Declines in Adolescent Smoking Accelerated As Vaping Rose, Suggesting the FDA's Campaign Is Fatally Misguided

Even among teenagers, efforts to prevent underage e-cigarette use may do more harm than good.



In the midst of a federal campaign against underage vaping, a new study finds that downward trends in smoking among teenagers and young adults accelerated as e-cigarette use rose. The findings, based on data from five national surveys, suggest that the official panic about the "epidemic" of e-cigarette use by minors, which has led to restrictions that affect adult access to vaping products and government-sponsored propaganda that exaggerates their hazards, is fatally misguided.

"A long-term decline in smoking prevalence among US youth accelerated after 2013 when vaping became more widespread," Georgetown public health researcher David T. Levy and his co-authors report in the journal Tobacco Control. "These findings were also observed for US young adults, especially those ages 18–21. We also found that the decline in more established smoking, as measured by daily smoking, smoking half pack a day or having smoked at least 100 cigarettes and currently smoking some days or every day, markedly accelerated when vaping increased." While "it is premature to conclude that the observed increased rate of decline in smoking is due to vaping diverting youth from smoking," Levy et al. say, "it is a plausible explanation."

Tobacco Control

What about the concern that vaping is having the opposite effect, leading to smoking by teenagers who otherwise never would have used tobacco? As Levy and his colleagues note, the fact that teenagers who try vaping are more likely than teenagers who don't to subsequently try smoking does not necessarily mean that vaping is a "catalyst" for smoking. "The joint susceptibility hypothesis, also known as the common liability hypothesis, suggests that vaping is more likely to occur within a population with a propensity to use cigarettes due to shared common risk factors," they write. But "even if there is some validity to the catalyst hypothesis, its impact is dwarfed by other factors."

Since vaping is far less dangerous than smoking (at least 95 percent less dangerous, according to an estimate endorsed by Public Health England), the balance between these two possible effects is crucial in evaluating the public health impact of underage vaping and efforts to prevent it. "The divergent findings between individual-level cohort studies, which show a possible causal relationship between vaping and smoking, and those of population trends showing a negative association between vaping and smoking are not necessarily inconsistent," Levy et al. note. "Rather, it is possible that trying e-cigarettes is causally related to smoking for some youth, but the aggregate effect of this relationship at the population level may be small enough that its effects are swamped by other factors that influence smoking behaviour." The substitution of vaping for smoking is one of those factors.

This study did not include data for this year, when the National Youth Tobacco Survey (NYTS) found a sharp increase in vaping among teenagers, who mostly use Juul e-cigarettes, which offer better nicotine delivery than many competing products and might therefore be more addictive. But Levy says that development won't necessarily change the main thrust of his team's conclusions.

"The data that I have seen so far indicates that vaping has increased, but little has changed in terms of smoking rates," Levy told Gizmodo. "Much of the vaping is low-intensity use (less than 5 days in the last month), but some is more regular use as indicative of addiction. It is much too soon to say the combined effects, and I expect that we probably will not even have a good indication of the effects for at least another year." The 2018 NYTS results for smoking, unlike the results for vaping, have not been published yet, but they reportedly include an increase in past-month cigarette smoking among high school students from 7.6 percent to 8.1 percent, a change that was not statistically significant.

Notably, Food and Drug Commissioner Scott Gottlieb says his agency did not consider the inverse relationship between smoking and vaping among teenagers when it decided to ban almost all e-cigarette flavors from stores that admit minors, which account for the vast majority of outlets selling e-cigarettes. "I'm sure that there's a component in there of kids who are using e-cigarettes in lieu of combustible tobacco and otherwise would have used the combustible tobacco," Gottlieb told me in an interview last Friday. "But from our standpoint, that's a hard justification for us to use as a public health justification when our mandate is no child should be using a tobacco product."

In other words, the FDA is bound to do everything it can to curtail underage vaping, even if that means more smoking-related disease and death over the long term. When the goal of preventing e-cigarette use by minors conflicts with the mission of minimizing morbidity and mortality, public health loses.

The flavor restrictions are not the only way the FDA is undermining public health. Consider "The Real Cost" Youth E-Cigarette Prevention Campaign, which the agency proudly unveiled in September. "There's an epidemic spreading," says one of the TV spots, which shows worm-like parasites wriggling and spreading under the skin of young vapers and invading their brains. "Scientists say it can change your brain. It can release dangerous chemicals like formaldehyde into your bloodstream. It can expose your lungs to acrolein, which can cause irreversible damage. It's not a parasite, not a virus, not an infection. It's vaping."

A recent analysis of the aerosol generated by eight Juul pod flavors, commissioned by Juul Labs, found no acrolein and no quantifiable amount of formaldehyde. The tests also looked for 20 other potentially harmful constituents, and the results were similar: Either the constituent was not detected or the level was too low to quantify. Since Juul is by far the most popular e-cigarette in the U.S. market and the brand about which the FDA has expressed the most concern vis-á-vis underage consumption, the agency's warnings about acrolein and formaldehyde are more than a little misleading. In any case, the ad's over-the-top brain parasite imagery certainly leaves a false impression of the health risks posed by e-cigarettes.

The intent of these ads, I'm sure, is to convince teenagers that vaping is not as harmless as they might think it is. The FDA notes with alarm that, according to the Monitoring the Future survey, "about 80 percent of youth do not see great risk of harm from regular use of e-cigarettes." But regular use of e-cigarettes, as far as we can tell, doesn't pose a "great risk of harm," certainly not when compared to regular use of combustible cigarettes. If teenagers erroneously conclude from the FDA's icky, scaremongering ads that vaping is just as dangerous as smoking and maybe even more dangerous, they may be more inclined to smoke rather than vape, even though smoking is in fact much more dangerous than vaping.

Furthermore, as Competitive Enterprise Institute policy analyst Michelle Minton notes, teenagers are not the only ones who see these ads. The share of American adults who incorrectly believe that vaping is just as hazardous as smoking is already on the rise, thanks in no small part to overwrought, misleading, and sometimes flat-out inaccurate warnings from activists and public health officials. In one survey, the share of adults who incorrectly said vaping is as harmful as or more harmful than smoking tripled between 2012 and 2015, from 13 percent to 40 percent. Propaganda like the FDA's can only encourage that trend, making it less likely that smokers will switch to vaping and more likely that those who have switched will resume smoking.

On top of that discouragement, the FDA is now making it harder for adult smokers to get the e-cigarette flavors they prefer. Products that were once available in thousands of supermarkets and convenience stores will now be available only from tobacconists, vape shops, or online outlets that have age verification. At the margin, the added inconvenience is bound to deter some smokers from switching and lead some who already have quit to return to the cigarettes they used to smoke, which remain as readily available as they were before. Gottlieb presents that cost, which is unambiguously bad for public health, as a necessary tradeoff for reducing underage vaping. But if reducing underage vaping results in more smoking by teenagers, it is hard to see any way in which the tradeoff can be justified.

[This post has been updated with information about potentially harmful constituents in Juul aerosol.]

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  1. Guvmint noes best!

  2. Vaping can lead to addiction, which can lead to harder drugs like meth and opiates. I know several people who started with vaping and later died from fentanol overdoses. If they can scare just one kid off vaping then the campaign is worth it.

    1. God, I hope you’re joking.

  3. It’s not about health. It’s about government controlling your actions it does not like.

    And states like NY lose revenue when people move from cigarettes to vape. What state wants that?

  4. No one’s going to mention the disfiguring scars that vaping causes?

    1. yeah, did that thing blow up in his face?

  5. I like how they for get to mention that many of the vapor users are smoking pot. Hell vaping started in the pot community to begin with. We almost got our own vaping company when this first started But the people that we worked with got greedy a ran the vaping business into the ground.

