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.

 

FDA’s Campaign Against Tobacco Retailers Doesn’t Hold Up to Inspection

Today Dr. Scott Gottlieb announced a draft compliance policy predicting that ““some flavored e-cigarette products will no longer be sold at all…other flavored e-cigarette products that continue to be sold will be sold only in a manner that prevents youth access…” (here)

Gottlieb has blamed a so-called youth vaping “epidemic” on illegal retail sales and “kid-friendly marketing.” (here)  Last week he spotlighted Walgreens, saying that 22% of its stores had illegal sales of tobacco products to minors “since the inception of the FDA’s retailer compliance check inspection program in 2010.”  He also listed 14 other national retail chains that had violation rates of 15% to 44%. 

These shocking numbers are, in fact, inflated through the use of cumulative math covering a nine-year period. I reported on public FDA inspection data just after the program started (here) and again in 2016 (here).  In response to current FDA news, I have now analyzed the data from 2018 (available here), the year Dr. Gottlieb said youth vaping skyrocketed, based on still unpublished data from the National Youth Tobacco survey.  My findings on the 2018 FDA inspection data are illuminating.

FDA contractors conducted over 146,000 retailer inspections in 2018, resulting in a national average violation rate of 12%, just one percent higher than in 2015-16 (here).  The following table contrasts the cumulative violation rate (range) reported by Dr. Gottlieb with the actual rate in 2018.

National Retailers’ Tobacco Sales Violations: “Cumulative” Versus 2018 Rates
Retailer	Gottlieb “Cumulative” Rate (%)	Actual 2018 Rate (%)
Walmart	15-24	6
Walgreens	15-24	9
Family Dollar	15-24	11
Circle K	15-24	12
Kroger	15-24	13
Casey’s General Stores	25-34	11
7-Eleven	25-34	14
Shell	25-34	19
Chevron	25-34	19
Marathon	35-44	26
Citgo	35-44	19
Exxon	35-44	20
Mobil	35-44	20
Sunoco	35-44	21
BP	35-44	24

Dr. Gottlieb did not need to use inflated cumulative numbers to demonstrate that national retail chains, especially those with gas stations, are still selling tobacco products to underage youth.  Additionally, his focus on Walgreens, with a 2018 violation rate of 9%, three points lower than the national average, seems inappropriate. 

Other key data points were omitted from Dr. Gottlieb’s remarks.  First, there is a large variation in state violation rates, from Georgia (2.2%), Montana (2.7%), Hawaii (3.0%) and California (4.2%) all the way to North Dakota and Michigan at 22.5%; Ohio and Nevada at 22.9%.  Retailers’ state rates were similarly diverse. For example, Walgreens and Walmarts in Georgia had much lower rates than those in Ohio.  This doesn’t absolve retailers of responsibility.  Rather, it indicates that state policies and attitudes may be contributing as significantly to underage sales as retailers.

While Dr. Gottlieb’s regulatory effort is aimed ostensibly at combatting youth access to e-cigarettes, only 19% of the cited 17,500 violations in 2018 involved those products.  Cigars were the most frequent culprit (44%), followed by cigarettes (33%), with smokeless tobacco at a mere 4%.

There is no excuse for a national tobacco sales violation rate of 12%; retailers everywhere must stop selling to underage youth.  Still, the federal government’s own survey data shows that more than 90% of teens who use tobacco products obtain them from social sources, such as friends or family.  Only 10% of current teen vapers buy their own e-cigs (here).  Given these facts, the FDA can’t hold retailers entirely responsible for teen e-cigarette use.

CDC Data Reveal Many Far More Dangerous Teen Behaviors Than Vaping

In the hierarchy of teenage risk behaviors, government data shows that vaping pales compared to drinking-, driving- and weapon-related activities. It is remarkable that public health officials and the media focus so greatly on the former, to the detriment of teen safety and health.

A report from the CDC earlier this year (here), based on the 2017 Youth Risk Behavior Survey (YRBS), allows us to put the data in context.

The prevalence of past-month e-cigarette use in the 2017 YRBS was 13%.  That rate is higher than those for cigarettes (8.8%), cigars (8.0%) and smokeless tobacco (5.5%).  However, as I discussed recently (here), the vaping rate pales next to those for marijuana (19.8%) and alcohol (29.8%).  In fact, the e-cigarette rate is nearly identical to the rate for binge drinking (4 or 5 drinks within a couple hours).

These rates of drug use are troubling, but there is much worse in the federal report for parents and policymakers to be concerned about.  Following is a list of other risky behaviors by high school students in the past 30 days.

Prevalence (%) of Risky Behaviors Among American High School Students (YRBS, 2017)
Past 30 Days
Rarely/never wore a seatbelt (as an occupant)	5.9%
Rode with driver who had been drinking	16.5%
Drove after drinking	5.5%
Drove after marijuana use	13.0%
Texted or emailed while driving	39.2%
Carried a weapon (e.g. gun, knife, club)	15.7%
Past 90 Days
Had sexual intercourse	28.7%
..…and used condom, 53.8% of previous
Past Year
Involved in physical fight	23.6%
Physically bullied on school property	19.0%
Electronically bullied	14.9%
Felt sad or hopeless	31.5%
Considered suicide	17.2%
Made suicide plan	13.6%
Attempted suicide	7.4%

Media coverage of the CDC YRBS report (here) was largely confined to the sensational -- “Fewer teens having sex and using drugs, CDC says.”

The absence of focus on the more prevalent and dangerous behaviors in part reflects the FDA-led public health community fixation on vaping.  This may stem from the fact that, of the many greater-risk categories outlined by the CDC, the FDA’s regulatory authority only extends to tobacco. To a federal agency with a hammer, everything is a nail.