Hints About Smokers Quitting with E-Cigarettes in National Cancer Institute Survey

 

The National Cancer Institute (NCI) released a Health Information National Trends Survey (HINTS 7, 2024) earlier this spring.  I previously used this survey to illustrate the extensive damage caused by mainstream medicine’s campaign against e-cigarettes, which has resulted in American smokers’ misperception about the relative safety of vaping vs. smoking (here and here).  HINTS 7 does not ask about harm perception, but it does ask if participants “believe that any of the following tobacco products can help people quit smoking cigarettes? - Electronic nicotine devices (ENDS), like e-cigarettes.” 

The results for smokers, described in the table and the following chart, are fascinating. 

It is striking, though not unexpected, that current vapers have the strongest belief that e-cigarettes can help people quit smoking, even though the only group over 50% is “former” smokers.  Still, even among “former” vapers, the belief was 22% to 47%.  

Tragically, only 5% of “current” smokers who had never used e-cigarettes believed they would aid quitting.  This is proof that the erroneous message promoted by the American Medical Association and other prohibitionists (discussed last week here) is working, when, in fact, we have population evidence that smokers are switching (here and here), and two smoking cessation trials reported in the New England Journal of Medicine in 2019 and 2024 clearly demonstrate that vapor products help smokers quit.

The HINTS survey tells us how many Americans were smokers and vapers in 2024 (see Note).  The following chart shows that there are fewer than a million 18-24 year-olds who only smoke, and vaping is popular among the majority of 25-34 year-olds.  However, 18.7 million of the 21.8 million exclusive smokers in this survey are age 35 and older.  These are the smokers who desperately need truthful information about the relative safety of vapes and their usefulness for quitting, in order to avoid untimely morbidity and mortality.   

 

Note: Although the HINTS survey is not used to count smokers and vapers, I compared these findings with numbers from the 2023 National Health Interview Survey, the instrument the CDC uses.  The numbers were comparable in all age categories.

 

FDA Commissioner Califf’s Anti-Misinformation Campaign Must Start at Home

 

In a recent interview with CNBC, FDA Commissioner Dr. Robert Califf said that “misinformation” is driving down U.S. life expectancy, which is now three to five years lower than in other developed countries.  Dr. Califf said that combating misinformation is one of his top priorities, and he called for more regulation by “specific authorities at FDA, FTC and other areas to root out misinformation.”

The Commissioner should put his own agency in order first.  U.S. life expectancy has declined for decades largely because some half-million Americans per year have died from burning tobacco and inhaling smoke.  This tragedy has been going on so long that today few see it as a crisis.  For proof, do a Google News search for “crisis” and here’s what you get: banking crisis, housing crisis, plastics pollution crisis, mental health crisis and opiate overdose crisis.  All of these are serious problems, but their severity pales in comparison with smoking-related deaths.

Today, smokers can avoid premature death by switching to e-cigarettes and vaping products.  The British government has seized on this fact, announcing, “One million smokers will be encouraged to swap cigarettes for vapes under a pioneering new ‘swap to stop’ scheme designed to improve the health of the nation and cut smoking rates.  As part of the world-first national scheme, almost 1 in 5 of all smokers in England will be provided with a vape starter kit alongside behavioural support to help them quit the habit as part of a series of new measures to help the government meet its ambition of being smokefree by 2030 - reducing smoking rates to 5% or less.”

Yet here in the U.S., rather than encouraging smokers to switch, the FDA has taken millions of vape products off the market; the only products the agency has approved for sale have been tobacco-flavored.  Imagine if the FDA approved a drug to help people suffering from alcoholism, but only if the product is bourbon-flavored!

The chart, showing data from the National Cancer Institute’s Health Information National Trends Survey (HINTS), reveals the extensive damage caused by the federal government’s campaign against e-cigarettes.  In 2020, only 10% of American adult smokers believed correctly that vaping was less harmful than smoking; two-thirds believed vapes were the same or more dangerous, and a quarter didn’t know. 

Who can blame smokers for not switching from cigarettes to products that most believe are as bad or worse for their health?   

A lot has been written about the 2022 Reagan-Udall Foundation report that criticized FDA tobacco regulations, but for me, the most egregious and deadliest regulatory misstep has been the government’s successful misinformation campaign against safer and satisfying smoke-free alternatives, and against nicotine itself.  Dr. Califf is correct in saying that “misinformation is driving life expectancy in the U.S. down,” but it is his own agency that is spewing the misinformation that dissuades smokers from stepping away from the fire.  It is long past time for the FDA and other public health agencies to reverse course and give smokers the tobacco truth.

 

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.