Is Industry to Blame for Teen Substance Use?

 

I’m a member of a tobacco policy discussion group that has focused many times on the so-called epidemic of teen vaping.  One recent exchange centered on how e-cigarette and vape manufacturers and retailers might demonstrate to government regulators and policymakers that they are serious about not marketing their products to children.  Frankly, I take issue with the underlying assumption that the industry is actually responsible for teen behaviors.

First, let’s define the so-called epidemic.  The first chart at left represents “current” – that is, past-30-day – nicotine vaping prevalence rates among U.S. high school seniors, according to the federal Monitoring the Future (MTF) survey.  In 2017, the first year the MTF collected this information, 11% of seniors vaped.  Over the next five years, the percentage spiked to over 25%, then settled at around 20%.  A similar pattern is seen in National Youth Tobacco Surveys covering 2013 to 2022 (here). 

Now, ask yourself: Do vape companies play any role in this teen vaping “epidemic”? 

If you answer NO, I agree with you, but if you answered YES, please examine the next chart.

 

Here we see the same vaping numbers, but with the addition of current alcohol use rates for the past 32 years.  Although the trend is going in a welcome direction, 28% of high school seniors in 2022 were current drinkers, putting them at far greater risk than the smaller percentage who were vaping.  Note that all of these teens were under the legal age to purchase alcohol or vape products.

Does the alcohol industry play a role in teen drinking?

Oddly, in contrast to the obsession with vaping, little is said about teen drinking, despite widespread alcohol advertisements and the more immediate and greater dangers posed to underage drinkers.  Parents Against Vaping E-cigarettes (PAVE) and the Campaign for Tobacco-Free Kids (CTFK) portray nicotine vaping as the ruination of an entire generation.  Where are the pressure groups for teen drinking and binge drinking?

If you still blame corporate America for teen alcohol use, consider the next chart. It includes marijuana use, the rate of which has remained above 20% for high school seniors since 1995.

 

 

What industry is responsible for teen marijuana use?  

Until recent years, marijuana, which is still federally illegal, was prohibited in all 50 states, so there were no corporations producing or marketing it.  Industry would appear to be blameless for any underage consumption.

Conclusion

The explanation for teen substance use is that adolescents are strongly attracted to adult behaviors and adult products.  Blaming the vape industry while giving the alcohol industry a pass is illogical.  Teen marijuana use underscores the fact that young people will adopt adult behaviors regardless of industry marketing.

Age Restrictions on Smoking, Drinking and Driving

State legislatures have been lobbied in a coordinated effort, called Tobacco 21 (here), to raise the minimum age for tobacco sales from 18 to 21 years.  Hawaii, California and the District of Columbia have adopted the higher age limit, but numerous city and county ordinances have been passed.

As an advocate of tobacco harm reduction, I strongly oppose any tobacco use by teenagers.  However, I am unconvinced that implementing a smoking ban for those under 21 is an effective strategy.

One of the arguments for Tobacco 21 is that the same age limit has reduced teenage drinking.  The National Minimum Drinking Age Act was passed in 1984.  By 1988, all states prohibited alcohol purchase by those under 21.  The impact on underage drinking is debatable.  It has been on the decline for many years, but rates remain disturbingly high (here). 

The chart above shows past-month (i.e., current) cigarette smoking, marijuana use, alcohol consumption and binge drinking (5 or more drinks on one occasion) among 16-17, 18-20 and 21-25 year olds in the 2014 National Survey on Drug Use and Health.  Despite almost 30 years of Alcohol 21 across the county, nearly a quarter of 16-17 year-olds and 44% of 18-20 year-olds were currently drinking, compared with 11% and 24% who were smoking.  In addition, a majority of drinkers were binging.  In 2014, recreational marijuana wasn’t legal for anyone, yet 15% of 16-17 year-olds and 21% of 18-20 year-olds were using that drug. 

We can also compare these figures with those from 10 years earlier.  Here are the changes in current use from 2004:

Percentage Change From 2004 to 2014 in Prevalence of Youth and Young Adults Who Currently Smoke, Toke, Drink or Binge Drink
Age (yrs)	Smoke	Toke(%)	Drink	Binge Drink
16-17	-51	+6	-28	-41
18-20	-36	+17	-14	-23
21-25	-25	+25	+4	-1

With Alcohol 21 in force for almost 30 years, drinking and binge drinking declined moderately among 16-17 year olds.  But smoking saw the steepest declines in all age groups, even in the absence of a ban for 18-20 year-olds.

Alcohol 21 and Tobacco 21 laws are promoted to save lives.  In the case of smoking, the lives saved are far in the future, as smoking generally takes a toll in advanced age.  With alcohol, the lives saved are primarily from traffic accidents.  With or without alcohol, traffic accidents are the number one killer of youth and young adults (age 16-24 years), with about 7,000 deaths each year (here).  Legislators seeking immediate life-saving impact should consider further age-restricted driving licenses. 

High School Seniors’ Post Largest Ever Single-Year Decline in Smoking; E-Cigs May Have Played a Role

The Monitoring the Future survey shows that past 30-day cigarette use among 12th graders dropped from 16.3% in 2013, to 13.6% in 2014, the largest single-year decline in the survey's 39-year history (data here). 

The data show that 17% of 12th graders had used e-cigarettes in the past 30 days in 2014, the first year this information was collected.

Good news included a decline in the percentages of high school seniors reporting alcohol use, being drunk and marijuana use in the past 30 days.

Instead of focusing on the historic drop in smoking, the media emphasized that more students had used e-cigarettes than traditional cigarettes.  However, Tim Worstall, a Fellow at the Adam Smith Institute in London, saw things differently, writing, “That vaping, at least so far as we know, is the most successful smoking cessation product any one has as yet invented (and do note that nothing else at all has halved teen [daily] smoking rates in only 5 years) means that we really shouldn’t be putting roadblocks in front of further adoption of the technology.” (here)   

Smoking prevalence among high school seniors has declined every year since 2007, about the time that e-cigarettes were introduced in the U.S.  With numbers like this, claims that e-cigarettes cause children to smoke are completely unfounded.  In fact, the evidence is strongly suggestive that e-cigarettes have played a role in this unprecedented decline in teen smoking.