MORE EVIDENCE THE YOUTH VAPING BOOM

IS A PUBLIC HEALTH TIME BOMB

 

New evidence confirms predictable outcomes: From large U.S. survey; From youth nicotine use in Ireland; From new survey of 800K U.S. youth – vaping stalling and reversing decades of previously declining youth cigarette smoking

 

by Clark Miller

Published November, 2018

Updated April 7, 2021; April 26, 2022

Accumulating evidence points to runaway rates of “vaping” of nicotine among youth, now characterized as posing unknown risks and as an epidemic warranting investigation by the Food and Drug Administration (FDA) who last year announced plans for promotion of e-cigarettes as harm reduction, a strategy endorsed by the nation’s leading medical journal. And characterized as  increasing rates of youth who will smoke tobacco. 

Endorsement of the FDA plan in the Journal of the American Medical Association (JAMA) cited a small downward shift in vaping by youth over just one year- 2016. But as described in new reports in the online news source Vox, more recent data point to booming use of e-cigarettes among youth, that use increasing likelihood of young people starting to smoke (tobacco) cigarettes.

Girl vaping

UPDATE BELOW, 2022:

New data from a large U.S. survey, from youth nicotine use in Ireland, and from a new survey of 800,000 U.S. youth confirm predicted outcomes – youth vaping is reversing decades of previously declining youth cigarette smoking

Additional takeaways from the 2018 report on e-cigarette use by the National Academies of Sciences, Engineering, and Medicine include:

– long term health effects are not known

– the evidence is not clear as to whether use of e-cigarettes reduces tobacco use

 

As outlined in a previous post

the FDA/Medical Industry plan and endorsement for vaping as effective harm reduction relied on an irresponsibly limited data base; was not grounded in a research base adequate to support confidence in vaping behavior as reducing use of tobacco overall or confidence in vaping health effects as significantly benign compared to those for tobacco; and ignored the direct links among nicotine, risk of onset of type 2 diabetes, and increasing rates of diabetes among youth.

More recent and accumulating evidence heightens concerns pointing to unknown risks of vaping for adults and especially youth, and known risks in the context of apparent rapidly increasing use of vaping among youth.

Nicotine, an addictive substance, may be delivered in vape devices in concentrations as high or higher than in regular cigarettes. The delivery and behavioral nature of vaping and smoking predict higher potential for conditioned psychological dependence. To a greater degree than other substances, the bioactive delivery of nicotine vaped or smoked, and the comforting behavioral ritual, are repeated many times each day, with each inhalation, up to hundreds of times each day. That is, the cycle of felt need or compulsion to deliver the mood-altering substance, its delivery by inhalation – and the rewarding sensory/mood alteration are repeated many to hundreds of times each day. That’s a lot of positive reinforcement of the behavior.

Teens who start vaping are more likely to continue than to quit, and more likely to start smoking tobacco; vaping may not help cigarette smokers quit; and surveyed, non-random samples of youth and adults who have started vaping have indicated little motivation to stop.

Use of e-cigarettes appears to predict initiation of tobacco smoking in both youth and adults.

cigarettes

Actual levels of nicotine delivered in vape devices remain largely unknown due to lack of needed research (see here); nicotine appears to be preferentially used by vaping youth (here and here); and the new, trending device appealing to youth and booming in use, advertises its appeal partly based on delivery of nicotine as effectively as in cigarettes.

 

To summarize and connect some links among accumulating research and findings:

Vaping is booming among young people

Driven by popularity of shrewdly advertised, designed, and marketed devices to deliver nicotine

In concentrations similar to or possibly higher than delivered in cigarettes

As often preferred by users

The retained dependence on nicotine supporting durable use of vape devices

Without consistent or convincing evidence of benefit as cessation aid for use of cigarettes

Instead evidence of “gateway” effect, or prediction of initiation of cigarette use

The presumed net benefit of vaping substituted for cigarette use not established, with long-term population effects of increased prevalence of nicotine dependence unknown

And concerning in the context of known health risks of nicotine regardless of delivery system, including contribution to incidence of type 2 diabetes, increasing in youth (increases now confirmed to be linked to surging vaping, not accounted for by obesity)

 

In that research and epidemiological context, the apparent trends and possible (statistically insignificant) increase from 2017 to 2018 in prevalence of cigarette use by teens is significant, congruent with accumulating findings, and alarming, following decades of decline in prevalence of teen cigarette use.

The CNBC report references unreleased CDC data reportedly indicating that after decades of decline, decreasing prevalence of youth cigarette use has leveled, then appeared to increase this year (from 2017) by 7%, that slowing of decreased cigarette smoking and possible increase concurrent with the sharp upturn in vaping over past years.

The presumed effectiveness of vape devices as harm reduction – substituting for, replacing, and preventing new cigarette use – predicted different results, expected increase in rates of decline of cigarette use over years vape use has been booming.

The apparent increase in youth cigarette smoking and/or deceleration of previous decline as vaping has increased is consistent with recent reports and research of vaping failure as a form of harm reduction: see here and here.

Graph of youth cigarette smoking trend

The 2018 apparent uptick in youth cigarette smoking was not statistically significant. Yet trends in dramatic vaping increase and concurrent leveling or increase in cigarette use are real.

The congruence of those trends with the accumulating evidence pointing to a gateway rather than proactive link from vaping to cigarette use and nicotine dependence appears to form another disturbing example of medical/pharmacologic fixes for non-medical problems predicting harm.

