Sunday, December 11, 2016

Youth Vaping Plummets in Wake of Surgeon General's Report

A survey conducted by the Pew Foundation this past weekend found that self-reported rates of youth vaping have dropped sharply following Thursday's release of the Surgeon General's report on e-cigarette use, which, after a 263-page review of the scientific evidence, warned that vaping is "not harmless" and that e-cigarette aerosol is not "just water vapor."

Foundation president Robert J. Pew said that although the survey results are subject to a margin of error, "the decline is so sharp that even with the maximum amount of error, the drop in vaping is significant." While Pew acknowledged that the decline cannot "definitively be attributed to the report," the timing of the findings is uncanny and "it is difficult to believe that anything else could explain such a sharp decline."

Pew also noted that it is plausible that the report would have immediately affected so many youth, because "we know how sensitive kids are to finding out that a behavior is not harmless. They immediately stop doing it. We saw exactly the same thing after the Surgeon General released his 2015 report on alcohol, in which he concluded that alcoholic beverages are not just "pure water." Youth drinking rates plummeted within weeks of that report's release.

The Surgeon General's office also defended the plausibility of the quick decline in vaping, reminding reporters of the immediate and dramatic increase in calls to the smoking quitline following the release of the landmark 1964 Surgeon General's report on smoking, which concluded that contrary to public opinion, smoking is "not harmless" and inhaling tobacco smoke is not the same as "breathing in clean air."

Health advocates across the nation have demanded that federal, state, and local governments take drastic action to protect youth from what the American Lung Association has called "a scourge of devastating impacts from exposure to non-harmless chemicals." The American Heart Association similarly warned of what it called "an impending epidemic of non-harmless recreational behavior among our nation's youth."

An American Lung Association spokesperson explained that: "Youth should not inhale anything other than pure, clean air. And they should only engage in behaviors which have been determined by the federal government to be harmless."

The Lung Association spokesperson cited several recent federal actions, such as the elimination of high school football in 2013 after studies showing that repeatedly getting hit in the head with a hard helmet worn by a 215-pound lineman is not harmless and the ban on resistance training programs in high school gym classes because it has been shown to cause an acute increase in the number of epithelial progenitor cells, which Dr. Stan Glantz has said "are markers of damage to the lining of arteries (called the vascular endothelium)." Glantz added that: "Damage to the endothelium is linked to immediate increases of the risk of a heart attack in people at risk of heart attacks and also contributes to the long-term development of atherosclerosis (buildup of blockages of arteries in the heart) and peripheral vascular disease (blockage of other arteries)."

A review of interventions to prevent risk-taking youth behavior published in Annual Reviews of Public Health in 2014 reported that educational campaigns which inform kids that there are possibly some risks associated with health behaviors are "highly effective" in preventing those risk-taking behaviors. The article cited the steep decline in youth marijuana use following the Surgeon General's 2015 conclusion that "the inhalation of smoke from burning leaves containing a psychoactive substance may not be risk-free."

When asked why the report could say nothing worse about vaping than that it is merely "not harmless," the Surgeon General's office explained that: "there actually have been no studies that have documented any actual harms to youth from vaping. It would be pure conjecture to conclude from the present evidence that vaping carries significant harms, and that is not something a Surgeon General's report would ever do."

Despite popular misconceptions, the tobacco companies did not try to impede the Surgeon General's report on smoking in 1964. Joseph F. Cullman III, Philip Morris president at the time, is widely reported to have joked in internal memos: "Johnny is alive and well. If all the Surgeon General can say about smoking is that it is 'not harmless,' we are in a position to thrive. Until something safer comes along - like a non-tobacco cigarette that delivers nicotine without combustion - the market for combustible tobacco products will remain strong and active."

Several high school youth interviewed over the weekend by CNN confirmed that as soon as their classmates learned that vaping was not harmless, they immediately stopped. "Instead of blowing vape rings at parties, the cool thing now is to drink pure mountain spring water," said 16-year-old Heather Walters of Oak Spring, Illinois.

The National Association for the Preservation of Puritan Practices (NAPPP) released a statement praising the Surgeon General's report on vaping: "It's great to see that the Surgeon General of the United States is so deeply committed to preventing even the most minor of risks among youth and that he is willing to hysterically cast as a dire threat any behavior that might convey any risk. It's also great to see that he understands the importance of not differentiating between the levels of different risks. To be pure, moral, and safe, you have to disavow all risky practices, not just the most strikingly dangerous ones. And if you think that switching from an extremely hazardous behavior to one that is just 'not harmless' will save you from eternal damnation, you've got something coming to you."

The Department of Health and Human Services' campaign to condemn e-cigarettes follows a long public health tradition of banning or seeking to prevent any behavior that merely reduces harm. According to a deputy secretary, the demonization of e-cigarettes is consistent with the Department's long-standing opposition to sex education, methadone maintenance programs, needle exchange programs, distribution of naloxone to emergency responders and law enforcement officers, and promotion of "low-calorie" rather than "no-calorie" diets.

ADDENDUM: This is a parody. It was written to highlight the absurdity of the Surgeon General's report and the approach it takes to tobacco control. I thought it was obvious but a number of people have been asking to see the survey results. Stay tuned, however, as there should be some actual survey results out later this week.

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