High School Seniors’ Tobacco Use: Another Year in Decline

Smoking by teens has declined to record-low levels, according to the latest University of Michigan annual Monitoring the Future Study, which examines youth tobacco, alcohol and drug use in 2013 (data tables here).  The figure at left, which shows the percentage of high school seniors using alcohol, marijuana, cigarettes and smokeless tobacco in the past 30 days over the period 1975-2013, is highly informative. 

Cigarette use continued a long-term decline, reaching 16.3%, the lowest prevalence since the survey’s introduction in 1975.  Cigarette use was lower than marijuana use (22.7%) for the fifth consecutive year.  Smokeless tobacco use among boys was 14.6%, and among girls 1.4%. 

The CDC issued a press release in September describing a scary but unsubstantiated gateway scenario, crystallized by CDC Director Tom Frieden: “Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

Frieden’s speculation was based on data from the National Youth Tobacco Survey in 2012, indicating that 0.054% of high school students in the U.S. used an e-cigarette at least once in the 30 days prior to the survey and had not smoked or used any other tobacco product.  Of the nearly 15 million high school students in the U.S., that’s about 8,000.  Meanwhile, about 1.8 million students smoked. 

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, it is unlikely that e-cigarette use has contributed to teen smoking. 

NYU to E-Cigarette Users: Cigarettes Are Healthier

I have noted in the past how prestigious organizations sometimes spew misinformation about the risks of smokeless tobacco; I have been especially critical of individuals representing the Mayo Clinic (here), the MD Anderson Cancer Center (here) and the Karolinska Institute in Sweden (here). 

Now, e-cigarettes are being institutionally maligned, as in a particularly egregious December 11 attack-by-press-release at New York University (here).  Under the dramatic headline, “NYU Researchers are Lifting the Veil on the Hidden Health Impact of Electronic Cigarettes,” a professor was quoted as saying, “Due to the frequency of puffing, depth of inhalation, and length of vaping, e-cig users may actually absorb higher concentrations of nicotine and other toxins than conventional tobacco smokers.”

This allegation is demonstrably false.  Numerous published studies comparing e-cigarette vapor and cigarette smoke reveal that the latter contains much higher concentrations of nicotine and toxic agents (this is one of many examples).  I am not aware of any legitimate study suggesting that vapor is more toxic than cigarette smoke.

The NYU press release obtained wide dissemination in the world’s media (example here).

E-cigarettes are used by millions of individuals throughout the world, the vast majority of them former smokers.  The apparently authoritative press release falsely informed them that vaping is more dangerous than smoking.  Based on this misinformation, it is likely that some vapers will abandon e-cigarettes and start smoking, which will constitute a public health tragedy.

It is remarkable that NYU’s press release revealed that Drs. Lin and Deepak Saxena were planning to “collect saliva and oral mucosa from College of Dentistry patients who are e-cig users to determine the relative abundance of oral bacteria and changes in DNA in these patients in order to compare them with the effects found among conventional cigarette smokers.”  There is no record that either researcher conducted prior research on the use of e-cigarettes or any other tobacco product.

Because NYU orchestrated the global dissemination of this false claim of vaping danger, I asked school officials to issue a press release retracting the statement. They did not respond.

Do E-Cigarettes Cause Passive Vaping?

“Passive smoking” has been hotly contested. Is there a case for “passive vaping”?  Hardly.

A detailed study of e-cigarette vapor by German investigators at the Fraunhofer Wilhelm-Klauditz-Institute’s Department of Material Analysis and Indoor Chemistry detected virtually no quantifiable levels of 20 volatile organic compounds (VOCs) present in cigarette smoke (abstract here).

They had a volunteer smoker puff three e-cigarette liquids and one combustible cigarette in a cramped test chamber measuring about 6 feet cubed.  The volunteer took six, deep 3-second puffs on each item at one-minute intervals; air samples were taken for 15 minutes after the fourth puff.

These are the results for the 20 agents with the highest concentrations. 

Concentrations (ug/m3) of Volatile Organic Compounds (VOCs) in Vapor From Three E-cigarette (Average) and Smoke From a Cigarette
VOC	E-cigarette Vapor	Cigarette Smoke
Propylene glycol	*	112
1-hydroxy-2-propanone	*	62
2,3-butanedione	*	21
2,5-dimethylfuran	*	5
2-butanone	2	19
2-furaldehyde	*	21
2-methylfurane	*	19
3-ethenyl-pyridine	*	24
Acetic acid	13	68
Acetone	20	64
Benzene	*	22
Isoprene	*	135
Limonene	*	21
M,p-xylene	*	18
Phenol	*	15
Pyrrole	*	61
Toluene	*	44
Formaldehyde	12	86
Acetaldehyde	2	119
Propanal	*	12

*Unquantifiable/same as empty chamber

Five VOCs were detected in e-cigarette vapor at minuscule levels.  The level of formaldehyde was similar to that measured before the e-cigarette puffs, leading the investigators to comment that it “…might be caused by the person in the chamber itself, because people are known to exhale formaldehyde in low amounts.”  Acetone and acetaldehyde may have resulted from combustion of propylene glycol during e-cigarette puffing, which also occurs to a larger extent during smoking.  Propylene glycol, a major component of vapor, was not present in the chamber during-after e-cigarette use. 

Although the investigators aimed to identify VOCs “under near-to-real-use conditions to estimate the effect of ‘passive vaping,’” the use of a 6 foot cubed chamber is not real-world.  They answered their title question, “Does E-cigarette Consumption Cause Passive Vaping?” in the affirmative, but these barely measurable results, extrapolated to rooms of normal size, confirm that bystanders have virtually nothing to worry about from vapers.

