New Study Tackles 5 Key Myths of the Youth Vaping “Epidemic”

By Lee Johnson Posted October 6, 2019

Vaping Epidemic Fact Check

 

Even in the wake of the vapocalypse, with the lung illness still affecting people across America (likely due to illicit THC cartridges made using vitamin E acetate), the response from the government and public health bodies has still maintained its laser-like focus on teens and youths vaping. The story is the same as always: there is an “epidemic” of youth vaping, and we’re told that innocent, wide-eyed kids who’d never have smoked otherwise are lured into nicotine use and ultimately smoking by the “child-friendly flavors” many e-liquids and pods are available in.

 

The “epidemic” was declared last year, as “preliminary data” (read: not available to analyze for other researchers) from the National Youth Tobacco Survey (NYTS) showed a shocking rise in past-month vaping among middle and high school students. Like Trump declaring an emergency at the southern border to bolster the case for his anti-immigration agenda, the “epidemic” was used – and still is being used – as justification for pushing through harsh restrictions on vaping. The target of these is (usually) the flavored products that many adults credit with playing a key role in their transition from smoking to vaping.

 

The big question is: is there really an epidemic of youth vaping? Declaring one while holding the key data close to your chest is easy, but maintaining it when the data is open for anybody to pore through is much more difficult.

 

A new study does just this. Martin J. Jarvis, Robert J. West and Jamie Brown from University College London have taken a look at the details behind the epidemic, and the results call into question five of the key claims made to justify this epidemic.

 

The National Youth Tobacco Survey and the Youth Vaping “Epidemic”

 

National Youth Tobacco Survey Results

 

Before getting into the details of the study, the key piece of evidence used by US health authorities when discussing this is the NYTS. This is an anonymous annual survey completed by middle and high school students from across the US, aiming to produce a nationally-representative “snapshot” of tobacco use across the country based on students in the 6th to the 12th grade. It covers most types of tobacco: cigarettes, cigars, other combustibles (e.g. hookahs), non-combustibles like chewing tobacco, snuff and snus, as well as nicotine products like e-cigarettes. They survey classes anybody who’s used a product in the past 30 days as a “current” user, and it also asks about ever having tried the product in question.

 

These are the two key measures authorities focus on when the results are reported each year. Press releases talk about the rise in “current” e-cigarette use, for example, amid continually-declining smoking rates. This is what they said about the “epidemic” last year: for high school students, the 2018 NYTS showed an increase of 78% in current vaping. The study quotes ex-FDA Commissioner Scott Gottlieb, who said:

 

The data show that kids using e-cigarettes are going to be more likely to try combustible cigarettes later. This is a large pool of future risk. … The data from this nationally representative survey…. show astonishing increases in kids’ use of e-cigarettes and other ENDS , reversing years of favorable trends in our nation’s fight to prevent youth addiction to tobacco products. These data shock my conscience.

 

The increase in vaping was real, of course. In 2017, 11.7% of high school students reported past-month vaping, while in 2018 it was 20.8% – a 78% increase just like they said. However, from this point onwards the picture painted by the data doesn’t really match the impression you’d have gotten from official statements on the topic.

 

1 – Never-Smoking Teens are Much Less Likely to Vape

 

Smokers vs. Never Smoker Chance of Vaping
Data from Jarvis, West and Brown (2019). Note that never-smokers are taken as a reference value, all the other odds are scaled relative to them.

 

The first problem with the narrative of an explosion in vaping among impressionable young teens is that the data shows that teens who smoke or who had smoked in the past are much more likely to vape. For teens who’d never smoked, in 2017, 2.9% had vaped in the past 30 days, and this rose to 8.4% in 2018. For those who’d smoked more than 100 cigarettes (i.e. 5 packs) in their lives, past-month vaping rose from 57.2% in 2017 to 71% in 2018.

 

The researchers compiled odds ratios to really make the data clear. Compared with teens who’d never used tobacco (using the 2018 data), those who’d used a non-combustible (but not a combustible product) were 4.4 times more likely to be a past-month vaper, for those who’d smoked one cigarette in the past, the odds were 7.1 times higher, and for those who’d smoked 100 or more cigarettes in their lifetime, the odds were a huge 26.8 times higher to be a past-month vaper than for a never-smoker. The 2017 data shows a similar picture.

 

In a nutshell, the chances of being a past month vaper are much higher for those who’d already smoked or at least used nicotine in some form.

 

2 – They Aren’t Vaping That Often

 

Smoking History and Vaping
Data taken from Jarvis, West and Brown's (2019) analysis of NYTS data. The black bars show frequent vaping, arranged by smoking history.

 

A key part of the narrative surrounding youth vaping relates to addiction. The fear is – understandably – that teens who’ve never smoked will pick up vaping and become addicted to nicotine. While the last point already shows that teens who’ve already smoked or at least used nicotine are far more likely to be current vapers, the next part of the progression is on shaky ground too.

 

The big problem is that past month vaping doesn’t mean “vaping all the time,” as “current vaper” might imply to a casual reader. Frequent use is what many people would picture, and if you define that as 20 or more days in the past month, the picture changes substantially. Only about a quarter of past month vapers had vaped frequently in either year, specifically 19.9% in 2017 and 28.4% in 2018.

 

And when you combine this with their smoking status, the reality falls sharply into focus. For those who’d never used tobacco, just 0.1% of never tobacco users vaped frequently in 2017, rising to 1 percent in 2018. In contrast, those who’d smoked over 100 cigarettes in their lifetime had frequent vaping rates of 26.8% in 2017 and 37.2% in 2018.

 

Of course, the rise in frequent vaping among never smoking teens from 2017 to 2018 is still quite large, proportionally speaking, but in absolute terms the numbers are unavoidably tiny.

 

3 – They Don’t Seem to Be Addicted

 

Are Teen Vapers Addicted
2018 NYTS data taken from Jarvis, West and Brown (2019). Vapers' dependence levels vary with smoking history, and are lowest in vapers who never smoked.

 

But that isn’t the end of the issues for the claim that there is an explosion in youth nicotine addiction as a result of vaping. The NYTS also asks some questions to indicate the level of dependence in the respondents, specifically, whether the teens have a craving for the tobacco product and how soon after waking up they want to use one. Of course, reporting cravings and using soon after waking are signs of dependence.

 

Only 3.8% of past-month vapers reported cravings, and 3.1% said they wanted to use tobacco products within 30 minutes of waking up. There is a problem with the terminology here, though, because teens who only vape didn’t really see themselves as “tobacco product” users at all. For example, when asked if they were thi