The “stalled” and reversing progress against cigarette use is concurrent with increased use of e-cigarettes endorsed by America’s medical/media collusion for harm reduction

by Clark Miller 

Published September 15, 2021

The American media/medical campaign to mass message and promote use of e-cigarettes with claimed (and invalidated) benefit for cigarette smoking cessation and as harm reduction,  including in America’s leading medical research journal in 2017, has been associated with significant increases in adult use of e-cigarettes. That 2017 endorsement in the Journal of the American Medical Association (JAMA) of the “FDA’s Innovative Plan” to reduce cigarette smoking by public and medical encouragement of use of e-cigarettes to deliver the addictive substance nicotine would have had a powerful influence on U.S. medical professionals who routinely encounter patients compromising their health by use of cigarettes. 

The rest, as they say, is history, including the emergence within months of that endorsement of a youth vaping epidemic. 

Current and daily use of nicotine by vaping increased between 2016 and 2018 for age groups from 18 to 40 years, reported here.

Previous studies report a strong association between exposure to e-cigarette marketing and its subsequent use.5 We speculate that increased e-cigarette advertisement expenditure over the years and increased social media presence correlates with increased e-cigarette use, especially in the youngest age group. The significant increase in daily e-cigarette use suggests that more users are becoming dependent on e-cigarettes rather than merely experimenting with them. This is concerning among younger adults because early use of e-cigarettes has been associated with subsequent cigarette smoking, as well as drug and alcohol use.

Use was found to increase for all age groups in this American Journal of Preventative Medicine (AJPA) survey of use over 2014 to 2018.

“The largest absolute population increase in e-cigarette users between 2014 and 2018 was among younger-adult never smokers (0.49–1.35 million) . . .

The continuous increase among younger-adult never smokers suggests a rise in primary nicotine initiation with e-cigarettes.”

That is, the largest, most persistent increases were in the 18 to 29 years range and as engagement in compulsive use of nicotine delivered by vape device, not to stop use of tobacco cigarettes, as “never smokers”.

This ABC News/AP report late last year cites CDC data pointing to continuing increases in adult use of e-cigarettes into 2019.

Meanwhile, about 4.5% of adults were counted as current e-cigarette users last year — about 11 million people.

That rate appears to be up from 3.2% in 2018 and 2.8% in 2017.

Per another survey, Michigan State University’s Monitoring the Future, the trend of increasing vaping of nicotine among youngest adults has been remarkable.  

Similarly, between 2017 and 2019, the 30-day prevalence of vaping nicotine increased from 6% to 22% among college students and from 8% to 18% among 19-to-22-year-olds not in college.

“This doubling to tripling of prevalence of vaping marijuana and vaping nicotine over just two years are among the largest increases in MTF history for any substance since the study began over 40 years ago,” said John Schulenberg, principal investigator of the Monitoring the Future Panel Study.

That change – significantly increased vaping by young adults – is associated with the remarkable change in annual cigarette smoking cessation rates, “stalling” for adults over the same time frame, and mirroring the same phenomenon for youth. That is, for both youth and adults, decades of steady declines in cigarette smoking slowed or stalled over past years indicating that the net change of young adults and youth starting use of cigarettes against those stopping, changed notably.  As reported here

NEW YORK — The U.S. decline in cigarette smoking could be stalling while the adult vaping rate appears to be rising, according to a government report released Thursday.

About 14% of U.S adults were cigarette smokers last year, the third year in a row the annual survey found that rate.

That is, over 2017 to 2019, rates of adults stopping cigarette smoking (= net change in adults stopping versus starting or continuing smoking) slowed compared to previous years and decades. That’s over years of remarkable increases in use of e-cigarettes, branded and endorsed as effective in smoking cessation, for both youth and adults.

Here’s what that looks like graphically for adults (in this survey age 15+).

The change in slope of the smoking rate line occurs after 2014, when use of e-cigarettes began to increase dramatically and means that annually, fewer smokers were quitting, or more were starting, or both, compared to earlier years.

Here’s what that stalling of cigarette quit rates looks like for youth –

Despite the best efforts of the designer of this graphic to hide the change in slope (the “stalling” of rates of cigarette smoking cessation over years) for high school students, the change in slope is clear. And the year at which the change occurred is . . . Anyone? Anyone?

That’s right. 2014.

If use of e-cigarettes under natural conditions in natural environments have had some protective or cessation benefit, the evidence and mechanism remain obscured, somehow.

Actually, we wouldn’t have expected results to be otherwise, based on the longstanding evidence.

