Tobacco Prohibitionists Kill Safer Cigarette Substitutes… and Smokers

 

Dr. Michael Siegel has published a blog entry criticizing a “new article in American Journal of Medicine claim[ing] that youths who use e-cigarettes are 5 times more likely to become cigarette smokers.”  The commentary was authored by tobacco and nicotine opponents Pamela Ling and Edward Goetzl.

Dr. Siegel correctly notes, “the article in question fails to provide any citation or source for its preposterous claim… Apparently, we are supposed to just take it on faith that this is true.”

Reviewing the Ling-Goetzl screed, I found that the authors specified that the five-fold claim was for “tobacco-naive adolescents.”  While that claim was not attributed, the commentary’s authors did include in their reference list one possible source: another commentary, authored by fellow prohibitionist Jonathan Winickoff and coworkers in September’s JAMA. 

Winikoff did not provide a source for his claim either, but he hinted at it with a reference to a 2019 article by Kaitlyn Berry, et al., in JAMA Network Open.

Further complicating the matter, I, along with David Abrams and Ray Niaura, had published a critical comment in that journal, documenting how Berry, et al., engineered their study to make e-cigarettes seem to increase smoking rates by 4 times (in their abstract), not 5.  I also wrote a blog entry on the subject in February 2019 that contained this highlight:

“While Berry, et al., and [then FDA] Commissioner Gottlieb, emphasized the 4.0% probability of current smoking among e-cigarette first users, we found a reverse result buried in a supplemental table: The probability of current e-cigarette use at follow up among cigarette first users was 8.3%.  This means that twice as many first-smoking teens currently used e-cigarettes at follow-up than first-vaping teens who currently used cigarettes.”

The critical lesson here is not about the transgressions of Ling-Goetzl, or Winikoff, or Berry.  It is how the incessant repetition of exaggerated, distorted and sometimes falsified research dangerously distorts public perceptions about vastly safer cigarette substitutes.  It happened with smokeless tobacco; it is happening today with vapor and nicotine pouches.  Millions of smokers will die, and prohibitionists will never be held accountable.

 

Federal Officials, Please Pay Attention to Federal Surveys: E-Cigarettes Are Not Gateway Products

I noted in 2013 that the CDC director’s claim – that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes” – was pure gateway speculation (here).  Youth surveys had just started collecting information that teens were using e-cigarettes, but there was zero evidence that they were “going on to smoke.”

In January I presented data from the CDC’s National Youth Tobacco Survey showing that e-cigarette experimentation since 2011 did not produce an epidemic of teen smoking (here).  The 2017 Monitoring the Future survey, illustrated in the chart at left, provides further evidence of a steady decline in cigarette smoking among high school seniors.  In 2017, the smoking rate in MTF dropped below 10% for the first time in history.  At 9.7%, the rate is almost half that of 2011 (18.7%), while the vaping rate remained at 16-17%.  Meanwhile, high school seniors used alcohol and marijuana at far higher rates than cigarettes (33% and 23% respectively).  Nineteen percent of seniors reported being drunk in the past month.

MTF vaping data in 2014-2016 didn’t specify the liquids used; in 2017 MTF collected information on non-specific vaping and vaping nicotine and marijuana in the past month.  Nonspecific vaping, illustrated by the green line in the chart, was around 16%, nicotine vaping was 11%, and marijuana vaping was 4.9% in the past month.

Federal officials are still obsessed with the vape-to-smoke gateway, despite virtually no evidence.  FDA Commissioner Scott Gottlieb recently tweeted a warning: “The [e-cigarette] industry isn’t sustainable if it leads to a whole generation of youth initiation on tobacco.” (here) 

I tweeted a reply urging Dr. Gottlieb to look at his agency’s data from the “…PATH survey of 9,909 never-smoking teens. One year later, 219 (2.2%) had smoked in past 30 days. All awful, but 175 (80%) had no prior tobacco product use; only 11 had used e-cigs. FDA data shows vaping not major gateway to teen smoking [here].” (emphasis added)

Federal officials should stop claiming that vaping is a gateway to smoking, because evidence is absent in all federal surveys.

Tobacco Gateway Report Omits Important Information

Here we go again.  Another federally funded study from the University of California, San Francisco, claims that “Nonsmoking adolescents who use e-cigarettes, smokeless tobacco or tobacco water pipes are more likely to start smoking conventional cigarettes within a year.” (UCSF press release here)  Researchers analyzed data on some 10,400 teens enrolled in the Population Assessment of Tobacco and Health (PATH) Survey in 2013-2014, then followed up with the subjects one year later.

“We found that teens who experimented with tobacco in any form were at greater risk of future smoking,” said senior author Dr. Benjamin W. Chaffee; his study appears in JAMA Pediatrics.

The researchers report that teens who had ever used e-cigarettes, hookah, other combustible products or smokeless tobacco at the baseline survey were two or three times as likely to be smoking cigarettes (in the past-30 days) one year later than those who had not tried any tobacco product.  Those who had tried two or more products were 3.8 times more likely to be smoking.

The authors used a sophisticated analysis to arrive at these results, but news stories describing this as evidence of a gateway to teen smoking (examples here and here) are inaccurate.

Chaffee and his colleagues, including anti-tobacco crusader Stanton Glantz, omitted information that is critical to putting their findings in perspective.  Although teens trying other tobacco products were more likely to smoke, the majority of new smokers after one year came from the group that had not tried tobacco at baseline.  I offer the following calculations based on obscure information in the published article.

Odds Ratios (ORs) And Numbers of Teens Smoking Cigarettes After One Year, According to Ever Tobacco Status at Baseline
Ever Tobacco Status- Baseline (n)	Odds Ratios	Number Smoking At One Year (%)
Never tobacco use (9,058)	Referent	175 (79.9)
E-cigarettes (255)	2.12	11 (5.0)
Hookah (189)	2.15	8 (3.7)
Other combustible (114)	3.08	7 (3.2)
Smokeless tobacco (93)	1.53	3 (1.4)
Two or more products (200)	3.81	15 (6.8)
All (9,909)		219 (100)

After one year, 219 teens had smoked a cigarette in the past 30 days, and 175 of those (80%) had never used any tobacco product at baseline.  Even though the odds of smoking were higher among youth who had tried other products, the number of smokers contributed by each of these groups was minuscule.  (While actual survey numbers may vary slightly, the relative contributions of the groups will not change.)

The Chaffee article emphasizes odds ratios but omits or obscures important contextual information.  While teens who try one tobacco product are more likely to try another, the dominant gateway in the PATH survey was from no previous tobacco use to cigarettes.

No underage tobacco initiation is acceptable; neither is misdirection by researchers.