Tuesday, November 26, 2024

Obsession with Youth Vaping Has Made Us Lose Sight of Far More Serious Threats to the Health of Adolescents and Young Adults

While public health agencies and anti-tobacco groups have made youth vaping nearly the sole focus of their adolescent health agendas over the past decade, far more serious substance abuse threats to the health of teens and young adults are escaping attention and wreaking greater havoc on the current generation of young people. 

For example, a new article just published in the American Journal of Medicine reveals that over the past two decades, the death rate from alcohol in the United States has doubled. The largest increase in the death rate from alcohol was among young people ages 25-34, among whom the rate nearly quadrupled.

According to a press release accompanying the article: "Results of the clinical research study, published in the American Journal of Medicine, reveal that alcohol-related deaths in the U.S. have surged dramatically in the last two decades, with the mortality rate nearly doubling from 10.7 per 100,000 in 1999 to 21.6 per 100,000 in 2020. The total number of alcohol-related deaths soared from 19,356 to 48,870, a dramatic twofold increase. Every age group has suffered increases, with the most alarming spike – nearly fourfold – in those aged 25 to 34.

According to data from Dr. Charles Gardner, approximately 4,000 teenagers die every year from alcohol (due primarily to binge drinking, motor vehicle crashes, and other injuries). Another 1,900 die from opiate overdose (due primarily to fentanyl). According to CDC, there were another 2,200 teenage deaths in 2022 from suicide. Thus, the combination of alcohol, opiates, and suicide are resulting in the deaths of approximately 8,000 teenagers each year. 

In contrast, the number of teen deaths from electronic cigarettes during the past two years is approximately 0.

Even if one includes the deaths that did occur due to vaping during the so-called EVALI outbreak, 0 of those deaths were due to e-cigarette use. They were due to the use of illicit THC vape carts.

The Rest of the Story

While many anti-tobacco groups lament the near disappearance of cigarette smoking due to the vaping fad among teens and would have us believe that vaping is an epidemic every bit as devastating as smoking, I believe that these groups have contributed to an obsession with youth vaping that has overshadowed more serious threats to adolescent health and allowed these threats to blossom unchecked because of the diversion in our focus. 

Because of these misplaced priorities, health agencies instructed youth not to use e-cigarettes during EVALI, rather than to avoid buying THC vape carts off the black market. Because of these misplaced priorities, public officials have banned flavored e-cigarettes, and in some places the sale of all e-cigarettes, while leaving the sale of flavored real cigarettes unchecked. Because of these misplaced priorities, the FDA has devastated the e-cigarette market, while leaving the deadly cigarette market completely unchecked. Because of these misplaced priorities, schools are using video surveillance to make sure no one is vaping in the bathroom, while letting kids use alcohol to their hearts content and while an opioid overdose epidemic rages. 

Don't get me wrong. I'm not saying that youth vaping is not a problem that needs to be addressed. But I think it needs be be addressed in a more reasonable (and more effective) way, as part of a more holistic approach to adolescent health that prioritizes the substances and behaviors that are the greatest threats to the lives of our children.

Monday, November 25, 2024

New Article in American Journal of Medicine Claims that Youths Who Use E-Cigarettes are 5 Times More Likely to Become Cigarette Smokers

I've only been back at this for one day and the very first new article that I came across makes the preposterous claim that use of e-cigarettes increases by 5-fold the initiation of cigarette smoking among youth. The article, published as a commentary in the American Journal of Medicine, states as follows: "E-cigarette use by adolescents increases by up to 5-fold their initiation of tobacco cigarette smoking."

The Rest of the Story

It is difficult to believe that anyone could look at the actual data on the prevalence of youth cigarette smoking in 2024 and make the claim that vaping by youth leads to a 5-fold increase in smoking initiation. If that were true, then given the tremendous rise in vaping that we have observed over the past decade, one would certainly expect to see that translate into a substantial increase in the prevalence of youth smoking. As I pointed out yesterday, an analysis by Dr. Brad Rodu demonstrated that in 2011, smoking prevalence among high school students was 15.7%, while the prevalence of vaping was just 1.4%. By 2022, the prevalence of vaping among high school students had skyrocketed up to 14.1%, yet smoking among high school students dropped to just 2.0%. And by 2024, smoking prevalence among high school students was only 1.7%.

These data definitively refute the contention that e-cigarettes are a gateway to smoking among youth and are completely inconsistent with the claim that e-cigarette use leads to a 5-fold increase in youth smoking initiation rates. 

Interestingly, the article in question fails to provide any citation or source for its preposterous claim that vaping is greatly accelerating the initiation of smoking by youth. Apparently, we are supposed to just take it on faith that this is true.

The article also makes two additional assertions that are hard for me to believe are still being made in 2024. 

First, the article claims that: "At least 4.5% of adults, 10% of high school students, and 4.6% of middle school students now use tobacco e-cigarettes." The problem with this statement is that there are no such things as "tobacco e-cigarettes." By definition and by intention, electronic cigarettes do not contain any tobacco. That is the entire point! If an e-cigarette did contain tobacco then I would not consider it to be an e-cigarette; it would be a heated tobacco product. Even the American Cancer Society admits that e-cigarettes do not contain tobacco. 

It has now been 17 years since e-cigarettes were first introduced in the United States. One would have thought that by now, smoking cessation experts of all people would appreciate the fact that the unique selling proposition for e-cigarettes is that they do not contain tobacco.

Second, the article claims that: "Nonetheless, in one trial, up to 80% of those who ceased tobacco cigarette smoking for 12 months with e-cigarettes continued to smoke e-cigarettes." This is apparently news to the authors of this commentary but you do not smoke an e-cigarette. You vape an e-cigarette. This is why e-cigarette use is referred to as vaping rather than smoking. E-cigarettes do not produce any smoke because they involve no combustion. Again, that is the entire point!  

It has now been 17 years since e-cigarettes were first introduced in the United States. One would have thought that by now, smoking cessation experts of all people would appreciate the fact that the unique selling proposition for e-cigarettes is that they do not involve any combustion and therefore do not produce any smoke; hence, you cannot smoke an e-cigarette. 

The question arises, then, whether the authors of this commentary are really so uninformed about the nature of e-cigarettes that they simply are not aware that these products do not contain tobacco and do not involve combustion, or whether they are intentionally using smoking-related terminology to create the impression that vaping and smoking are essentially equivalent.

Sunday, November 24, 2024

American Heart Association and American Cancer Society are Still Spreading Misinformation about Vaping

After the start of the COVID-19 pandemic, I took an almost complete break from blogging about tobacco policy to concentrate on some other public health topics. Now that more than 4 years have passed, I decided to take a look at the websites of some of the major national health organizations to see whether they have started to accurately communicate the facts about vaping and smoking. I figured that during the past 4 years there has been so much definitive science about the relative risks of vaping and smoking, the cause of EVALI, the question of whether youth vaping is a gateway to smoking, and the effectiveness of vaping in helping smokers quit that the major anti-tobacco groups would by now be communicating accurately to the public. I also figured that with all the public attention being given to misinformation, these groups would certainly be a lot more careful about the validity of the public claims they were making.

I start today by reviewing recent "fact" sheets from the American Heart Association and the American Cancer Society.

American Heart Association

In a 2024 article entitled "Is Vaping Better than Smoking," the American Heart Association makes the following claims:

1. "E-cigarette promoters claim the devices can help people quit smoking. But much more evidence is needed to determine if they are an effective way to quit. Research suggests that users are more likely to continue smoking along with vaping, which is referred to as dual use."

2. "Many people think vaping is less harmful than smoking. While it’s true that e-cigarette aerosol doesn’t include all the contaminants in tobacco smoke, it still isn’t safe."

3. "E-cigarettes have been linked to thousands of cases of serious lung injury, some resulting in death. While the exact cause is still not confirmed, the CDC recommends that people not use e-cigarettes."

4. "E-cigarettes’ biggest threat to public health may be this: The increasing popularity of vaping may “re-normalize” smoking, which has declined for years. Reversing the hard-won gains in the global effort to curb smoking would be catastrophic."

American Cancer Society

In a November 7, 2024 article on the risks of vaping and smoking, the American Cancer Society makes the following claims:

1. "Misconception: Many people believe vaping doesn’t carry the same health risks as cigarette smoking because e-cigarettes do not contain tobacco."

2. "Misconception: Some people also think vaping is safer than smoking because they believe the vapor from e-cigarettes does not contain the same harmful chemicals as smoke."

The Rest of the Story

Let's analyze each of the above claims. Below are the claims followed by the actual facts.

American Heart Association

In a 2024 article entitled "Is Vaping Better than Smoking," the American Heart Association makes the following claims:

1. "E-cigarette promoters claim the devices can help people quit smoking. But much more evidence is needed to determine if they are an effective way to quit. Research suggests that users are more likely to continue smoking along with vaping, which is referred to as dual use."

The Truth: There is plentiful evidence that e-cigarettes can help smokers quit. The most recent evidence found that among smokers who tried vaping daily in an attempt to quit smoking, more than one-fourth (28%) quit smoking successfully. In the most recent clinical trial of vaping as a smoking cessation aid, subjects who were randomly assigned to receive e-cigarettes were twice as likely to quit smoking as those who did not receive e-cigarettes. As of 2022, there were 6.1 million e-cigarette users who had quit smoking by switching to vaping. If 6 million successful ex-smokers is not enough evidence to show that e-cigarettes are an effective way to quit, then no data ever will be for the American Heart Association. This is blatant misinformation.

2. "Many people think vaping is less harmful than smoking. While it’s true that e-cigarette aerosol doesn’t include all the contaminants in tobacco smoke, it still isn’t safe."

The Truth: This is intentional misinformation. The American Cancer Society avoids telling an overt lie by failing to explicitly answer the question. They intentionally use the word "safe" rather than "safer." However, few readers are going to pick this up and the implication of the first sentence is that the belief that vaping is less harmful than smoking is untrue. The clear intention here is to mislead the public into believing, falsely, that vaping is just as harmful as smoking. Even my long-time hero and mentor - Dr. Stan Glantz - acknowledges that smoking is more dangerous than vaping. And the Food and Drug Administration has concluded unequivocally that smoking is more hazardous than vaping.

 3. "E-cigarettes have been linked to thousands of cases of serious lung injury, some resulting in death. While the exact cause is still not confirmed, the CDC recommends that people not use e-cigarettes."

 The Truth: This is essentially an outright lie. Vaping THC carts, not e-cigarettes, was shown to be the cause of the so-called EVALI outbreak of serious lung injury that resulted in many deaths. The cause has been confirmed. The lung injury was caused by vitamin E acetate, a substance added to black market THC vapes to create the illusion of a more concentrated product so that it would reap in more money on the street. There is no evidence that e-cigarettes (nicotine-containing vapes produced for what at the time was an entirely legal market) have caused a single case of severe or fatal lung injury.

4. "E-cigarettes’ biggest threat to public health may be this: The increasing popularity of vaping may “re-normalize” smoking, which has declined for years. Reversing the hard-won gains in the global effort to curb smoking would be catastrophic."

The Truth: This statement is the exact opposite of the truth. Rather than re-normalize smoking, vaping has hastened the near complete elimination of smoking among youth. A brilliant analysis by Dr. Brad Rodu has revealed that the use of electronic cigarettes among youth has not served as a gateway to increased smoking but on the contrary has led to the virtual disappearance of smoking among high school youth. In 2011, smoking prevalence among high school students was 15.7%, while the prevalence of vaping was just 1.4%. In 2022, the prevalence of smoking among high school students dropped to just 2.0%, even though past-month vaping prevalence increased to 14.1%. It should be noted that in 2024, e-cigarette use among high school students dropped to 7.8%, while smoking declined further to 1.7%. Second only to e-cigarettes causing popcorn lung and possibly to e-cigarettes causing EVALI, the claim that youth vaping is a gateway to smoking has to go down in history as one of the greatest tobacco-related myths of all time not propagated by Big Tobacco.

American Cancer Society

In a November 7, 2024 article on the risks of vaping and smoking, the American Cancer Society makes the following claims:

1. "Misconception: Many people believe vaping doesn’t carry the same health risks as cigarette smoking because e-cigarettes do not contain tobacco."

The Truth: Like the nearly identical claim by the American Heart Association, this appears to be intentional misinformation. The clear implication is that these people--who believe vaping doesn't carry the same health risks as smoking--are wrong. Thus, the American Cancer Society is suggesting to readers that vaping does carry the same health risks as cigarette smoking. The truth, however, is that the Food and Drug Administration has concluded unequivocally that smoking is more hazardous than vaping.

2. "Misconception: Some people also think vaping is safer than smoking because they believe the vapor from e-cigarettes does not contain the same harmful chemicals as smoke."

Like the claim above, the clear implication is that these people--who think vaping is safer than smoking--are wrong. Thus, the American Cancer Society is again suggesting to the public that vaping is just as hazardous as smoking. This is unequivocally false.

Conclusion

In this age of misinformation as well as distrust of health authorities, it is more important than ever that public health organizations communicate accurately, honestly, and transparently with the public. After being away from blogging about tobacco issues for about 4 years, it is extremely disappointing for me to come back and find the situation no better than when I left. It is difficult for me to believe that this has now been going on for 15 years. It all started with that 2009 press conference when the FDA announced it was seizing e-cigarette products of Smoking Everywhere and NJOY. That was when what was to become a decade and a half long campaign of disinformation about electronic cigarettes began. It is disheartening to know that we are still talking about this campaign of disinformation in the present tense. And so the battle for truth and honesty within public health continues.