Thursday, June 09, 2016

CDC Data Reveal Drastic Decline in Youth Smoking, Blowing E-Cigarette Gateway Hypothesis Out of the Water

The Centers for Disease Control and Prevention (CDC) yesterday released new data from the Youth Risk Behavior Survey (YRBS) revealing that despite a striking increase in youth e-cigarette use in the past two years, the prevalence of current smoking among high school students nationally declined by a whopping 31% from 2013 to 2015, falling from 15.7% to 10.8%. This represents a historic low and a 41% decline since 2011. Frequent smoking also fell to a historic low, dropping from 5.6% to 3.4%, a 39% decline. Daily smoking dropped by 42%, from 4.0% to 2.3%, and overall tobacco use declined by 23%, falling from 24.0% to 18.5%.

The 41% drop in youth smoking from 2011 to 2015 occurred at the same time as a 24-fold increase in youth e-cigarette use, which rose from just 1% to 24%.

In response to these data, and in spite of the data, anti-smoking advocates and groups claimed that this shows e-cigarettes are leading kids to smoking.

For example, according to a Health Day article: "Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said, 'While cigarette smoking in high school students is at an all-time low, the rise of e-cigarette use poses a risk that teenagers will transition from 'e' to 'real' cigarettes.'"

The Campaign for Tobacco-Free Kids claimed that: "this survey also raises fresh concerns that other tobacco products, especially electronic cigarettes and cigars, are undermining overall efforts to reduce youth tobacco use and could be luring a new generation of kids into nicotine addiction."

The Rest of the Story

For the first time in a long time, I have to admit that the anti-smoking groups are correct about electronic cigarettes: these products are indeed a gateway.

They are a gateway away from smoking.

It is increasingly becoming clear that the advent of vaping has contributed to the most marked decline in youth smoking in recent history. In contrast to what the anti-smoking groups are saying, overall tobacco use is falling, not staying the same, and the use of e-cigarettes is not undermining progress in reducing youth smoking but contributing to it.

There are simply too many youth using e-cigarettes to argue that vaping is not to some extent replacing smoking as a behavior in the youth population.

Moreover, it is now abundantly clear that e-cigarettes are not serving as a gateway to smoking and tobacco use. In contrast, vaping appears to be acting as a deterrent, or more accurately, as a diversion away from smoking. In other words, it appears that as an alternative to smoking, electronic cigarettes are diverting kids from smoking to vaping.

Obviously, reducing smoking by diverting youth to an alternate form of nicotine use is not an ideal solution to the problem of youth tobacco use and smoking addiction. It would be preferable to reduce smoking without having youth turn to any other behavior that carries some risk. Nevertheless, the rest of the story is that e-cigarettes are not undermining efforts to reduce youth smoking and/or youth tobacco use. They are actually contributing to those efforts.

To be clear, this does not mean that we should be encouraging vaping among youth. However, it does mean that the widespread concern that e-cigarettes will be a gateway to smoking is just not panning out. Vaping is clearly not resulting in the re-normalization of smoking. It is quite the opposite. Vaping is helping to further de-normalize smoking. Vaping is becoming increasingly cool among youth and helping to make smoking ever more unpopular and uncool. What is playing out is exactly the opposite of what anti-smoking groups claim.

There is no question that the FDA's recent ban on sale of e-cigarettes to minors is warranted, as are restrictions on marketing of e-cigarettes to youth and educational campaigns to help youth understand the health risks of both smoking and vaping. But we also need to be careful. The last thing we want to do at this stage of the game is to create an increased demand for real cigarettes by removing the competition. Banning e-cigarette flavors would do just that, as would allowing the predicate date in the current e-cigarette regulations to remain.

What this story also reveals is that anti-smoking groups have a pre-scripted message and that they automatically twist their interpretation of scientific data to facilitate that message, rather than allowing the science to inform their communications and their agenda. This is a striking example because the data are so inconsistent with the anti-smoking groups' conclusions that it is almost comical to see.

Indeed, as youth e-cigarette use increased from 1% to 24% concurrently with a massive 41% decline in youth smoking, anti-smoking groups are concluding that vaping is re-normalizing smoking. If that's the case, then I guess we should strive to re-normalize smoking as much as we can.

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