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 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.
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
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.
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.
Actual levels of nicotine delivered in vape devices remain largely unknown due to lack of needed research (see here and 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.
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
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 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.
Remarkably, the esteemed Academies and Medical Industry reviews and recommendations along with media analyses of results, policy, and implications for public health have not yet addressed the concurrent public health epidemics directly impacted by proposed use of an FDA vaping promotion campaign – childhood obesity epidemic and childhood and adult diabetes epidemic fueled partly by nicotine use.
The missing, potentially lethal, epidemic links – missing from the scientific reviews, medical industry recommendations, and media accounts – are the: