Miscounting Teen Perceptions of E-Cigarettes

The journal Pediatrics recently published a report based on the 2012 and 2014 National Youth Tobacco Surveys (here).  Stephen Amrock and coauthors from the Oregon Health Sciences University found that 51 percent of middle and high school students believed that e-cigarettes were less hazardous than cigarettes. 

Given the tsunami of e-cigarette misinformation generated by some in the public health community, it is downright impressive that even this many youths know the truth about these products.  Still, only 13 percent correctly believed that chew, dip or snus posed less danger than cigarettes.  

The media, in keeping with its general anti-tobacco, anti-e-cigarette bias, sensationalized the Pediatrics report with a negative spin. A HealthDay article on October 25 (here) featured three false statements:

• Headline: “3 in 4 Teens Think E-Cigarettes Safer Than Tobacco: Survey”

• Opening line: “Close to three-quarters of American teenagers believe e-cigarettes are less harmful or addictive than real cigarettes, a new study finds.”

• Paragraph 8: “...Amrock and his colleagues found that 73 percent of teens believed e-cigarettes were less harmful than cigarettes.”

All of the above are demonstrably false, as they transformed the 51 percent response rate to 73 percent.  Amrock himself misstated the 13 percent for smokeless tobacco as 20 percent.  How did this happen?

The “3 in 4” or 73 percent result was generated only after Amrock excluded 27 percent of students who reported that they “don't know enough” about e-cigarettes and 4 percent who were unaware of the products.  This is shown in Table 1 of the article. 

It was improper to omit these students in order to make the result almost one-half higher.  Amrock and his colleagues went on to use the altered figure as the principal finding in their abstract, and the media followed suit.  The altered figure was also prominent in an October 17 blog by the journal’s editor-in-chief, Dr. Lewis First (here).     

Only 13 percent of American students know that smokeless tobacco is safer than cigarettes and only 50 percent know the truth about e-cigarettes – a sorry commentary on education, the performance of our public health institutions and the credibility of some in the research community. 

FDA Tobacco Director Ignores 2.5 Million “Anecdotal Reports” About E-Cigarettes

A feature of this month’s annual meeting of the Smoke-Free Alternatives Trade Association (SFATA) was a videotaped interview with Mitch Zeller, the director of the FDA Center for Tobacco Products.  Following the video, I participated in a panel discussion of Zeller’s statements about e-cigarettes.

Mr. Zeller clearly implied that there was no population-level evidence that smokers had quit with e-cigarettes.  He said that the FDA is “absolutely aware of the anecdotal reports about individuals using e-cigarettes to help them quit, but we can’t make population-level policy on the basis of anecdotal reports…FDA is required to use a population health standard.” 

The FDA should also be required to acknowledge population evidence generated by federal surveys.  I informed the SFATA audience that the CDC has 2015 National Health Interview Survey data documenting that 2.5 million former smokers were current users of vapor products (that is, they were vaping every day or some days).  Given that CDC and FDA investigators work closely on the NHIS survey, it is inconceivable that the FDA doesn’t know this fact.  These 2.5 million former smokers are more than anecdotes.  They constitute population-level evidence. 

Also noteworthy: In May the CDC published smoking statistics from the 2015 NHIS (here), but it just produced information on e-cigarettes today (here).  Unsurprisingly, the CDC feigned alarm that 58.8% of vapors were current smokers (here) while ignoring the 2.5 million anecdotes.  In fact, my July 16 blog (here) remains the sole source for this information. 

I have previously documented that the CDC has withheld information about the relative safety of smokeless tobacco (here and here).  This egregious behavior continues to deny important health information to smokers, dippers and chewers.  The FDA’s refusal to acknowledge population data on e-cigarettes facilitates its effort to impose industry-killing regulations on the vapor market. 

The chief federal regulator of tobacco products should acknowledge government survey data showing that e-cigarettes have helped as many as 2.5 million Americans quit smoking and/or stay smoke-free.

Memo to Feds: Tobacco ≠ Smoking

Government officials almost always use the word “tobacco” when they are actually discussing “cigarettes” or “smoking”.        

This practice is apparent in a 2015 progress report from the Centers for Disease Control’s “Winnable Battles” campaign (here).  In the body of the document, the agency states that “smoking and exposure to tobacco smoke are responsible for more than 480,000 premature deaths annually, as well as at least $289 billion in health care expenses and other economic costs each year.” But, as shown in the image from the report, it’s headline and list of key strategies substitutes the catch-all term “tobacco” for “cigarettes” and “smoking” seven times.

The obvious purpose of this conflation of terms is furtherance of the government’s decades-long drive for tobacco prohibition (here). 

Eradication of all tobacco products could only be justified if all such products posed substantial risk to public health.  They do not.  Decades of scientific studies document that use of smokeless tobacco products is vastly safer than smoking (here, here and here).  Even strident tobacco control groups like the Truth Initiative acknowledge the difference (here).     

Maintaining that tobacco, cigarettes and smoking are synonymous is indefensible.