  6. As far as government and most idiots are concerned, it looks like smoking therefore it is smoking and the government will tax it like smoking and ban it like smoking even if it’s just water vapor.

    That the FDA hasn’t banned coffee yet is a miracle since coffee is, shockingly enough, extremely addictive and kids can buy it at thousand of Starbucks that are everywhere without even being carded.

    Don’t think coffee is addictive? Drink three or four cups a day for a month then quit cold turkey. See how it goes.

    1. Caffeine can also be obtained in read to drink form, from every grocery and/or convenience store (cola anyone?).

      1. Or, and this is an interesting fact, in pill form and no they don’t card you for it even though you could overdose and kill yourself with it. Just like Tylenol!

        *clutches pearls*

        1. In fact, using the caffeine tablets is about the only way to to get a lethal overdose.

          Caffeine LD50

          The LD50 of caffeine in humans is dependent on individual sensitivity, but is estimated to be 150?200 milligrams per kilogram of body mass (75?100 cups of coffee for a 70 kilogram adult).[113]

          75-100 cups would be 4.7 to 6.25 GALLONS.

          From what I’ve read elsewhere (I don’t have a cite right now) it takes around 8 hours for a dose of caffeine to be cleared out from your body.

          Caffeine is also a diuretic, it makes you pee more. You try drinking 4+ gallons of coffee in less than 8 hours.

          Hmm, 45 to a 100 cups of coffee in 8 hours is 1 cup every 4.8 to 6.4 minutes. I don’t think that’s gonna happen.

          1. A real man eats ground coffee straight out of the bag.

            1. 75-100 cups of coffee would require 2-3 pounds of ground coffee beans. I’d almost be willing to pay money to see someone try to eat 2-3 pounds of dry ground coffee.

            2. bag? a real man picks the coffee beans himself and eats them raw.

            3. A real man eats the individual kopi luwak beans straight out of the civet while they’re still warm.

    2. water vapor

      If it’s a nicotine “vapor” delivery system then it’s propylene glycol smoke and/or glycerin smoke.

      If it’s dry plant matter like cannabis (or tobacco) then it’s the “vapor” of the organic substances contained in the plant matter.

      If it’s an oil or wax, then it’s a “vapor” of the oil or wax.

      No vaporizer juice that I’ve ever seen produces just water vapor in addition to the active ingredient.

    3. The government has enough trouble with a smoking population that they claim is only one adult in five. Even the government isn’t (quite) stupid enough to try to ban something drunk by two out of three adults.

  7. The biggest problem is, as it has always been, lifestyle public health itself. You have to go back well before e-cigs (first gen, the ones that looked like cigs) and vaping (present tech, whatever generation it is now) arrived on the market. The amount of deceitful propaganda that has come from anti-smoking activists and public health organizations (most of which are wedded to pharma’s nicotine products) is staggering, so it is little surprise that it is business-as-usual when it comes to how those people view e-cigarettes.

    The second biggest problem is the vaping community allying with lifestyle public health when the community should have denounced every last one of those zealots. I always say this, but I have zero sympathy for the current plight of vapers because they were all warned that this would happen and they failed and still fail to heed that advice. Public health shamed them for being smokers, and now public health shames them for being vapers. It’s insane.

    1. I always say this, but I have zero sympathy for the current plight of vapers because they were all warned that this would happen and they failed and still fail to heed that advice.

      Haha, yeah, like anyone would listen to a bunch of addicts when they say that their particular addiction is relatively harmless compared to other perfectly legal, yet still personally harmful, activities.

      At least they won’t stop people from drinking alcohol which, of course, will kill you dead and possibly a minivan full of children too! After all, it’s popular!

    2. The second biggest problem is the vaping community allying with lifestyle public health when the community should have denounced every last one of those zealots. I always say this, but I have zero sympathy for the current plight of vapers because they were all warned that this would happen and they failed and still fail to heed that advice.

      Look, we just wanted to stick it to Big Tobacco. We didn’t know the firing squads would be turned on us.

      1. Yeah, because it was always pretty unreasonable to market their product as a harm reduction to their clients when it’s a harm reduction to their clients.

        *rolls his eyes*

      2. Look, we just wanted to stick it to Big Tobacco. We didn’t know the firing squads would be turned on us.

        I can’t tell if that’s a serious comment, but if it is, why did you want to stick it to Big Tobacco?

        1. Have you seem the ass on Big Tobacco?

    3. They bought their tickets. They knew what would happen. I say let ’em crash.

  8. No vaping products I’ve seen include Polonium, an isotope not very different from Strontium 90, but one that accumulates in tobacco. But the inclusion of anti-vaping verbiage in home lease agreements is a little too reminiscent of the “neighborhood restrictive covenants” which ordered homeowners to sell or rent homes to white people only. These fears are doubtless stoked by the likes of the Vatican and other purveyors of shoot-first prohibitionism. Far better to have the cops “accidentally” waste a few kids as examples than to see someone puffing on a rival religion’s entheogen–such as ayahoasca.

    1. Hey, Hank, care to estimate how many people died specifically from the minute and perfectly safe amount of polonium that ‘accumulates’ in tobacco?

      I think that last I saw that number is sitting at zero.

    2. What covenant or policy is trying to stop vaping in leases? I don’t recall seeing that anywhere. Even if it were, just how do anyone plan to enforce restriction of small amounts of water vapor exhaled to the atmosphere?

      The only thing that could get you is your crazy spouse/lover. The correct response to any other accusations is prove it.

    3. You’re getting worse, Hank. Please see your mental health provider.

  9. Of course, as a libertarian, even if teen smoking was going up, not the government’s job to regulate it. WTF Reason.

  10. What about the concern that vaping is having the opposite effect, leading to smoking by teenagers who otherwise never would have used tobacco?

    Smoking among teens may be declining rapidly, but imagine how much more rapidly it would be declining if vaping weren’t causing so many kids to take up smoking.

    That’s Government 101 – when a program is sold as a way to accomplish a certain goal and the outcome is the exact opposite of the goal, declare the program a success on the grounds that without the program we’d be even further from the goal. Obamacare succeeded in lowering healthcare costs in just this manner.

    And when heavily restricting vaping leads to the natural and entirely-foreseeable consequence of driving teens to get their nicotine fix from the more-readily available cigarettes, you can point to the sharp rise in teen smoking as proof of the evils of vaping and demand further restrictions. Sure, there’ll be that handful of nuts insisting the rise in teen smoking isn’t due to vaping but rather due to the banning of the vaping, but nobody will listen to those nuts since they’re the same people who crazily insisted restricting vaping would lead to an increase in teen smoking.

  11. I think this is the first time I’ve seen a linear regression in a Reason article.
    Well done!

  12. Oh the kids and what they’re into these days, I don’t get it!

  13. Everybody knows all of this. Even the FDA knows. It doesn’t matter. Facts be damned; this is the Age of Feelz.

  14. Roger Stone argued before the 2016 election that standing up against restrictions on vaping would be a vote-getter, and he was proved right in several races. This could be a Stupid Party vote-getter. Why not dismiss Gottlied, if he’s not a career civil servant?

    1. “This could be a Stupid Party vote-getter.”

      Some people seem to think we have a Stupid Party and an Evil Party. They are wrong. We have a Stupid Evil Party and an Evil Stupid Party.

  15. Sounds like a boring movie. Hart was a dumbass. He thought he could stare down the press…or that the press would give a Democrat candidate a free pass. He was wrong, but we’ve learned that there’s no shortage of people like him running for and serving in positions of public trust.
    TUNEL Apoptosis Assay (Chromogenic)

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