Commissioner Makary on High Schoolers Vaping: Half or Half a Percent?

 

In his Congressional testimony on May 22, FDA Commissioner Dr. Martin Makary said, “There are high schools in America now where kids are saying half of the kids are addicted to these vaping products.”

During the 2024 campaign, President Trump promised to save vaping.  Now that job falls to Dr. Makary, whose agency “oversees the safety of more than $3.9 trillion worth of food, tobacco, and medical products produced in the U.S. and abroad.”  With so much on his plate, he can be forgiven for not having all the facts yet on youth vaping.

Last December, I took a deep dive into vaping among American high schoolers, using the CDC’s 2023 National Youth Tobacco Survey (here), the latest available dataset.

My analysis demonstrated that some 73,092 of the nation’s 15.8 million high schoolers vaped frequently enough (20-30 days in past month) to be at risk for being addicted.  That represents only 0.5%, not 50%.

No one is comfortable with youth vaping, but Dr. Makary and his team should understand that vaping has contributed to the disappearance of smoking among American high schoolers, and the rate among young adults is similarly minimal.  This means that in 25 to 30 years, smoking-related diseases will nearly disappear, too.  It’s time for the FDA to focus on adult smokers over age 40, whose risk grows with each cigarette.  Going smoke-free will give them the chance for longer and healthier lives. 

 

 

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.

 

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.