A Deeper Dive into High School Vaping from the 2023 National Youth Tobacco Survey

 

The Centers for Disease Control and Prevention (CDC) reports that about 1.56 million U.S. high school students were current users (i.e., past 30 days) of e-cigarettes or other vaping products in 2023.  Although this number is substantially lower than at vaping’s peak in 2019 (here), it is still represented as a public health crisis by anti-tobacco crusaders.  This post takes a closer look at this number by examining other factors that were ignored by the CDC. 

The chart on the left breaks down the report’s 1.56 million vapers to calculate the actual number of exclusive, or “virgin” vapers.  I use a sequential subtraction method to isolate factors integral to vaping.  The chart reflects CDC weighting to estimate the numbers in detail, but in the following text, acknowledging real world facts, I’ll use abbreviated estimates.

According to the CDC, there were 15.8 million high schoolers in 2023, so about 9.9% of those were current vapers, that is, they had used the product at least once in the past 30 days.  About 204,000 of the 1.56 million current vapers were also current smokers, which leaves 1.36 million. 

Of these remaining vapers, 397,000 “ever” smoked a cigarette, even one puff, leaving 963,000.

After subtracting another 192,600 “ever” cigar smokers, we have 770,600 current vapers.

Finally, we have a factor that the CDC completely ignores, despite its coverage in the NYTS: “ever” vaping marijuana, tetrahydrocannabinol (THC) or cannabidiol (CBD).  There were 535,500 current vapers who had also vaped those marijuana-related products.

Now we have a reasonable estimate for virgin vapers, or those high schoolers who have not had any other exposure to similar tobacco or marijuana products.  The grand total is 235,021, representing only 1.5% of all high school students.

For further context, consider the frequency of vaping among virgin vapers: 63% had vaped only 1-9 days in the past month, 6% had vaped 10-19 days, and 31% had vaped 20-30 days.  While the latter group is at risk for being addicted to nicotine and vaping, these 73,092 frequent vapers represent just 4.7% of all high school vapers.  Even more importantly, they represent only 0.5% of all U.S. high school students.

Vaping among high school students is a legitimate concern, but vaping is not a new, isolated epidemic or crisis threatening to enslave a generation of teens to nicotine.  The NYTS demonstrates that vaping is connected with smoking cigarettes and cigars, and particularly with the use of THC/CBD. 

The FDA refuses to recognize that teen vapers also smoke and toke.  When the government obsesses over an imaginary “teen vaping epidemic” and denies its actual modest scope, it ignores the 480,000 adult tobacco smokers who die each year.

 

CDC’s Misuse of EVALI Misleads Americans That Smoking Safer Than Vaping

In a campaign of disinformation, culminating in the prolonged mischaracterization of the EVALI (e-cigarette, or vaping, associated lung injuries) crisis, the Centers for Disease Control and Prevention has caused more Americans to believe the untruth that vaping is more dangerous than cigarette smoking.

Bentley University economist Dhaval Dave and colleagues at the City University of New York and Cornell have authored an article titled “News That Takes Your Breath Away: Risk Perceptions During an Outbreak of Vaping-Related Lung Injuries,” published by the National Bureau of Economic Research.  It analyzes the effect of actions taken by the CDC.

Dave et al. describe the federal response to EVALI: “Statements issued by the CDC during the early ‘crisis’ period were direct and clear suggesting that individuals should stop using all vaping products in the late summer of 2019.” (emphasis added). 

The CDC was silent on marijuana until December 10, 2019, when it acknowledged in a tweet that “products that contain THC, particularly from informal sources…play a major role in the current lung injury outbreak.”  The agency had delayed focusing public attention on cannabis products for over three months, as it was clear by early September to many observers, including me (here) and Boston University’s Dr. Michael Siegel (here), that the lung injuries were unrelated to nicotine-based e-cigarettes and vaping products which had been used by tens of millions of consumers for some 10 years with no serious lung problems.    

Figure 5 in Dave’s article, seen above, shows the effect of the anti-vaping misinformation campaign that has been supported since 2012 by the transfer of hundreds of millions of dollars from the FDA to the National Institutes of Health to cooperating university researchers.  This scheme has generated hundreds of laboratory and epidemiologic studies reporting exaggerated or downright false vaping harm. 

The chart shows the success of the misinformation campaign from 2012 to 2019.  The percentage of Americans viewing e-cigarettes as more harmful than cigarettes grew at a consistent rate of about two percentage points per year. 