Predictably, “research” marshaled and mass messaged by public health, vaping industry, medical harm reduction, corporate and social media seized on results from a single study as strongly supportive of cigarette cessation benefit by use of e-cigarettes, noted as a “seminal study” by a trusted medical authority. It was seminal, in a way.

But in this seminal study, rapidly advertised over mass and social media as conclusive or important, potential conclusions regarding benefit from use of e-cigarettes for smoking cessation were nullified independently by three basic flaws in experimental design and interpretation. There was no no-treatment control group to identify potential confounding factors common to or acting differentially among the treatments (including nicotine replacement therapy, NRT) compared. More invalidating, the study’s design failure disallowed attributing any beneficial effect to use of e-cigarettes versus the talk therapy also provided to study participants, effective therapy itself (alone) providing smoking cessation benefit of up to 7 to 12 percent success rates. (The errors are basic, fundamental, of the type that should not happen, and should not be endorsed by science writers in major media. Yet, would we expect anything different from the same medical/media collusion that lethally fabricated and mass messaged the entirely unsupported outcome results generating the opioid crisis?)

Related to that nullifying flaw and independently, the study lacked expectation for “external validity” – that any supported benefit due to e-cigarette use could be assumed to occur in natural settings i.e. in the “real world”, where there is little to no reason to think that Americans believing the false claims of e-cigarette benefit for smoking cessation fabricated by America’s media/medical collusion would engage in therapy services when initiating use of vaping to quit smoking versus simply beginning use of a nicotine vaping device. The fabricated outcome was hyped, of course, not as “Study: combination of talk therapy – established as beneficial in cigarette smoking cessation – may remain beneficial when nicotine vaping is concurrent”, instead from the NY Times, ““Do e-cigarettes actually help smokers quit? Now, the first, large rigorous assessment offers an unequivocal answer: yes.”, asserting that smokers can expect cessation success rates by use of e-cigs of “18 percent”.  That would tend to encourage Americans to believe that getting a Juul and using it is an effective way to stop smoking. Maybe a Juul and vape juice that delivers a higher dose of nicotine than a commercial cigarette?

How is that encouragement by America’s medical/media collusion working out?

The epidemiological evidence clearly paints a picture incongruent with the fabricated benefit of use of e-cigarettes for smoking cessation.

Last year, use of cigarettes by adults increased as measured by sales of cigarettes, likely a more reliable and quantifiable measure of cigarettes consumed than smoker self-reports on surveys. That’s remarkable, following decades of steady decline. Additionally, by smoker self-report, the Gallup tracking poll points, over the years 2019 to 2021, to an uptick in adult smokers using 20 cigarettes per day or more, and decrease in smokers using less than 20 cigarettes per day, a trend that occurs over the period of significant increase in adult use of e-cigarettes and of mass messaging in advertising, major and social media of alleged benefit of e-cigarette use for tobacco smoking cessation. As with signs of increasing youth use of tobacco cigarettes and reversing cessation rates, the shift appears to have begun pre-pandemic.

And from a USA Today report,

Adult smoking rates dropped from 42% in 1965 to 14% in 2019, according to Centers for Disease Control and Prevention. The CDC has not released last year’s data but the Quitline report cited U.S. Treasury Department data showing cigarette sales increased 1% in 2020 after dropping 4 to 5% each year since 2015.

That increase in cigarette sales led the Wall Street Journal to headline a reversal of decades of decline in adult smoking rates.

The decadeslong decline in U.S. cigarette sales halted last year as people in lockdown lit up more frequently and health concerns around e-cigarettes caused some vapers to switch back to cigarettes.

But the Journal’s interpretation of factors driving the increase is inconsistent with what we know about the changes.

The Wall Street Journal conclusion that health concerns drove reduced use of e-cigs is not supported. The survey question selection used in the JAMA survey was “because it may weaken my lungs”, not e.g. “because it may cause me to get COVID” or similar question; it was well-messaged through the study period that young persons were relatively invulnerable to severe COVID outcomes; it was messaged that regular use of tobacco cigarettes, in contrast, represented a significant risk factor related to the respiratory morbidity tied to COVID; consequently, health concerns related to serious illness and/or COVID would have motivated continued use or initiation of use of e-cigarettes versus tobacco cigarettes as mass messaged pre- and during pandemic.

