UPDATE –

Nicotine Links Booming Youth Vaping With Previously Declining Cigarette Use Reversing and Rebounding,  With New Warnings on Latent Youth Diabetes Epidemic

by Clark Miller

December 6, 2018

Evidence continues to accumulate pointing to increased prevalence of “vaping”, or use of e-cigarettes to inhale vaporized nicotine (the addictive chemical in cigarettes), in adults and youth as providing no established net population health benefit and likely harm. As noted in a previous post in a series here at A Critical Discourse – as with other “harm reduction”, replacement, and healthcare practices driven and implemented by the medical industry in collaboration with drug manufacturing and delivery industries, medical/pharmaceutical fixes for entirely non-medical problems have resulted in predictable failed outcomes and harms.

vaping adult

As the FDA declares youth vaping an epidemic and reacts with urgent regulatory changes, mounting evidence paints a picture of alarming escalation of e-cigarette use in U.S. youth to administer nicotine, delivered per inhalation (puff) in amounts widely variable and potentially 6 times greater (ranging from 0.5 to 15.4 milligrams) than the highest levels in an inhalation from a conventional tobacco cigarette (ranging from 1.54 to 2.60 milligrams). Last year the FDA branded vaping as an important “harm reduction” strategy, that approach endorsed in the nation’s leading medical journal.

Use of e-cigarettes appears to predict initiation of tobacco smoking in both youth and adults. See additional evidence discussed in context in this post.

Preliminary corroborating epidemiological evidence congruent with those results points to prevalence of cigarette use – after years of decline – increasing, not decreasing, concurrently with increases in prevalence of nicotine delivered in vape devices. The uptick in cigarette use is indicated by a trend of clearly diminished reduction in prevalence with a statistically insignificant increase in cigarette smoking in youth in the U.S., discussed and graphically reproduced in this post. Following those findings, Health Canada released data that, similarly, is both predicted and alarming.

That apparent reversal of historically declining cigarette use in youth concurrent with booming vaping is now evidenced by newly released data from both Health Canada and from population health surveys in France, where ““the downward trend in daily smoking observed between 2000 and 2008 reversed, with a slight increase over the 2008 – 2014 period.”

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 including 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.

Mounting and alarming evidence  links trends, risks and harm:

Vaping is booming among young people

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

In concentrations comparable to or higher than delivered in cigarettes

As often preferred by users

The retained dependence on nicotine supporting durable use of vape devices

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

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

Including new evidence of reversal of years of declining cigarette use among youth with cigarette smoking now trending up in the U.S., Canada, and France

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 alarming 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 significance and potential public health threat of these trends, which may include nicotine use by youth increasingly by mutually reinforcing routes of administration – vaping and return to cigarette smoking – is heightened by concurrent increases in incidence of type 2 diabetes and a primary risk factor for its onset, obesity.

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 vaping “harm reduction” promotion campaigns – childhood obesity epidemic and childhood and adult diabetes epidemic fueled partly by nicotine use.

vaping-teen

That confluence of risk factors potentially contributing to a latent epidemic of type 2 diabetes in youth comes with new warnings about the severity of T2DM in children and their vulnerability:

“Research has indicated type 2 diabetes appears to be more aggressive in youth than in adults, with a faster rate of deterioration of β-cell function and poorer response to glucose-lowering medications,” said lead author Silva Arslanian, MD, Scientific Director and Principal Investigator of the Center for Pediatric Research in Obesity and Metabolism, UPMC Children’s Hospital of Pittsburgh, and the Richard L. Day Endowed Professor of Pediatrics at the University of Pittsburgh School of Medicine. “Furthermore, there is a higher risk for complications in people with earlier-onset type 2 diabetes, which is possibly related to prolonged lifetime exposure to hyperglycemia and other atherogenic risk factors, including insulin resistance, dyslipidemia, hypertension, and chronic inflammation. Thus, we must continue to make strides in recognizing the specific needs of youth and adolescents who are at-risk or diagnosed with type 2 diabetes.”

Compulsive use of nicotine, like that of any other mood-altering substance including food, is a behavioral health, not medical, condition with indicated, evidence-based treatments established by longstanding bodies of evidence for psychotherapies and related psychosocial supports and prevention strategies guided by ACE-informed, developmental and psychosocial understanding of risk factors and inner and environmental stressors driving the compulsive behaviors.

That is, it may be time to consider allocation of healthcare system focus and public healthcare funds to evidence-based therapies and strategies rather than diverted to additional medical industry fixes for a non-medical condition – as in this case of a medically-endorsed harm reduction plan that has predictably generated another public health epidemic.

smoking teen girl

TAKEAWAYS

As incidence of nicotine vaping by use of e-cigarettes booms especially among youth, cigarette use downward trends show reversals and rebound including for youth in the U.S., Canada, and France.

The apparent reversals are inconsistent with claims of protective effects of vaping against cigarette use and point to alarming upward trends in total nicotine use among youth in those populations.

The apparent trends are concurrent with new warnings for increased incidence of type 2 diabetes in youth fueled by increasing prevalence of obesity.

Increase in youth exposure to nicotine appears to form a contributing risk factor, along with obesity, with new warnings about the severity of T2DM in children and vulnerability to life-span complications, the role for nicotine direct: