Wednesday, December 16, 2015

New National Survey Refutes CDC Claim that E-Cigarettes are Addicting Kids and Leading to Smoking

The Centers for Disease Control and Prevention (CDC) has claimed that electronic cigarettes are condemning youth to lifetime addiction to nicotine and serving as a gateway to cigarette smoking. New data released today by the National Institute of Drug Abuse (NIDA) from the 2015 Monitoring the Future (MTF) survey demonstrate that the CDC's claims are baseless.

First, the MTF survey revealed that despite the huge number of youth using electronic cigarettes and the dramatic increase in use of e-cigarettes by youth over the past four years, the rate of youth smoking has declined dramatically during the same time period. Moreover, the decline in smoking continued from 2014 to 2015. If e-cigarettes were a significant gateway to smoking, we would have expected to see an increase in youth smoking, or at least a discontinuation of the rapid rate of decrease in youth smoking. However, from 2014 to 2015, daily smoking among high school seniors dropped from 6.7% to 5.5% (an 18% decline, which nearly matches the 21% decline from 2013 to 2014). This is the second largest decline in daily smoking among high school seniors that has been observed in the past 25 years.

Second, the MTF survey revealed that the majority of youth who use e-cigarettes reported using non-nicotine-containing products. Across all grades, more than 60% of youth who used e-cigarettes in the past month reported using a product with just flavoring (without nicotine). Among high school seniors, only 22.2% reported using a nicotine product. Nearly two-thirds (65.4%) of youth past-month e-cigarette users reported using a non-nicotine, flavored product. Just over six percent (6.3%) reported not knowing what the product contained. Based on these data, it appears that the majority of youths who are using e-cigarettes may not actually be using a nicotine-containing product. This certainly casts doubt upon CDC's claim that e-cigarettes are leading to a lifetime of nicotine addiction among youth users.

The Rest of the Story

Although severe damage has already been done, I believe that the CDC needs to immediately correct its baseless claims.

In light of the fact that the past two years have marked the two largest year-to-year declines in daily smoking among high school seniors, it is inexcusable for the CDC to be telling the public that e-cigarettes are a gateway to real cigarette smoking.

And in light of the finding that only one-fifth of high school seniors who used e-cigarettes in the past month reported using a nicotine-containing product, it is also inexcusable for the CDC to be telling the public that e-cigarette use is condemning youth to a lifetime of nicotine addiction. We don't even know whether e-cigarettes are creating nicotine addiction in the first place.

Clearly, more research is necessary to characterize the nature of the electronic cigarette products that youth are using. It is not clear whether youth are accurately reporting the absence of nicotine in the products they are using. Also, some brands that are labeled as zero nicotine have been found to contain nicotine. So caution is necessary in interpreting the survey findings regarding nicotine-containing e-cigarette product use. However, there is no existing evidence that large numbers of youth are becoming addicted to nicotine via experimentation with electronic cigarettes.

Surprisingly, NIDA expressed disappointment that daily cigarette use was lower than daily marijuana use (for the first time in history) and that overall marijuana use exceeded that of cigarette use. Youth marijuana daily use has remained stable at around 3% to 4% for the past two decades. So by stating that they are disappointed that marijuana use exceeds daily cigarette use, NIDA is essentially saying that they would have preferred to see daily cigarette smoking rates remain above 4%. I feel quite differently. I am very pleased that youth daily smoking rates have dropped below the stable rate of daily marijuana use. It means that fewer people will die, which it seems to me is a good thing.

According to an article in the New York Times, NIDA also expressed disappointment that youth seem to be transitioning from real cigarettes that kill people to fake ones that are much safer and which do not appear to have any serious acute health effects.

Here is what the article had to say about NIDA's position: "Dr. Volkow and others were displeased, however, by what appeared to be a lack of progress in areas related to smoking. For the first time in the survey’s 41 years, the percentage of high school seniors who said they smoked marijuana daily (which remained steady at 6 percent) exceeded those who smoked traditional cigarettes daily (5.5 percent, a large drop from last year’s 6.7). Although this derived mostly from the continued decrease in cigarette smoking since the 1970s, many students appear to be transitioning to e-cigarettes, which are unregulated and can contain nicotine and other harmful products, Dr. Volkow said."

The good thing is that NIDA seems to be acknowledging, unlike the CDC, that what we are observing is a transition in youth-preferred products from tobacco cigarettes to e-cigarettes (i.e., non-tobacco cigarettes). Why NIDA would be displeased that youth are transitioning away from smoking boggles my mind.

In another complete misinterpretation of the data, the Campaign for Tobacco-Free Kids stated: "These results also indicate e-cigarettes are more likely to be a pathway to tobacco addiction than away from it." Nothing in these data suggests that e-cigarettes are a pathway to tobacco addiction. The Campaign for Tobacco-Free Kids is just completely making this up. There's not a shred of evidence in the MTF survey that e-cigarette experimentation is leading to tobacco use. If anything, the findings of this survey suggest the opposite.

The rest of the story is that our major health agencies and supposedly anti-tobacco organizations do not appear to want kids to refrain from smoking unless they refrain from anything that looks like smoking. And they appear to prefer that kids smoke tobacco cigarettes than use tobacco-free cigarettes. Sadly, such an attitude is going to cost us a huge number of lives, as these organizations truly are condemning youth to a lifetime of nicotine addiction, disease, and death.

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