 From the same USA Today report, whatever trends have been occurring for nicotine use and method of delivery by young adults, there was little motivation for or interest in use of nicotine cessation counseling, 

“The number of people seeking help to quit smoking plummeted 27% last year as the public grappled with stress during the COVID-19 pandemic, a new report says. About 190,000 fewer Americans last year called toll-free smoking cessation help lines compared to the year before, and cigarette sales increased after years of decline, according to a North American Quitline Consortium report issued Friday. . . Still, Bailey said the national Quitline is free and offers people access to counseling.”

Readers may recall that “counseling”, or talk therapy, was included in the e-cigarette “treatment” group in the widely cited “seminal” study falsely attributing smoking cessation benefit to e-cigarette use. Therapy, independently, is evidenced as beneficial for cigarette cessation, disallowing any conclusions from that flawed experiment about benefit from e-cigarette use. And potentially lethal, given the lack of any evidence for such benefit and the mass public messaging of e-cigarette use by itself as a smoking cessation tool,  “an unequivocal answer: yes”.  In that mass messaging context and in any case, there is no evidence that Americans wanting to stop cigarette use would engage in therapy supports in addition to using e-cigarettes or NRT, for which there is no evidence of benefit. 

Why spend an hour a week in therapy when all I have to do to quit smoking is buy a vape and some nicotine juice so I can keep inhaling nicotine?, is the epidemic-friendly thought inserted by the trusted experts of America’s medical/media collusion saturating mass and social media with the unsupported harm-predicting fabrications of research results. 

Over the past 18 months – 

  • Reported here, “More than two-thirds of teen and young adult users in the United States have reduced their e-cigarette use during the COVID-19 lockdowns, according to the study published last week in JAMA Network Open.”
  • From the same source, “However, researchers said 18 percent of those surveyed increased nicotine use [emphasis added], 8 percent used cannabis more, and 7 percent switched to other smoking products [emphasis added] during the spring, when much of the country began shutting down in response to COVID-19″.
  • From the same source, “Researchers said the decline was mainly due to people having less access to stores. Since the pandemic began, 32 percent of e-cigarette users said they quit. Another 35 percent said they’d reduced their use. Both groups cited “product unavailability” as the main reason.
  • That young adult age group is the group showing the largest absolute gain in initiation of nicotine use and dependence as never-cigarette-smokers, by use of e-cigarettes over the preceding years, 2014 to 2018, by almost 1 million new nicotine users.
  • Per the JAMA report, about 10 percent of young adults (18 and older) switched from e-cigarette use to “combustible cigarettes” (young adults age 18 to 21 were included with individuals younger than 18 in data reporting, Table 2). Again, that’s the population that increased initiation of use of nicotine using vape devices over immediately preceding years by about one million new users, all never cigarette smokers.

Connect the dots. The predictable is occurring, again.

Fabricated evidence for medical/pharmacological “treatments” for non-medical, behavioral/psychological conditions predicts increasingly lethal public health outcomes, like the “stalling” of decades of gains against cigarette use for youth and adults.  

Driven by a pathologically incompetent and reckless medical/pharma/public health collusion, protected by useful idiots and with mass and social media along for the ride and for pats on the head for messaging the fabrications that need to be messaged.

What about users and abusers of opioids? Do they ever become dependent initially by being provided licit and/or prescribed opioids like pain pills, suboxone or methadone for pain? (If that’s not recognized as a rhetorical question, please catch up on the research.) Do opioid dependent individuals then often resort to use of illicit, higher-risk opioids like diverted pain pills, heroin, methadone, “subs” (Suboxone) depending on tolerance, potency, availability, social and other circumstances, other factors including costs, in a continuously shifting economy of supply and need to satisfy compulsive use? (Right. Rhetorical).

But not for nicotine? The evidence, including that outlined in this post, says otherwise. My sources (of information) often rely on loose tobacco, purchased in a bag and that they roll into cigarettes, highly economical compared to commercial cigarettes. They don’t complain about the lack of a filter. I wonder if roll-your-own is economical compared to nicotine vape juice and, as necessary to deliver that juice, the vape devices, which can be misplaced or otherwise lost.

Get a fracking clue. Don’t be like America’s trusted health experts and news sources, the respected authorities who created the opioid crisis – use your head and find the courage to question the fabrications and to say and report things that are true.

Nicotine dependence by initiation of vaping, driven by advertising, fabricated assurance of benefit, and the desperate needs of youth and young adults to be part of a trend, included within a group, and to signify adult behaviors, establishes high risk for new use or return to use of tobacco cigarettes. As does compulsive delivery of nicotine by any device or means, by any age group.

That should never have been unforeseen.

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.

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