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.

Another UC San Francisco E-Cigarette Gateway Claim, Based on Tiny Numbers

Last week I called for retraction of a flawed study by University of California San Francisco’s Benjamin W. Chaffee, Shannon Lea Watkins and Stanton A. Glantz that appeared in the journal Pediatrics (here and here).  

Once again using the FDA Population Assessment of Tobacco and Health (PATH) survey, the same authors exaggerated the gateway effect of e-cigarettes, hookah and smokeless tobacco in a January JAMA Pediatrics article (here).  I criticized at that time the omission of information that would have provided context for their findings (here).  The exaggerations were amplified in the media.

In an interview with National Public Radio (here), Dr. Watkins failed to note the minuscule numbers used in her study to support the gateway claim.  I have inserted those numbers in bold in her quote, here:

“We found that kids who tried e-cigarettes [n=11] or hookah [n=8] or smokeless tobacco [n=3] or cigars [n=7] – any noncigarette tobacco product – were all twice as likely to try cigarettes a year later compared to kids who hadn’t used any of those other tobacco products [n=175].  Kids who were using two or more noncigarette products [n=15] were four times as likely to report using cigarettes a year later.” (I have confirmed these numbers in the FDA data; they are in the table below)

Dr. Watkins added the extraordinary claim that trying one tobacco product changes one’s perception of cigarettes: “Using these products might change a kid’s perception of the harm of cigarettes, and so they are perceived as less dangerous and they get used to using tobacco and so using conventional cigarettes is not so scary or ‘bad’.”

In her view, trying a tobacco product causes one to change friends: “It will expose them to different kinds of kids, maybe kids that are already using conventional cigarettes, and then they might go on to try them.”

Instead of sharing her conjecture on how e-cigarettes led 11 children to begin smoking, Dr. Watkins should have focused on the fact that 80% of the 219 new smokers [n=175] in her study had not previously used any tobacco product.

Odds Ratios And Numbers of Teens Smoking Cigarettes After One Year, According to Ever Tobacco Status at Baseline
Ever Tobacco Status- Baseline (n)	Odds Ratio	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)

Drinking, Bingeing and Toking More Popular Than Smoking Among Teens in 2014

Teen smoking deservedly gets a great deal of attention from the media and public policymakers, but one government survey shows that teens consume alcohol and marijuana at far higher rates than cigarettes.

The National Surveys on Drug Use and Health (NSDUH), which I discussed last week (here), provide intriguing insights into use of licit and illicit products.

At left are 2014 NSDUH estimates of the numbers – and percentages by age – of Americans using cigarettes, smokeless tobacco, alcohol and marijuana in the past month. (Binge drinking is defined as consuming five or more drinks within two hours)  There were nearly 56 million smokers, 8.6 million smokeless tobacco users, 22.5 million marijuana users and a whopping 140 million drinkers.  There were actually more binge drinkers (61 million) than smokers. 

The following table shows the number of teens (12-17 years) and young adults (18-20 years) who used these substances in 2014.

Numbers (millions) of Teens and Young Adults Who Were Past-Month Smokers, Smokeless Users, Drinkers, Binge Drinkers and Marijuana Users in 2014
	Teens (12-17 yrs)	Young Adults (18-20 yrs	Total
Smokers	1.23	3.24	4.47
Smokeless Users	0.50	0.66	1.16
Drinkers	2.80	5.88	8.68
Binge Drinkers	1.53	3.74	5.27
Marijuana Users	1.85	2.77	4.62

There were some 1.2 million past-month smokers under 18, and about half a million underage smokeless users.  These numbers pale in comparison to those for alcohol.  There were 2.8 million drinkers under 18, and another 5.9 million between 18 and 20.  There were more underage binge drinkers (1.5 million) and marijuana users (1.85 million) than smokers.  The totals for marijuana, drinking and binge drinking are all greater than smoking.

Teenage smoking must be prevented, but teen abuse of alcohol and marijuana also requires attention.