Medscape on Tobacco Harm Reduction: Part 1 – Nicotine

 

Most health professionals are familiar with Medscape, a free resource that describes itself as “the leading online global destination for physicians and healthcare professionals worldwide, offering the latest medical news and expert perspectives; essential point-of-care drug and disease information; and relevant professional education and [continuing medical education, CME].”

Recently, Medscape invited me to assist in developing a series of short CME programs on tobacco harm reduction, which evolved into an examination of nicotine and the differential risks of combusted versus smoke-free tobacco/nicotine products, among others.

The first program “Nicotine Misperceptions: What Does the Evidence Say,” professionally produced and based entirely on facts in the scientific literature, is now available online to everyone (here).  I encourage all health professionals and concerned members of the public to spend 30 minutes getting fresh insight into one of the most widely used drugs on the planet.

 

 

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.