New Study Finds that Youth Vaping Served as a Substitute for Smoking But Concludes the Opposite

A new study published in the journal Tobacco Control purports to show that the immense decline in youth smoking over the past decade had nothing to do with the emergence of vaping products. The study concludes: 

"Cigarette smoking has declined precipitously among both adolescents and young adults since 1997. Starting in 2017, adolescent e- cigarette vaping surged, concomitant with the popularity of flavoured, high nicotine e-cigarettes that have been shown previously to lead to dependence. Our findings do not support the previously suggested evidence that this increase in e-cigarette vaping was associated with a more rapid decline in adolescent cigarette smoking."

The Rest of the Story

Anyone who reads the conclusion of this article without reading the full article will come away with the impression that this study found evidence to dispel the notion that vaping contributed to the rapid acceleration of the rate of decline in youth smoking that occurred during the past decade. However, those who take the time to read the article will note these two major findings of the article:

1. "40% of the drop in cigarette smoking prevalence was ‘replaced’ by the increase in nicotine vaping prevalence... ."

2. "We hypothesise that the rapid increase in e-cigarette vaping between 2017 and 2020 was related to the products’ appeal to individuals with the same risk profile for cigarette smoking, but who may have been subject to strong social norms against cigarette smoking."

What these two statements suggest is that a large proportion (40%) of the observed decline in cigarette smoking prevalence occurred because smoking was "replaced" by vaping among adolescents. The authors even hypothesize that e-cigarettes served as a substitute for cigarette smoking among youths with the same profile for cigarette smoking. This finding and hypothesis are consistent with a growing body of literature demonstrating that cigarettes and e-cigarettes are essentially substitutes, both among adults and youth. 

So the rest of the story here is that for some reason, the paper concludes the exact opposite of what the research finds and what the authors hypothesize. 

I can't explain this, other than to infer that the authors set out with a predetermined conclusion that they were going to articulate regardless of what the results of the paper actually showed. There is, sadly, no question in my mind that a large number of researchers who study vaping hold a strong bias against e-cigarettes and that this skews their interpretation of study findings. Here is an example of a study whose results are consistent with a body of literature suggesting that vaping is one factor associated with the dramatic recent declines in youth smoking but which concludes that vaping is not associated with the dramatic recent declines in youth smoking. 

This conclusion is not consistent with the data presented in the paper. The research demonstrated that there was a substantial acceleration in the rate of decline in youth smoking between 2013 and 2018. During the same period, there was an astronomical increase in youth vaping. The paper emphasizes the rapid increase in e-cigarette vaping among youth between 2017 and 2020 but ignores the fact that the rapid rise in youth vaping began not in 2017, but in 2013. From 2013 to 2019, the prevalence of youth vaping increased more than six-fold. From 2013 to 2017, the prevalence of youth vaping doubled. 

I truly do not understand the demonization of e-cigarettes that is occurring in the tobacco control movement. I have never seen public health practitioners shun the concept of harm reduction. For some reason, we rely upon a harm reduction approach for all public health issues other than nicotine use.