NICOTINE LINKS YOUTH VAPING, REVERSAL OF DECLINES IN CIGARETTE SMOKING, NEW TROUBLING DIABETES TRENDS
With new vaping approvals this week, have regulators been “snuck up on” again?
by Clark Miller
Published December 6, 2018
Updated April 8, 2021; October 28, 2021
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 – 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.
Below – UPDATE: NEW EVIDENCE OF TROUBLING YOUTH DIABETES TRENDS CONSISTENT WITH PREDICTED EFFECTS OF INCREASING NICOTINE USE WITH VAPING
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). Four years ago the FDA branded vaping as an important “harm reduction” strategy, that approach endorsed in the nation’s leading medical journal.
Evidence that use of e-cigarettes appeared to predict initiation of tobacco smoking in both youth and adults appeared early after. 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.” Ireland now joins the U.S., Canada and France with clear signs of reversal of decades-long declines in youth cigarette use, linked to vaping of nicotine as a gateway.
Endorsement of the FDA plan to encourage vaping as harm reduction 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 over past years 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.
That endorsement in the nation’s leading medical research journal would have been taken as compelling and authoritative by suggestible medical providers who routinely encounter youth and adult smokers in primary care and other settings. Licensed medical providers suggestible enough to rely on clinical advice from pill salesmen who generously provided dinners over which they explained the research establishing safety and effectiveness of opioid pain medications for all types of pain. Suggestible enough to practice according to that clinical advice from pill salesmen against all relevant longstanding evidence of predicted harm that would have been provided in any legitimate medical education. Suggestible enough to dispense the opioids without providing informed consent based on risk of harm.
“Research has indicated type 2 diabetes appears to be more aggressive in youth than in adults . . . there is a higher risk for complications in people with earlier-onset type 2 diabetes . . . 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.”
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.
The missing, potentially lethal, epidemic links – missing from the scientific reviews, medical industry recommendations, and media accounts – are the:
1) direct effects of nicotine on risk of onset of type 2 diabetes and worsening of diabetes,
2) normalization and worsening (increase) of nicotine use in youth and adults by trends in e-cigarette use, encouraged by harm-reduction strategies, and
3) the diabetes public health epidemic described as posing the greatest risk to public health , looming and fueled by increased latent risk from a childhood obesity epidemic.
“A meta-analysis found that current smokers had a 45% increased risk of developing diabetes compared with nonsmokers.”
“Nicotine, acknowledged as the major pharmacologically active chemical in tobacco, is responsible for the association between cigarette smoking and development of diabetes.”
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.”
UPDATE: NEW EVIDENCE OF TROUBLING YOUTH DIABETES TRENDS CONSISTENT WITH PREDICTED EFFECTS OF INCREASING NICOTINE USE WITH VAPING
Pediatricians are raising alarms about new evidence for increasing prevalence of type 1 and type 2 diabetes over the past two decades, based on a 2021 report in JAMA.
The findings appear more consistent with effects related to the known direct relationships among nicotine and risk of development of diabetes and surging nicotine use in youth tied to the vaping epidemic than to effects of persistent increases in youth obesity alone, another significant risk factor.
From the JAMA report –
For type 1 diabetes, increases appear larger for ages 10 to 19 compared to younger children, the older age range affected differentially by increased nicotine use and not differentially by other identified factors for risk of diabetes.
For type 2 diabetes, increases in prevalence appear greater for ages 15 to 19 compared to 10 to 14 and for that 15 – 19 group greater for the time period 2009 to 2017 that includes years after youth vaping of nicotine surged, compared to 2001 to 2009, prior to significant onset of youth vaping.
Childhood obesity and overweight have been increasing generally for all age groups over past years and decades, so don’t seem able to account for the observed differential pattern in increasing prevalence in diabetes that are associated with time frame and ages most likely to represent effects of increased nicotine use due to vaping. Across youth ages 13 to 18, prevalence of vaping increases significantly and consistently from younger to older, consistent with the apparent differences in increases in diabetes rates.
The findings for youth diabetes trends unfortunately do not include data after 2017, and these findings are open to multiple interpretations. Additional evidence will be required to evaluate population effects on youth diabetes incidence related to known risk related to nicotine use and epidemic increases in youth delivery of nicotine by inhalation
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.