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.

 

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.

 

@CDCTobaccoFree is Obsessed with Teen Vaping, But It Has Reduced Far More Harmful Teen Smoking

 

Yesterday the CDC released results from this year's National Youth Tobacco Survey, and the agency focused only on teen vaping.  The data will likely be embargoed for several months, preventing analysis by independent investigators.  The CDC never mentioned smoking, so I expanded findings from the National Survey on Drug Use and Health (NSDUH) that I originally published in this blog (here).   

The new results, seen in the chart at left, are crystal clear.  Everyone knows that teen vaping started after 2010.  Teen smoking had been declining prior to that, but the pace was modest.  The pace accelerated after 2010, and the connection to vaping is not coincidental. 

Unfortunately, NSDUH has never collected teen vaping data -- yet another bizarre omission by government health authorities.

Another important point is that the NSDUH calculated the teen smoking rate in 2018 to be 5%.  This is far lower than NYTS rate of 8.3% for the same year.  I have previously documented that NYTS smoking rates are much higher than those recorded in other federal surveys.