More Evidence the Youth Vaping Boom

is a Public Health Time Bomb

by Clark Miller

November, 2018

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 journalAnd 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 juul

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.

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

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.

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

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.

CNBC teen cigs up with vaping header2

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.

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.

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.

“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)