Legacy Tells the Truth – Tobacco Harm Reduction Revolution Gains Momentum

After 20 years of staunch opposition to and misinformation about tobacco harm reduction from anti-tobacco forces, one prominent figure has broken ranks, offering the truth and a cautious endorsement of safer tobacco products. 

David B. Abrams, PhD, Executive Director at American Legacy Foundation’s Schroeder Institute for Tobacco Research and Policy Studies (here), recently acknowledged in a college newspaper (here) that smoke-free tobacco products are vastly safer than smoking.  Here is the key passage from that article:

“Though he said that there is not much research on e-cigarettes, Abrams said the studies he has seen ‘put e-cigarettes in the category of somewhere between nicotine replacement therapy, which is pharmacy-grade nicotine from a pharmacy, and smokeless tobacco products, which are not harmless but are also much less harmful than cigarettes.’  He said that in terms of risk, he would slot e-cigarettes between snus — a type of powdered tobacco — and dissolvable nicotine products.”

Coming from an executive at one of the most anti-harm-reduction organizations, this is a revolutionary statement.  As readers of this blog know, numerous published epidemiologic studies document that American and Swedish smokeless tobacco products have disease risks so low that they cannot be measured with any precision.  Dr. Abrams’ risk assessment for e-cigarettes is therefore accurate.

This was the second time in two weeks that Dr. Abrams acknowledged the substantial risk differential between combusted and smoke-free tobacco.  On November 25, he commented at a Wells Fargo e-cigarette forum in New York:

“[E-cigarettes are] dramatically less and probably in the order of 10 to 100 times less dangerous than combusted cigarettes.  And certainly even less harmful than the data I've seen for

smokeless tobacco, although they're also dramatically less harmful than cigarettes.  So I'd say they're somewhere in between the ‘safest nicotine replacement pharmaceuticals’ and smokeless. And I would regard smokeless as a decent harm reduction strategy along with e-cigarettes in the map of harm reduction versus quit or die total abstinence.” 

Thus far, the campaign to inform smokers about safer products has been led by a handful of tobacco research and policy experts (here).  Dr. Abrams’ statements should pressure harm reduction deniers to abandon their failed quit-or-die mantra and start telling smokers the truth about safer cigarette substitutes.  This underscores my view that the tobacco harm reduction revolution is unstoppable.

The CDC Abuses the Facts About E-Cigarettes – Part II

In a previous post (here), I noted false and misleading information in a U.S. Centers for Disease Control and Prevention press release about e-cigarette use by youth. 

The CDC reported that 76.3% of youth using an e-cigarette in the past 30 days had also smoked at least once in the same period, and it used that number to suggest that e-cigarettes are a gateway to youth smoking.  First, there is no evidence in the dataset to support that claim.  Second, the CDC didn’t report survey information on other tobacco products.  Only about 10% of vapers were not concurrent users of any tobacco product, and only about 5% had no past history of smoking. 

Here, I’ll present other important facts that the CDC didn’t share about youth vapers who were questioned in the 2012 National Youth Tobacco Survey (NYTS).

The NYTS is a comprehensive survey of youth tobacco use, attitudes and perceptions; it contains a lot of e-cigarette information that the CDC failed to report.  I analyzed a number of questions relative to use of both cigarettes and e-cigarettes, comparing smokers who had also vaped in the past 30 days (smoker-vapers) with those who had not (exclusive smokers).  The results, summarized in the table below, illustrate differences (all of which are statistically significant – p< 0.05) between the two groups.

Here are the relevant NYTS questions and answers for smoker-vapers and exclusive smokers: 

Question 12.  About how many cigarettes have you smoked in your entire life?  Sixty-four percent of smoker-vapers had consumed over 5 packs of cigarettes, compared with 39% of exclusive smokers. 

Question 13.  During the past 30 days, on how many days did you smoke cigarettes?  Fifty-one percent of smoker-vapers reported smoking on 20 days or more, compared with 29% of exclusive smokers. 

Question 14.  During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?  Thirty-one percent of smoker-vapers consumed 6 or more cigarettes, versus 18% of exclusive smokers.

Question 57.  Are you seriously thinking about quitting cigarettes?  Forty-one percent of smoker-vapers said they were not seriously thinking about quitting, compared with 28% of exclusive smokers. 

Question 58.  If you decided to quit cigarettes for good, how likely is it that you would succeed?  Thirty-two percent of smoker-vapers labeled themselves as somewhat or very unlikely to succeed, compared with only 17% of exclusive smokers. 

There was another insightful survey item:

Question 69.  Do you believe that electronic cigarettes or e-cigarettes…are (less harmful, equally harmful, or more harmful) than regular cigarettes?  Seventy-two percent of smoker-vapers correctly answered that e-cigarettes were less harmful, and 51% of exclusive smokers also got it right.  These are impressive numbers, given that tobacco opponents uniformly insist that “we don’t yet understand the long-term effects of these novel tobacco products,” as FDA tobacco center chief Mitch Zeller said in the CDC press release (here). 

This post is not a comprehensive analysis of the 2012 NYTS findings on e-cigarettes.  My purpose is to report some interesting findings that the CDC failed to mention in their PR campaign to portray e-cigarettes as a teenage scourge.

Federal officials should fully and accurately report the results of taxpayer-funded research.  Americans – including teenagers – deserve the truth about e-cigarettes.

Percentage of Smoker-Vapers and Exclusive Smokers With Answers to Selected Questions, NYTS 2012
Question=Answer	Smoker-Vapers	Exclusive Smokers
Cigarettes smoked, entire life= 5+ packs	69%	39%
Days past month smoked= 20+	51%	29%
Cigarettes on days smoked= 6+	31%	18%
Seriously thinking about quitting cigarettes= No	41%	28%
Successful quitting= somewhat or very unlikely	32%	17%
E-cigarettes less harmful than cigarettes	72%	51%