 

UPDATES, 2022:

New data from a large U.S. survey, from youth nicotine use in Ireland, and from a new survey of 800,000 U.S. youth confirm predicted outcomes – youth vaping is reversing decades of previously declining youth cigarette smoking

From a post 6 months ago – 

Population-level signs of the vaping-cigarette gateway effect were evident – and ignored- as reported in October of 2018 in a news piece by CNBC. Signs of the same effect in Canada and France soon followed.

New survey reports from Ireland point to the same effect: after decades of declining use of tobacco cigarettes by youth, that trend may be stalled or reversed, as evidence accumulates for a direct link between increasing initiation of nicotine inhalation using vape devices leading to new cigarette smokers.

For the first time in 25 years, rates of smoking among teenage boys in Ireland are increasing, according to a study published in ERJ Open Research.

The study also shows that rates of vaping among teenagers have risen in the last four years and that teenagers who use e-cigarettes are more likely to smoke.

The researchers say their findings indicate that Ireland will not meet its targets to reduce smoking rates and they add to evidence that vaping could be promoting a new generation of young people addicted to nicotine.

A new survey, published in JAMA,

. . . analyzed nationally representative data on youth tobacco use from the National Youth Tobacco Survey (NYTS), a cross-sectional, school-based, self-administered survey of US middle school (grades 6-8) and high school (grades 9-12) students.31 For each survey, a nationally representative sample of US students was selected to participate using a 3-stage cluster sampling procedure. The US Food and Drug Administration collaborates with the CDC to administer the NYTS. Each survey asked 15 000 to 36 000 students about their tobacco-related beliefs, behaviors, and addiction, as well as their exposure to protobacco and antitobacco influences.31 We included all 16 NYTS surveys from 1999 to 2020. 

The large survey, published in America’s top medical journal, the Journal of the American Medical Association (JAMA), was publicized by the University of Alabama in the UAB News, with this lead sentence:

“Cigarette smoking has decreased steadily among adolescents in the United States over the past two decades.”

Here are the relevant line graphs from the study, portraying youth use of “combustible” tobacco products (essentially cigarettes), along with use of electronic cigarettes (“e-cigarettes”, “vape”) to deliver nicotine –

There is no need to address or understand the complexities of experimental design or statistical analysis to see what has happened over the past decades based on this survey with large sample size. All that is required are the understanding of what is represented by a line graph, the ability to note associations, to think critically about related evidence, and the lack of cowardice that otherwise prevents expressing what is obvious.

The salient points:

Cigarette use is represented by the blue line, vaping by the black line

Vaping among youth emerged in 2013 to 2014 and increased rapidly

Vaping of nicotine has been promoted and asserted authoritatively to be supported by scientific evidence as protective against cigarette smoking and beneficial for smoking cessation

To the extent that those claims are true, it would necessarily be predicted that as vaping increased dramatically among youth beginning 2013 to 2014, the decades-long, established historical trend of decreasing cigarette use would begin to decrease even more – at an increased rate, with a steeper downward slope – or at least not level out, or “stall

“Stalling” is exactly, clearly what the consistent historical trend in decreasing cigarette smoking did, exactly as vaping began to increase.

The inflection points in the line for cigarette use are pronounced and clear – synchronous with the onset of vaping

For high school students, the historical trend of consistent annual reductions in prevalence of cigarette use stalled, flattened, remaining flat over the period of most pronounced increase in vaping, 2017 to 2019, then decreasing from 2019 to 2020 when vaping decreased

For middle school students, there are signs of the historical, decades-long decrease reversing – all values for frequency of cigarette use by that age group for the years 2016 through 2020 are greater than the lowest historical value, in 2015 at the beginning of the surge in vape use

That apparent population, or epidemiological, gateway effect was predictable based on available evidence and considerations of psychological, behavioral, and social influences on youth choices and potential use of nicotine by various delivery methods

From the new analysis of 800,000 U.S. youth nicotine users – 

“may complicate”?

Really? The runaway use by youth of devices designed to be appealing, often with higher nicotine delivery than cigarettes, predictably leading to nicotine dependence – “may complicate” frequency of youth switching to or continuing to use cigarettes? 

As in, “The pervasive presence of fentanyl in supply and street economies of illicit opioids may complicate  risk to users of illicit opioids? 

That’s how to lie with a headline, which should have accurately read: 

As nicotine vaping surges, fewer youth can stop cigarette smoking after decades of decline

Among U.S. teens, unsuccessful attempts to quit smoking rose in 2020 after years of decline—a reversal that might relate to the recent rise in vaping.

. . .

The team found that students reporting unsuccessful attempts to quit cigarette smoking reached a low of 1.27% in 2019, but then rose to 2.23% in 2020. This was the first rise since 1997. In addition, 4.12% reported unsuccessful quit attempts for e-cigarette vaping in 2020, nearly double that for cigarette smoking. In total, the percentage of all teens who reported an unsuccessful quit attempt was 5.74%.

. . . 

“These results indicate that failed nicotine quit attempt levels have gone back to where they were about 17 years ago for adolescents,” Miech says.

Right. 

Stalling and reversal of decades of decline in cigarette use by youth, tied to corresponding surge in initiation of nicotine dependence by vaping.

In the U.S., in Ireland, and elsewhere

For adults as well, and predictable based on all lines of relevant evidence

Predictable when America’s top medical journal endorsed the FDA’s “innovative plan” to promote vaping. 

Predictable when NPR provided the necessary smokescreen for that plan and endorsement. 

Predictable when corporate and social media lied about research on vaping. 

As predictable as the American Media/Medical collusion’s disinformation and lies about lethal threats to public health. 

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.

Pierre Bourdieu - Outline of a Theory of Practice 1972

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