The direct link explains doubling of youth prediabetes rates not explained by obesity, warnings provided media 4 years ago continue to be ignored while vaping still surges

by Clark Miller

Published September 11, 2022

A month or so ago, a flood of media headlines

heralded a stalling or decrease in use of nicotine by vaping (e-cigarettes) among American youth. Paragraphs down, typically, the source of the data was reported as being for 2020.

This is the year 2022, or later, as you are reading this. 2020 was two years ago. Right. 

The leveling of youth vaping in 2020 is easily understood as tied to pandemic conditions: closure of schools; quarantine in place; young people unable, unwilling, or disallowed to congregate in places where they had been to engage in what is largely a social behavior for them; at home challenges to vape nicotine without detection and undesired consequences. And, possibly some inhibitions about inhalation of any substance in the context of COVID-period campaigns based on fear. 

Those transient effects were seized on as representing broader trends, and they don’t. 

From a local report – 

SAN ANTONIO — Vaping among children may have lost its news cycle, but its lure remains intact, and some believe it grew.

“The first thing that’s important to realize is that while the headlines are gone, we still have a youth e-cigarette epidemic,” Matt Myers said.

Myers is the president of the Campaign for Tobacco-Free Kids. His organization and the National Association of School Nurses want the Food and Drug Administration to ban flavored e-cigarettes.

“As kids are coming back together, the data is showing increased sales of the very flavored products that kids use,” he said. “Which is why we’re so concerned.”

The groups point to FDA and CDC-sponsored data from the 2021 National Youth Tobacco Survey. According to the survey, over two million kids in middle and high schools use e-cigarettes regularly.

Vaping nicotine by youth did grow, “despite leveling off in 2020 during the earlier part of the pandemic” according to the National Institutes of Health. 

Vaping: Nicotine vaping in the past month increased significantly among young adults in 2021 despite leveling off in 2020 during the earlier part of the pandemic. The continued increase in 2021 reflects a general long-term upward trend: in 2021, nicotine vaping prevalence nearly tripled to 16% compared to 6% in 2017, when the behavior was first recorded.

As covered by Health Day – 

TUESDAY, Aug. 23, 2022 (HealthDay News) — Marijuana and nicotine vaping reached historically high prevalence among young adults in 2021, according to a report published by the National Institute on Drug Abuse at the National Institutes of Health.

Megan E. Patrick, Ph.D., from the University of Michigan Institute for Social Research in Ann Arbor, and colleagues examined young adult substance use prevalence and trends since 1975 in the Monitoring the Future panel study. Participants were first sampled in 12th grade, corresponding to age 18 years, and were then surveyed every other year through age 29/30 years.

As youth vaping of nicotine continues to surge, so does risk of  prediabetes and diabetes due to the established, direct relationships with nicotine. 

From a previous post – 

As predicted, large increases among youth in use of nicotine by inhalation as use of e-cigarettes (vaping) has surged are associated with newly reported doubling of teen prediabetes prevalence over the same period. That was foreseeable based on the direct link between nicotine and risk of diabetes onset, as explained here at A Critical Discourse beginning in August of 2018 and in posts repeatedly after that. The new report follows publication of the same predictable results for adults four weeks ago, described here.

Prediabetes prevalence nearly doubled among U.S. youth from 1999 to 2018, national data indicated.

According to National Health and Nutrition Examination Survey (NHANES) data on over 6,500 youth, the prevalence of prediabetes increased from 11.6% in 1999-2002 to 28.2% in 2015-2018, Junxiu Liu, PhD, of Icahn School of Medicine at Mount Sinai in New York City, and colleagues reported in JAMA Pediatrics.

. . .

Some of the sharpest spikes in prevalence occurred in youth with obesity. Increases across BMI groups form 1999-2002 to 2015-2018 were:

  • Underweight or normal weight: 9.42% to 24.3%
  • Overweight: 15.3% to 27.5%
  • Obesity: 18.2% to 40.4%

This dramatic spike in prediabetes prevalence was apparent for youth of all ages. Specifically, those ages 12 to 15 saw a rise in prediabetes prevalence from 13.1% in 1999-2002 up to 30.8% by 2015-2018. As for older teens ages 16 to 19, these rates likewise more than doubled from 10% up to 25.6%.

That’s a distortion of the results. For kids with obesity, the prevalence about doubled, that is, increased by a factor of 2.2. For overweight kids, prevalence was close to doubling, a factor of 1.8. 

An exact doubling would be an increase by a factor of 2.0. 


And for kids underweight or normal weight, the increase in prevalence was greater than for overweight or obese kids, 2.6, or a factor of slightly more than two and a half. 

That is, the spike in prevalence of prediabetes for youth over a period of surging use of nicotine by vaping was not accounted for by obesity. The increase was about as much for overweight as for obese (a higher BMI than overweight) and was, notably, highest for kids who were normal weight or underweight. 

That’s right, nicotine

has a direct effect on insulin biochemistry and would whether administered by smoking combustible cigarettes or by vaping. Nicotine is nicotine.

That all sounds alarming, on top of multiple, worsening lethal public health threats, and especially in the context of runaway use of nicotine by youth by vaping and a youth obesity epidemic already raising concerns about increasing incidence of diabetes.

Who saw that coming?

I did, at A Critical Discourse, in multiple posts over the past 4 years including this post in August of 2018 noting the direct contribution of nicotine to risk of onset of diabetes, then repeatedly over the following years, like here, and here, and here, some 6 to 10 posts in all noting the links among nicotine – diabetes – youth vaping epidemic.

Almost without exception, those posts published here at A Critical Discourse on the established relationships among nicotine and risk of diabetes as related to surging use of nicotine by youth and adults in e-cigarettes were summarized and provided to media and health writers  by email in the form of a “story tip”.

Those went to some 30 to 40 major media outlets and healthcare writers.

Described in this post

That seems like a public health concern worth the investigative and reporting attention of American journalism over the past 4 years, while vaping boomed among adults and youth. To be fair, American media have been distracted, focused on other reporting related to vaping – as described here, and here, here,  here, here, and here

Why A Critical Discourse?

Because an uncontrolled epidemic of desperate and deadly use of pain-numbing opioid drugs is just the most visible of America’s lethal crises of drug misuse, suicide, depression, of obesity and sickness, of social illness. Because the matrix of health experts and institutions constructed and identified by mass media as trusted authorities – publicly funded and entrusted to protect public health – instead collude to fabricate false assurances like those that created an opioid crisis, while promising medical cures that never come and can never come, while epidemics worsen. Because the “journalists” responsible for protecting public well-being have failed to fight for truth, traded that duty away for their careers, their abdication and cowardice rewarded daily in corporate news offices, attempts to expose that failure and their fabrications punished.

Open, critical examination, exposure, and deconstruction of their lethal matrix of fabrications is a matter of survival, is cure for mass illness and crisis, demands of us a critical discourse.

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.

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