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 in the nation’s leading medical journal. And is 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 and increasingly elsewhere, more recent data point to booming use of e-cigarettes among youth, that use increasing likelihood of young people starting to smoke (tobacco) cigarettes.
New research published in the British Medical Journal is consistent with a body of preceding evidence and trends in use of e-cigarettes (vaping) among youth and prevalence of smoking of tobacco cigarettes: congruent evidence of increasing nicotine dependence from vaping of nicotine preparations, positive association of vaping with use of tobacco by smoking (“smoking”), and leveling or reversal to increase of longstanding declines in smoking by youth.
The study compared vaping and smoking prevalence in 2017 and 2018 for 16 to 19 year-olds in the U.S., Canada, and England.
Results varied, pointed to notable increases in prevalence of vaping, and were consistent with a causal role for vaping in changes in tobacco smoking for this age group, rather than providing a harm-reducing protective effect.
In Canada, vaping prevalence increased as did tobacco smoking, following years of decline.
In the U.S. tobacco smoking prevalence did not change with significant increases in vaping prevalence, a clinically and epidemiologically significant result representing a change following years of steady decline in youth smoking.
The increase in smoking among Canadian adolescents raises important questions about the association between vaping and smoking behavior. After several decades of steady decline, smoking among 15 to 19 year olds did not change significantly between 2015 and 2017, and no other national estimates are available for 2018. (14) If the increase in smoking prevalence in Canada was directly related to an increase in vaping, similar increases in smoking would be expected among US adolescents, who reported a similar rise in vaping; however, no statistically significant changes in smoking were observed between 2017 and 2018 in the US. Estimates from the current study are closer to the 0.5% increase in past 30 day smoking observed in the National Youth Tobacco Survey study (16, 17) than the 0.8% decrease recorded in the Monitoring the Future study in 2018. (18) The greater increase in smoking in Canada might reflect emergent trends leading up to the legalization of non-medical cannabis in October 2018. Cannabis use increased among Canadian adolescents in 2018, consistent with Canada’s benchmark survey, which also found an increase in cannabis use among adolescents in the six months before its legalization. (28) Given that smoking is the primary mode of cannabis use, and some users mix cannabis with tobacco (although to a lesser extent in North America than in Europe), it is plausible that greater cannabis use could increase cigarette smoking. However, supplemental tests indicated that the increase in smoking and vaping prevalence in Canada remained statistically significant after adjusting for cannabis use. Therefore, without discounting the possibility of common upstream determinants, the increases in vaping and smoking in Canada from 2017 to 2018 were not directly related to increased cannabis use over the same period.
Results from England pointed to slight increase in prevalence of tobacco smoking and no change in prevalence of vaping, interpretation qualified by limitations in England on nicotine content of liquids used in e-cigarettes compared to tobacco cigarettes and associated responses in user behaviors.
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.
For example, 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-randm samples of youth and adults who have started vaping have indicated little motivation to stop.
And congruent with the new evidence in the British Medical Journal pointing to a gateway rather than proactive link from vaping to cigarette use and nicotine dependence – illustrated here, U.S. Centers for Disease Control (CDC) data appear to point to an uptick in teen use of cigarettes in 2018 (from 2017) by 7%, after decades of decline concurrent with the sharp upturn in vaping over past years.
Prior Canadian public health figures – for e-cigarette and cigarette use among Canadians 15 years of age and older – appear to model the alarming trends. Prevalence of that population in Canada having ever used e-cigarettes increased by 15% in 2017 compared to 2015. And concurrently with the increased use of vaping, instead of the desired and industry-promoted projection of decreased cigarette use related to vaping, instead cigarette use increased, also by 15%, over the same period. As in the U.S., cigarette use had apparently prior to the upturn been in decline, “In 2017, the overall prevalence of smoking among Canadians aged 15 and up was 15 per cent, representing 4.6 million current smokers, an increase from 2015 when it hit an all-time low of 13 per cent.”
It appears that France has joined other populations for the alarming and predictable trend. Vaping there has increased among youth since its introduction and marketing began a decade or so ago.
Noted in this 2017 report, in 2016 more than half (53%) of French 17-year-olds had tried vaping, and 2 percent had become daily users. And their use of tobacco cigarettes increased, for 17-year-olds, “the downward trend in daily smoking observed between 2000 and 2008 reversed, with a slight increase over the 2008 – 2014 period.”
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 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:
That’s not good.