Previously, I discussed a CDC study which found a doubling of the prevalence of current electronic cigarette use among youth from 2011 to 2012. This report has been used to alarm the public and policy makers about the hazards of electronic cigarettes, with the CDC director claiming that these data demonstrate that e-cigarettes are serving as a gateway to a lifetime of youth addiction to smoking.
In my previous analysis, I pointed out that the CDC has been consistently leaving out an important part of the story: despite the doubling of electronic cigarette use, most of the current use is taking place among adolescents who already smoke cigarettes. The real concern would be if non-tobacco users were trying electronic cigarettes, becoming addicted to nicotine, and then progressing to cigarette smoking.
The Rest of the Story
Today, I report that the CDC's misrepresentation of its study results goes even deeper. Dr. Brad Rodu, Professor of Medicine at the University of Louisville, has revealed that the CDC has left out even more critical information.
In its report, the CDC noted that in 2012, 76.3% of middle and high school students who used e-cigarettes in the past month were smokers. Thus, 23.7% of students who currently used e-cigarettes were nonsmokers. However, Dr. Rodu's own analysis of the National Youth Tobacco Survey for 2012 shows that of these nonsmokers, more than half were actually using other tobacco products, such as smokeless tobacco or cigars. And of the remaining half who were not using other tobacco products, about half of that group had already experimented with smoking.
Thus, only 10.8% of electronic cigarette users were non-tobacco users with no previous tobacco cigarette use.
This means that the estimated prevalence of youth in the population who are current e-cigarette users but have never used tobacco products is only 0.25%.
This does not mean that the possibility of youth starting with e-cigarettes and progressing to smoking should not be a concern. What is does mean is that the CDC appears more interested in promoting a particular position on e-cigarettes than in providing the public with the facts.
There is little evidence regarding why youth are using electronic cigarettes. It is possible, for example, that many youth who are smokers or other tobacco product users may be trying electronic cigarettes in an effort to quit their tobacco use. If this is the case, then experimentation with electronic cigarettes could actually have a net benefit among youth. I emphasize that this is merely a hypothetical possibility. But the point is that we don't understand the reasons behind electronic cigarette use among youth. It does us no good to draw conclusions, as the CDC has done, without the proper evidence.
Dr. Rodu concludes: "CDC director Tom Frieden may wish to use his position as a
bully pulpit to oppose e-cigarette use, but abusing the facts is inexcusable."
I agree, but would change the end of the sentence to emphasize that not providing the relevant facts is inexcusable.
To be sure, the issue of electronic cigarettes is a complex one, especially as it relates to youth experimentation with these products and how that changes the overall cost-benefit picture. There is room for debate on the issue and it actually helps ensure appropriate policy to have folks who force us to remain vigilant about the possibility that electronic cigarettes could serve as a gateway to established smoking. However, it does not do us a service for public health organizations to hide relevant facts from the public in order to promote a pre-established position. The best and most appropriate policy will come from a full consideration of the facts, not from the hiding of the facts.