The 2019 EVALI debacle took the public’s fear of nicotine e-cigarettes and vaping products to new heights.  As Dave et al. write, “the immediate impact…was to increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking by about 16 percentage points.”  After the CDC issued its December 10 tweet emphasizing “the role of THC e-cigarette products, e-cigarette risk perceptions were partially revised downwards.”

That downward movement was minimal, as Figure 6 from the analysis illustrates:

Dave et al. generously refer to the CDC’s delayed identification of marijuana as the cause of EVALI as “precautionary” but they suggest that it may have had “unintended consequences. More targeted advice about the risks of THC e-cigarettes might have more effectively reduced the use of those products, potentially preventing EVALI cases. Moreover, the increase in e-cigarette risk perceptions might discourage adult smokers from using e-cigarettes…the increase in e-cigarette risk perceptions might slow the downward trend in youth smoking.”

By not announcing early on that contaminated marijuana products cause EVALI, the CDC increased the number of injuries and deaths.  The agency inaction also discouraged smokers from switching and might have even encouraged teens to smoke.

Vaping (Marijuana) and Lung Disease: Tale of Two State Health Departments

A few days ago, vaping-related deaths in two states were publicized by their respective state health agencies.  The announcements reflect a stark difference in tone and accuracy.

MICHIGAN

“The Michigan Department of Health and Human Services (MDHHS) [announced] the third death associated with the outbreak of vaping-related lung injuries in the state” on January 10.  Dr. Joneigh Khaldun, MDHHS Chief Medical Executive and Chief Deputy for Health, said “We extend our deepest condolences to the family. I urge people not to use THC-containing e-cigarettes or vaping products until the specific cause of these vaping-related severe lung injuries being reported nationwide has been identified.”  (emphasis added)

MDHHS recommendations start with the following: “People should not use THC-containing e-cigarette or vaping products, particularly from informal sources such as friends, family or in-person or online sellers.” (emphasis added)  The agency says people should avoid vitamin E acetate and “should not add any other substances not intended by the manufacturer to products… Adults using e-cigarettes or vaping products as an alternative to cigarettes should not go back to smoking.”

This is an example of a public health agency providing useful information to marijuana and tobacco users: Don’t vape THC products that are not from legitimate retailers.  Don’t stop vaping legitimate nicotine products and return to smoking.

 

KENTUCKY

On the same day, the Kentucky Department for Public Health “announced the state’s first probable fatality related to vaping.”  Eric Friedlander, acting Secretary of the Cabinet of Health and Family Services, said, “To protect public health, we urge Kentuckians – especially young people -- to stop using all vaping products.” (emphasis added)  Public Health Commissioner Dr. Angela Dearinger added, “health experts can’t guarantee the safety of any e-cigarette or vaping product.”

In its three-page press release, Kentucky never identified THC liquids as the probable cause of the lung injuries, and failed to inform marijuana users about the dangers of unregulated THC products. Officials urged the public “to stop using all vaping products,” which is likely to send those former smokers who had successfully switched to e-cigarettes back to smoking.   

The Kentucky Health Cabinet boasts that it “is one of the largest agencies in state government, with nearly 8,000 full- and part-time employees located across the Commonwealth focused on improving the lives and health of Kentuckians.”  It is regrettable that with all these resources, public health officials are distributing misleading information that may contribute to higher smoking rates.

Australian tobacco researchers, led by Coral Gartner at the University of Queensland, have published a scathing analysis of how THC-related lung injuries and deaths in the U.S. were – and still are – exploited by American health officials and media to fuel a crusade against e-cigarettes and nicotine vaping products.  The Australians itemize the key flaws in this misguided campaign:

“[M]ost [lung injury] cases developed suddenly within a short period, mostly in young males, in only one country. Over 40 million people have vaped nicotine in the UK, USA and Europe, and vaping has been around for nearly a decade without any similar clusters of serious acute cases of lung injury.  If vaping nicotine were the cause of these lung injuries, many more cases should have been reported in these countries…”

“[C]annabis oils, like nicotine‐based vaporisers, have also been used since around 2014 with almost no reports of lung injury. What recently changed is the proliferation of black market cannabis vaping products, some of which are sold in the same packaging as legal cannabis vaping products.”

“In October, the CDC concluded that vaping contaminated THC products was the likely cause of the lung damage.” 

While the CDC was slow to blame unregulated THC products, it is inexcusable that state health departments continue to release inaccurate information about dangerous products.