Washington Post Attack on E-Cigarettes Deserves Emergency Room Treatment

 

Dr. Leana Wen, an emergency physician and Washington Post columnist, attacked tobacco harm reduction in a Post column last week, “The New Nicotine Product Replacing e‑Cigarettes to Addict Teens” (paywalled).  It dealt mainly with Zyn nicotine pouches, but it touched on the gamut of safer cigarette substitutes. 

Matt Holman, Ph.D., Chief Scientific and Regulatory Strategy Officer at U.S. Philip Morris International, has responded (here) with an accurate point-by-point rebuttal of Dr. Wen’s numerous misstatements. 

I’d like to focus on one especially egregious statement in Wen’s article: “Mitch Zeller, former director of the FDA’s Center for Tobacco Products, explained that as much as 70 percent of people who vape continue to smoke. He showed me industry data from two years ago that showed 84 percent of adult pouch users kept up cigarette use.”

I was astonished that Zeller would cite 70 percent, when he can readily access updated information from the gold standard CDC National Health Interview Survey (NHIS). In this chart of the smoking status of 17.8 million vapers estimated from the 2024 NHIS, the highest percentage were former smokers, while only 26 percent were current smokers.

While dual use is a transition period for many smokers, dual use has another, more ominous driver: misinformation from federal agencies and major medical organizations.  For example, Matt Holman noted: “under the helm of Mr. Zeller, [the FDA Center for Tobacco Products] authorized more than 2,800 cigarette products to be marketed while only authorizing 30 novel smoke-free products (heated tobacco products, Swedish snus, and vapes). These actions resulting in 100 times more authorizations for combusted tobacco than novel smoke-free products are in direct opposition of CTP’s stated mission ‘To protect the public health of the U.S. population from tobacco-related death and disease...’”

Additionally, in 2018, CTP director Zeller launched the FDA Real Cost E-Cigarette Campaign, which is a misinformation circus.  It ostensibly targets kids, but I calculated – using the FDA’s formula – that this campaign also dissuaded hundreds of thousands of smokers from switching to safer vape products (here).

The Washington Post should run a major correction for Dr. Wen’s article.

Federal Surveys Demonstrate E-Cigarettes Have Been Successful Quit-Smoking Aids For a Decade

 

New research based on U.S. government survey data shows, “The most popular methods used to stop smoking were nicotine products (53.9%; 1.5 million adults), especially e-cigarettes in combination with other methods (40.8%; 1.2 million) and e-cigarettes alone (26.0%; 0.7 million)” [confidence intervals removed by me]. Additionally, “Prescription drug products (8.1%; 0.2 million) and non-nicotine, non-prescription drug methods (6.3%; 0.2 million) were less popular.”

Tobacco researchers Floe Foxon (Pinney Associates) and Ray Niaura (New York University) made those observations in their new report, “Use of nicotine products, prescription drug products, and other methods to stop smoking by US adults in the 2022 National Health Interview Survey,” appearing in the journal Internal and Emergency Medicine (abstract here).

Foxon and Niaura analyzed “U.S. adults who self-reported having stopped smoking cigarettes for 6 months or longer in the last year and the methods they used, or who did not stop smoking but tried in the last year.”  The survey that supplied the raw data is the standard instrument used by the Centers for Disease Control and Prevention to count 29 million adult current and 56 million former U.S. smokers each year. 

The researchers note that their results are similar to those in an earlier analysis of adult smokers in the FDA’s Population Assessment of Tobacco and Health (PATH) Survey.  I conducted that study along with Nantaporn Plurphanswat and noted in a blog post, “e-cigarettes were one of the most commonly used quit aids by American smokers in 2013-2014, and that they were the only aid more likely to make one a former smoker (i.e., a successful quitter) than quitting cold-turkey.”

Now we have definitive population-level evidence, provided by the federal government, that e-cigarettes have been the most popular and among the most successful quit-smoking aids for almost a decade.  It is long past time for government officials to acknowledge these facts.

 

More Federal Data on Smoking & Vaping Rates Among American Adults

 

Recently I described how high school vaping rates reported in the National Survey on Drug Use and Health (NSDUH) are much lower than those reported in the CDC’s National Youth Tobacco Survey (NYTS) (here).  Today I review NSDUH adult vaping rates, compared to those in the National Health Interview Survey (NHIS), which is the CDC’s traditional source for adult smoking estimates.

The chart at left shows smoking and vaping rates among all American adults 18+ years.  In 2022, the NHIS estimate of current smokers was 11.6%, or about 29 million. 

Now let’s turn to vaping, keeping in mind that the “Dual Use” column segments count both current vaping and smoking.  In 2022, the NHIS estimate of current vapors was 6%, or nearly 15 million, including almost 4 million dual users.

As I demonstrated in a 2009 published analysis (here), NSDUH current smoking estimates are always higher than NHIS estimates.  Neither survey estimate is right or wrong; instead, taken together, they probably represent a reasonable range.  The 2022 NSDUH percentage of smokers was 15.9%, or about 39.5 million, while the NSDUH vaping prevalence for that year was 8.5% or 21 million, with 8.1 million dual users.

Turning to young adults 18-24 years old, in 2022 the NHIS estimate of current smokers in this group was 4.8% or about 1.4 million, but the vaping prevalence was even higher, at 15.1%, representing 4.3 million.  This means that vaping surpassed smoking among young adults.  The proportions are the same in NSDUH, even though the numbers are higher: the percentage of smokers is 10.6%, or about 3.7 million, figures that are swamped by the percentage of vapers, at 24.3%, or 6.9 million.

 

 

 

Why are NSDUH smoking and vaping estimates always higher than those in NHIS?  First, the surveys ask different questions to account for “current” use.  As we noted in our previous study, “NSDUH identifies almost twice as many some-day smokers as the NHIS, which is likely due to differences in the questions that subjects are asked.”  But we also discussed an even more important factor: “the respondents’ perceptions of smoking within the context of the two surveys. The NHIS is focused on the health status of participants, with more limited attention on behavioral risk factors. In this context, smoking may be perceived as one of the more undesirable behaviors that subjects are asked to report, which may lead to under-reporting.  In contrast, the NSDUH is devoted almost entirely to substance use, with questions about marijuana, cocaine and crack cocaine, hallucinogens, inhalants and non-medical use of prescription drugs. In the context that these substances are far more socially unacceptable than cigarettes, participants may be more comfortable acknowledging that they smoke.”

Fifteen years ago, we wrote, “It is surprising that estimates of national smoking prevalence have been derived from a single source, the NHIS, and that little research has been conducted to assess its accuracy over time… Further investigation of the NSDUH/NHIS discrepancy may lead to better surveys and an improved understanding of smoking trends in the USA.”

To date, nothing has been done to explain this discrepancy, so it is reasonable to consider the NHIS and NSDUH figures as low and high estimates for U.S. smoking and vaping.