Vaping Is Not the Real Health & Safety Threat in Kentucky High Schools

Foundation for a Healthy Kentucky (FHK) and Kentucky Youth Advocates (KYA) recently launched a campaign to discourage e-cigarette use by youth (here).  KYA executive director Dr. Terry Brooks predicted that “unless we as a commonwealth treat e-cigs as the health threat it is — in terms of now and in the future — then in 2038, Kentucky will still be the cancer capital of the nation.”  According to Ben Chandler, FHK chairman and CEO, “the fact that youth e-cig use is often a gateway to cigarette smoking makes immediate action imperative.”

Does evidence support the claim that e-cigarettes are a gateway to cigarettes? No.  Since the campaign cites the biennial Kentucky Youth Risk Behavior Survey, I have used KYRBS data to illustrate smoking and vaping among high school students in the Commonwealth from 2005 to 2017.

The chart at left shows that current (past-30-day) smoking declined from 26% in 2005, to 24% in 2011.  E-cigarettes were not widely available during that period.  In contrast, during the e-cigarette era (2011 to 2017), current smoking dropped from 24% to 14%.  The prevalence of current vaping, collected only in the latter two years, was 23% and 14% respectively. 

With the data showing show an unprecedented decline in smoking rates, there is no e-cigarette crisis among Kentucky high schoolers. 

KYA asserts that they “are laser-like in our efforts to…protect kids from abuse and neglect,…help kids grow up healthy and strong…” (here)  If that’s the case, they shouldn’t ignore behaviors that are far more dangerous than vaping.  For example, 27% of Kentucky high schoolers were current drinkers, 13% were current binge drinkers, and 16% were current marijuana users.  Additionally:

Prevalence (%) of Risky Behaviors Among Kentucky High School Students (KYRBS, 2017)
Past 30 Days
Rarely/never wore a seatbelt (as an occupant)	9%
Rode with driver who had been drinking	14%
Drove after drinking	4%
Texted or emailed while driving	35%
Carried a weapon (e.g. gun, knife, club)	21%
Past 90 Days
Had sexual intercourse	29%
..…and used condom, 51% of previous
Past Year
Involved in physical fight	21%
Physically bullied on school property	21%
Electronically bullied	18%
Felt sad or hopeless	29%
Considered suicide	15%
Made suicide plan	13%
Attempted suicide	8%

Kentucky health organizations should stop obsessing about a mythical high school vaping crisis and focus instead on stopping other behaviors and activities that State data define as immediate health and safety threats.  

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.