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.

 

New York Times’ Call for Marijuana Legalization Advances Harm Reduction

A milestone in the fight for harm reduction was reached on July 28, when the New York Times formally endorsed the legalization of marijuana.  A Times editorial, “Repeal Prohibition, Again,” called for reversal of the government’s 40-year ban on the popular weed (here).  Legalization is overdue, as use of this psychoactive substance that is less dangerous than alcohol has led to the senseless prosecution of hundreds of thousands of Americans.

In 1994, as I was developing my tobacco harm reduction strategy, I read a brilliant article on drug policy reform in the prestigious scientific journal Science.  Entitled “Drug prohibition in the United States: costs, consequences, and alternatives” (abstract here), the article was written by Ethan Nadelmann, a pioneer in drug harm reduction.  Later that year, I described my strategy in a letter to Whitney Taylor of the Drug Policy Foundation (now the Drug Policy Alliance, here):

“Thanks for taking my recent phone call.  First, the proposal: that smokers unable or unwilling to quit consider switching to smokeless tobacco, which is far safer than smoking.  Smoking-related cancers, heart diseases and lung disorders are responsible for 419,000 deaths every year in the U.S.A.  In contrast, if all 46 million American smokers instead used smokeless tobacco, annual tobacco-related deaths (from a small risk of oral cancer) would number only 6000 [references here and here].  In fact, smokers who switch to smokeless tobacco reduce their risk for all smoking-related illnesses, including oral cancer.  Newer smokeless tobacco products deliver the nicotine kick smokers crave and they can be used almost invisibly; spitting, once the stigma of smokeless tobacco use, is minimal or nonexistent with these products.  Smokeless tobacco is already working for many Americans.  Statistics from the Centers for Disease Control and Prevention (CDC) show that 1.5 to 2 million former smokers have chosen this option on their own [reference here].

“I realize that your organization is only concerned with illicit drugs.  However, the current tirade against tobacco use(rs) demonstrates alarming parallels to the long-term crusade against other drugs.  First, as tobacco use is increasingly characterized as not just unhealthy but immoral and criminal, users are now experiencing an alienation process similar to that of narcotics users in the first three decades of the century.  Health professionals with ideas on the medical management of nicotine addiction are being ignored or attacked.  A cadre of prohibition-minded anti-tobacco activists has insisted on increased federal regulation (FDA, OSHA, EPA etc.) of tobacco use, which is endorsed without a hint of dissent by all major medical organizations.  In fact, tobacco use is the only major medical issue in which there is no debate whatsoever.  Prohibition may not be imminent, but smuggling from low to high tax states and the disastrous effects and ultimate reversal of the recent Canadian tax increase offer a great preview of where the crusade is headed and what the consequences will be.

“This proposal has much in common with harm reduction models proposed for illicit drug use with one important exception: smokeless tobacco is legal.  No new regulatory or legislative measures will be required.  Only interested and informed smokers.”

Mr. Nadelmann invited me to share my observations at drug policy reform conferences in 1999 and 2001.  Tobacco harm reduction has been explored at various other drug policy meetings over the last decade. 

The Times editorial board echoed the principals of harm reduction in its marijuana statement, as it weighed the relative risks of using various substances: “We believe that the evidence is overwhelming that addiction and dependence are relatively minor problems, especially compared with alcohol and tobacco.  Moderate use of marijuana does not appear to pose a risk for otherwise healthy adults.  Claims that marijuana is a gateway to more dangerous drugs are as fanciful as the ‘Reefer Madness’ images of murder, rape and suicide.  There are legitimate concerns about marijuana on the development of adolescent brains. For that reason, we advocate the prohibition of sales to people under 21.”

Advocates of tobacco harm reduction will recognize several themes in this passage.  First, there are no apparent health risks for moderate marijuana use (and even fewer health risks for smoke-free forms versus combusted), just as there are no significant risks related to the use of smoke-free nicotine/tobacco products.  Second, the “fanciful” gateway claim is as illegitimate for smoke-free tobacco as it is for marijuana.  Finally, while it is appropriate to protect children from substance use, there is no credible reason to deny adults access to alcohol, tobacco or marijuana.   

The Times has effectively advanced the cause of harm reduction, perhaps to the ultimate benefit of tobacco users and of public health generally.