 2021 and 2022, NSDUH collected information on vaping.  The chart at left presents the most important data from these surveys: smoking/vaping rates among high schoolers, compared to data from the National Youth Tobacco Survey (NYTS). 

Now we have further evidence that NYTS grossly exaggerates teen vaping rates.  The chart at left shows that NSDUH vaping rates in 2021-2022 among high schoolers are much lower than the rates reported in NYTS, which I previously demonstrated were higher than those reported in the FDA’s Population Assessment of Tobacco and Health Survey (here and here) and the federal Knowledge Panel (here). 

As I documented in a peer-reviewed journal (here), NSDUH adult smoking rates tend to be higher than rates reported from NHIS.  That result also holds true for high schoolers, as seen in the chart. 

My research has shown that the higher adult smoking prevalence estimates in NSDUH may be due to the survey’s inclusion as current smokers those persons who smoked as infrequently as one day in the past month.  That is not the case here, however, as NYTS also counts as current any high schooler smoking one day in the past month.

It is unsurprising that the CDC counts high school vapers using only the bloated NYTS survey, and that little research has been conducted to assess its accuracy.  Furthermore, government officials at the CDC and other agencies largely ignore legitimate surveys from NSDUH, PATH and Knowledge Panel when they should consider all available evidence before making claims about teen vaping.


Monday, February 19, 2024

Scaremongering’s Forever Effects


With the emergence of nicotine pouches, claims from the 1980s about the health risks of smokeless tobacco (ST) use have reappeared. Nicotine pouches are an important addition to smokers’ options for reducing harm, but it is inappropriate to devalue them by overstating the risks of ST use, such as opining that it causes leukoplakia and periodontal disease.  This is not the case, and I wish to set the record straight.


In 1995, my research group published an article, “Tobacco Use and Cancer,” that discussed leukoplakia: “Oral leukoplakia was originally defined in 1978 by the World Health Organization as a ‘white patch or plaque that cannot be characterized clinically or pathologically as any other disease.’ This definition was recognized as overly broad, and in 1984 a revised definition excluded white lesions such as frictional keratoses and also specified tobacco-induced leukoplakias as a distinct category. Furthermore, [ST keratosis, STK] was separated from smoking-related leukoplakia on the basis of presentation with additional differences in prevalence, frequency of dysplasia, and rate of malignant transformation. STK is common; it occurs in up to 60% of ST users.” (references omitted)

While anti-tobacco zealots never adopted the accurate terminology, preferring the scarier term leukoplakia, findings from 92 biopsies in one of these scaremongering studies were consistent: “All lesions were benign, but one specimen had mild epithelial dysplasia.”  The term mild dysplasia is subjective, so it’s likely that none of the findings were significant.

When our article was published, we were unaware that the infamous study by Winn et al. in the New England Journal of Medicine involved only women who had used powdered dry snuff (here).  That misleading study led nearly everyone, including health professionals, to mistakenly believe that moist snuff (dip) and chewing tobacco use among men causes mouth cancer.  For confirmation of that fallacy, see the October 2016 report by Annah Wyss of the National Institute of Environment Health Science and 20 government-funded coauthors (discussed here) that found that American men had no excess mouth cancers associated with dipping or chewing tobacco (Odds Ratio, OR = 0.9), while women, who mainly use powdered dry snuff, had a 9-fold elevated risk (here). 

Periodontal Disease

The CDC describes gum or periodontal disease as “mainly the result of infections and inflammation of the gums and bone that surround and support the teeth.”  The same scaremongering study cited above also reported that “gingival recession and attachment loss [4 mm or more] were greater in sites adjacent to lesions in [ST] users.”  These findings aren’t the same as infections and inflammation in and loss of the supporting bone, which is periodontal disease.  In fact, a comprehensive review by Kallischnigg et al. in BMC Oral Health concluded, “Two of four studies report a significant association of snuff with attachment loss and four out of eight with gingival recession. Snuff is not clearly related to gingivitis or periodontal diseases. Limited evidence suggests chewing tobacco is unrelated to periodontal or gingival diseases.” (emphasis added)

These two conditions, leukoplakia and periodontal disease, pale in comparison to lung cancer and heart attacks, so why am I focusing on them?  Because misinformation, particularly about safer smoke-free cigarette substitutes, has a dangerously long shelf-life.

I have dedicated the past 30 years to setting the record straight about ST use, but the American public remains grossly misinformed due to misinformation published decades ago.  For example, the National Cancer Institute Health Information National Trends Survey documents that 86% of Americans don’t believe – or don’t know – that ST use is less harmful than smoking (here).  Similar fake science now inundating the medical literature about newer smoke-free products, if not stopped, will have the same long-term effects. Public health and tobacco experts need to approach misinformation about tobacco risks as seriously as physicians counter quackery in medicine. 


Friday, February 9, 2024

Where are the Crusades to Ban Alcohol, Marijuana & Caffeine – For the Children?


The National Institute on Alcohol Abuse and Alcoholism (NIAAA) just introduced a program to discourage underage drinking, aimed specifically at middle schoolers (here). It’s called “Too Soon = Too Dangerous.”  The chart at left, based on data from the government’s Monitoring the Future Survey (MTFS), shows that attention to early substance abuse is timely.

There’s long been a broad crusade to prohibit all tobacco and nicotine products. Local and state governments are banning vaping and e-cigarette flavors (examples here, here and here), and the FDA has rejected thousands of flavored products that were already on the market (resulting in a todal wave of illicit products).

In contrast, 6% of eighth graders say they consume alcohol.  Of course, all alcoholic drinks are flavored. 

Where is the crusade against alcohol, which is inarguably much more dangerous than nicotine?  According to the CDC, “Underage drinking is a significant public health problem in the U.S.  Excessive drinking is responsible for more than 3,900 deaths and 225,000 years of potential life lost among people under age 21 each year.”  The same potential danger exists with marijuana, which is also consumed by eighth graders. 

Like alcohol and marijuana, nicotine is addictive, but no teenagers have died from using it.  Nicotine is more like caffeine, which is also represented in the chart by the 14% of eighth graders who currently consume energy drinks or shots.  Some health professionals (here, here, here, here and here) and federal agencies (here) have expressed concern, and there is at least one study claiming, “Teens who drink high-caffeine energy beverages such as Red Bull or Monster may be more likely to use alcohol, drugs and cigarettes.”  There is even a report of “a 16-year-old [who] tragically lost his life after consuming an energy drink, a soda and a latte — drinks routinely consumed by and often intensively marketed to youths — all within a few hours.”

Where is the crusade to ban energy drinks and shots?  Tobacco harm reduction advocates will be interested to know that Senators Richard Durbin (D-IL), Richard Blumenthal (D-CT) and Edward Markey (D-MA) have agitated about the marketing and advertising of these products, but no one is talking about banning them.

Let me remind you about the stakes here.  While nearly half-a-million American smokers needlessly die each year because they are unable or unwilling to quit nicotine and tobacco, there is a crusade, mostly in the name of protecting children, to ban effective and vastly safer tobacco substitutes.  In contrast, there is no organized movement to ban far more dangerous alcohol and marijuana, nor addictive caffeine, all of which are frequently consumed by American adolescents.