Why Do High Schoolers Vape? National Youth Tobacco Surveys Suggest Answers

 

 

 

Federal officials blame vape manufacturers and retailers for teen vaping, focusing in particular on the industry’s use of flavoring, but government surveys indicate the truth is more nuanced.

The government’s National Youth Tobacco Surveys (NYTS) routinely collect information on teenage e-cigarette use.  I examined survey data for the years when vaping accelerated (2018 and 2019), and when it declined (2020 and 2021).  In the first three years, the survey asked, “What are the reasons that you have used e-cigarettes?”  In 2021, the question changed to, “Why do you currently use e-cigarettes?”  Other survey modifications occurred, as noted in the Table footnotes.

 

High School Vapers: Percentage Reporting Why They Have Used [Currently Use*] E-cigarettes, NYTS 2018-2021
Reason	2018	2019	2020	2021
Used by friend	30%*	21%*	37%	27%
Used by family member			8	6
To quit other tobacco	11	9	8	4
Costs less than other tobacco	6	6	3	4
Easier to get than other tobacco	6	6	5	5
Used by people on TV, online, movies	1	4	3	2
Less harmful than other tobacco	25	18	14	10
Flavors	36	23	20	13
Use unnoticed	8	18	17	14
Other reason	30	18	25	19
Peer pressure	---	8	---	---
Used to do tricks	---	23	24	19
Curious	---	48	42	9
Use when anxious, stressed, depressed	---	---	---	42
Nicotine buzz	---	---	---	44

 

*Friend and family member combined

--  Reason not asked

Participants could choose multiple reasons

 

Let’s look at some of the bigger trends.  First, among reasons measured in all four years, “friends’ use” is consistently the most important, which jibes with the common observation that most teens obtain e-cigarettes from friends rather than retail stores.  “Other” reasons ranks second, followed by “flavors”, “less harmful”, and “use unnoticed at home or school”.  Note that the percentage of respondents mentioning flavors fell from 36% in 2018, to 13% in 2021, undercutting activist arguments to ban them.  The percentage mentioning less harmful also declined, from 25% to 10%, likely reflecting the success of the FDA’s grossly misleading “Real Cost” campaign that asserts that e-cigarettes are equally or more harmful than cigarettes.

Additional reasons for vaping, offered in NYTS after 2018, were also selected at high rates; these included “performing tricks” and “curiosity”.  In 2021, 42% of vapers said they vaped because they were anxious, stressed or depressed, and 44% were trying to get a nicotine buzz.

Also of note: “Quitting other products”, “costing less”, “easier to get”, and “celebrities” were not frequently cited as important reasons to vape. 

Why, one might ask, was there so much variation across the four years?  The answer may well lie with the inherent variability of self-reporting by teenage respondents.

 

The American Medical Association Only Promotes and Protects Doctors, Not Public Health

 

Dr. Gerald E. Harmon, president of the American Medical Association (AMA), authored a commentary November 19 claiming that the “FDA made the wrong choice in allowing Vuse marketing.”

Dr. Harmon said that the FDA’s decision “is wrong on many levels,” but I will show that his commentary better fits that description.

Harmon says that the FDA’s “gravest error is to frame its action as ‘appropriate for the protection of the public health.’”  Gravest error?  Harmon tells his readers in the next paragraph that the FDA had no choice: Congress dictated that precise standard in legislation giving FDA regulatory authority over tobacco in 2009 (here).

Next, Harmon claims that “the role that e-cigarettes may play in smoking cessation strategies is unclear.”  That may be true – for someone who has never looked at federal surveys (here, here and here), never read the scientific literature (here, here and here) and/or never met a former smoker (also called an “anecdote”) (here).    

Incredibly, Harmon cites a recent study from the University of California San Diego involving “smokers who turned to e-cigarettes as a cessation device.”  No.  They.  Didn’t.  As I recently explained in a critique on that study (here and here). 

Then he gets to the core of his commentary: “The AMA has specifically recognized the use of e-cigarettes and vaping as an urgent public health epidemic and has called for a total ban on all e-cigarette and vaping products that do not meet FDA approval standards as cessation tools.” (emphasis added)  In other words, the AMA wants prohibition if the FDA doesn’t regulate e-cigarettes as harshly as it regulates cancer chemotherapy.

Harmon comes up with a claim that will make ever smokers laugh out loud: “Data has shown that using FDA-approved cessation medicine can double a persons [sic] chance of quitting smoking successfully.” 

Double what?  Every year only 5% of smokers quit, so doubling that number makes 10%.  Does Harmon care about the other 90% of smokers who couldn’t quit the AMA way?  I don’t think so.

A lot of Harmon’s rant about Vuse was devoted to “fruit- and candy-flavored” products.  This is strange.  The only Vuse products the FDA authorized are tobacco-flavored.

Why does the AMA, one of the most influential organizations in American medicine, take such a prohibitionist position when 480,000 American smokers are dying prematurely every year?  Well, its influence derives not from its commitment to public health, but from its power as a trade organization.  And trade organizations’ first and foremost goals are to advance the interests of its members.  According to blogger Matthew Yglesias, the AMA actively makes the number of doctors in the U.S. scarce, by blocking increased scope of practice for nurses, making it hard for foreign-trained doctors to practice in the United States, and historically pushing to train too few doctors here at home.  This results in big salaries for doctors and dismal, expensive access to medical care for Americans compared to many other developed countries (see chart below). 

The AMA protects and promotes doctors, it doesn’t care about American smokers.

 

 

The Vape Industry Can’t Advertise to Kids, But Anti-Tobacco Crusaders Are Doing It For Them

Anti-tobacco crusaders have for three years been blaming e-cigarette manufacturers and retailers for increased teen vaping, which the CDC, citing National Youth Tobacco Survey results, dramatically terms an epidemic. 

The vape industry is accused of enticing youth with kid-friendly flavors, cartoons and images, however, it may not be industry advertising that’s driving young vapers. Anti-vape organizations are running pervasive information campaigns that inundate youth with cartoons and other hip images, photos of kids vaping, and attractive illustrations of vape flavors. Anti-tobacco forces are actually encouraging kids to try e-cigarettes by underscoring how easy it is to use the products, the array of available flavors, and the enticing nicotine buzz that accompanies their use. 

Charles Gardner provides an impressive collection of prohibitionists’ unintended pro-vaping images and advertisements in this twitter thread. I’ve organized the images into three groups – Kids Vaping, Cartoons and Flavor Advertisements – with notes on who funded them. 

KIDS VAPING

Last year, Clive Bates ridiculed the FDA’s poorly crafted vaping epidemic ad campaign, which basically invited kids to experiment. Here are more images:

 

CARTOONS

FLAVOR ADVERTISEMENTS

You probably noticed that at least five of the previous ads highlighted a pod device that looks a lot like a JUUL, and one even mentions the brand. Here’s another JUUL ad that the company didn’t pay for: