E-cigarettes

The FDA Plans To Ban Flavored E-Cigarettes Based on a Nonexistent 'Epidemic' of Adolescent Nicotine Addiction

A new study indicates that heavy vaping remains rare among teenagers who don't smoke.

|

The main justification for state and federal bans on flavored e-cigarettes is the "epidemic" of underage vaping, which former Food and Drug Administration Commissioner Scott Gottlieb worried might result in "a whole generation of young people becoming addicted to nicotine." A new analysis of survey data on e-cigarette use by teenagers suggests such fears are overblown, since heavy vaping is rare among adolescents who are not current or former smokers.

The study, reported yesterday in the online journal Qeios, is based on 2017 and 2018 data from the National Youth Tobacco Survey (NYTS). Although it does not include results for this year, when e-cigarette use by teenagers rose again, the analysis demonstrates the fallacy of casually equating vaping with nicotine addiction.

Between 2017 and 2018, the prevalence of past-month e-cigarette use among high school students rose by 78 percent, from 11.7 percent to 20.8 percent. Last fall that surge prompted Gottlieb to propose new restrictions on the flavored e-cigarettes that are popular among teenagers, which are also overwhelmingly preferred by former smokers. Last month the FDA cited the continuation of the upward trend in underage vaping as the justification for the outright ban it plans to impose on e-cigarette flavors other than tobacco.

In the new study, University College London health psychologist Martin Jarvis and his co-authors argue that a closer look at the survey data suggests the FDA exaggerated the threat posed by adolescent e-cigarette use. While use on 20 or more days in the previous month rose between 2017 and 2018, it remained rare among students who had never used tobacco products ("never tobacco users").

"Frequent use occurred in 0.1% of never tobacco users in 2017 and 1.0% in 2018,"  Jarvis et al. report. "Among past-30-day e-cigarette users who had never tried tobacco products in 2018, 3.8% reported craving, 3.1% reported wanting to use within 30 minutes of waking, and 61.8% said they had used e-cigarettes on ≤10 days in their life."

In other words, it does not look like adolescent vaping is leading to the "epidemic of addiction" that Gottlieb predicted. "Data from the NYTS do not support claims of a new epidemic of nicotine addiction stemming from use of e-cigarettes, nor concerns that declines in youth tobacco addiction stand to be reversed after years of progress," Jarvis et al. write. "Among current e-cigarette users who had never tried tobacco products, responses consistently pointed to minimal dependence."

The story is quite different for tobacco users. "By comparison with never tobacco users, the odds of current e-cigarette use rose steeply and in a graded fashion with extent of tobacco experience," the researchers say. "Heavier use was strongly associated with lifetime tobacco use history….The observed frequency of 20+ days use [in the previous month] increased with the extent of lifetime tobacco use, and reached 26.8% in 2017 and 37.2% in 2018 among students who had smoked more than 100 cigarettes."

Tobacco users also were much more likely to report signs of addiction. Among "e-cigarette users with a lifetime history of smoking more than 100 cigarettes," 75 percent reported craving, while 51 percent said they wanted to vape within half an hour of waking up in the morning.

What about Gottlieb's concern that vaping might lead to smoking by teenagers who otherwise never would have used tobacco products? "It is notoriously problematic to draw inferences about direction of causality from cross-sectional data," Jarvis et al. note. "In principle, the strong and graded association observed between likelihood of using e-cigarettes in the past 30 days and lifetime history of use of tobacco products could point to an effect of using e-cigarettes on subsequent uptake and use of cigarettes and other combustible products. This appears to be the view adopted by the FDA."

But Jarvis and his co-authors argue that the evidence does not support the FDA's view:

While it may well be the case that in some individual instances initial trying of an e-cigarette led on to trying and using cigarettes, the data strongly suggest that this is not the dominant pattern observed at the level of the whole population. Among high school students we found that, for the great majority of those with any substantial cigarette smoking history, cigarettes were the first tobacco product tried, prior to any use of e-cigarettes. Clearly, for these students their use of cigarettes and the development of characteristic nicotine dependence must be attributed to cigarettes as the uptake product, rather than to e-cigarettes. Similarly, the observed rapid decline in trying combustible products and in the prevalence of cigarette smoking since 1999 has not yet given any sign of being reversed through the upsurge of e-cigarette use since 2011. At the population level, therefore, the NYTS fails to give evidence of e-cigarettes acting as a gateway to smoking in adolescents.

In fact, pre-2018 data from the NYTS and other surveys indicate that the downward trend in smoking accelerated among teenagers and young adults as e-cigarettes became more popular. Those trends suggests that people who would otherwise be smoking are instead vaping, a much less hazardous source of nicotine.

"Cigarette use generally declined between 2002 and 2018 across all age groups," the Substance Abuse and Mental Health Services Administration noted last August in a report on the 2018 National Survey on Drug Use and Health. "Some of this decline may reflect the use of electronic vaporizing devices ('vaping'), such as e-cigarettes, as a substitute for delivering nicotine."

Jarvis et al. think the weight of the evidence indicates that vaping is, on the whole, replacing smoking rather than promoting it. "In these circumstances," they say, "there is plausibility to the suggestion that e-cigarettes are likely to reduce the disease burden in the US by helping adult smokers to quit."

Advertisement

NEXT: Let Us Now Thank Donald Trump for Revealing Brutal Truths About How Power and Privilege Operate

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. The cover-up rationalization may be as you said, but the open-secret justification is to expand government power. Nothing has changed except that technology and innovation supplies ever more ways to exercise government power.

  2. They can’t be our saviors without having something to save us from.

  3. I’m more concerned about the plan to sue every drug company in the country into bankruptcy over the Chinese-manufactured fentanyl “opioid crisis”. It’s just a manufactured narrative to disguise a pure strong-arm robbery.

  4. Such bullshit. The narrative is that “flavored” vaping juice is promoted to snag teens into addiction. No doubt sponsored by big tobacco.

    Of course only children and teens like cherries, apples, vanilla… Adults can only enjoy plain oatmeal. -sarc

    Governor Walz in MN is seeking permission from the MN house of Representatives to ban flavored vaping juice. I had to call King Walz’s office today and ask “how is it that King Walz can mandate that the not so great state of MN to adopt California emission standards, but must ask permission to regulate vaping?” King Walz’s toadie was not impressed. Well, she can stick it! They work for me.

    1. The kicker (which only reason.com seems to be talking about) is that these respiratory illnesses weren’t even caused by e-cigarettes, they were caused by THC vape cartridges which were purchased illegally on the black market. There are no standards with illegal cartridges and a lot of black marketeers use chemicals like butane to produce said cartridges.

      I wonder who is pressuring the FDA to ban flavored e-cigarettes… who would have the most to gain? *coughs* tobacco companies.

      Anyway you look at this, this is downright absurd and this is a complete overreach of government.

      1. “I wonder who is pressuring the FDA to ban flavored e-cigarettes… who would have the most to gain? *coughs* tobacco companies.”

        Those black-market purveyors of potentially toxic cartridges might have something to gain too lol

      2. Government has a lot to gain as well given that it seems vape rigs have ‘cost’ the government billions of dollars by some analysis. Can’t say if those reports were 100% accurate, but it seems possible at the very least.

  5. Gotta protect that tobacco tax revenue somehow. And if more kids decide to vape instead of smoking, Social Security is gonna go broke even sooner.

  6. Non-standard comment:
    If they do this fellow vapers…. the best of the tobacco flavored juice is an old flavor named RY4. It’s outstanding. It’s a flavor that’s a virginia flu cured with black sesame and caramel overtones.

    1. You ever tried Black Note’s Naturally Extracted Tobacco liquid? The only thing that comes close to real tobacco flavor, and what I used to quit smoking for the fourth time around.

  7. “The FDA Plans To Ban Flavored E-Cigarettes Based on a Nonexistent ‘Epidemic’ of Adolescent Nicotine Addiction.”

    If I said it once, I said it a million times.
    Flavored E-cigarettes should be banned until they have butter pecan, rocky road and deli style mustard flavors in their cigarettes they’re selling.
    Until then, they can just go out of business.

  8. As others have pointed out, it’s about tax revenue that ‘belongs’ in government hands and job security.

    On a related note, I was talking to another doctor the other day about vaping – he said ‘Chantix is the only “cure”‘ and admonished my emphasis on harm reduction because ‘vaping is killing thousands, all over the US!’ I asked where he got that number, and he said ‘the government.’

    I explained the recent spate of what, a couple dozen respiratory illnesses, were due to grey market liquids containing pesticides that essentially pyrolyze into hydrogen cyanide. His answer? ‘Well, there’s no peer-reviewed paper yet so you can’t know that. Just assume it’s all deadly!’

    Then again, this guy has literally told me ‘Libertarian ideas of self-governance and personal responsibility are insane and “kooky”‘ and he ‘supports forcing compliance at gunpoint and making others do what HE knows is best for them because he has a medical degree.’

    1. Chantix is not a cure.

      After 52 weeks of follow-up, subjects receiving varenicline had significantly higher smoking abstinence rates compared with those receiving placebo (44% versus 37% continuous abstinence over weeks 13–52, OR 1.34, 95% CI: 1.06–1.69).

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2962400/#!po=56.2500

      A 7% increase over placebo may be statistically significant but hardly a panacea and there are significant side affects in many people.

      Even the CDC has not recommended that current cigarette smokers should not switch to vapes. They do recommend that regardless of the investigation people should not use “street” products and “Adults who do not currently use tobacco products should not start using e-cigarette, or vaping, products.”

      There are multiple studies done on e-cigs reported in medical journals prior to this disease. Your friend has just not bothered to look them up.

      Just on common observation. These things have been around for some time now and we are just seeing this lung disease the vast majority in street products containing THC. The CDC and other reports are focused in on contaminants or additives used.

      1. ” These things have been around for some time now and we are just seeing this lung disease the vast majority in street products containing THC.”

        I haven’t seen articles mentioning that America’s extensive lung problems haven’t been reported abroad. (There are probably some cases out there, but likely due to individual quirks, like allergies or specific vulnerabilities.) This suggests that these lung problems aren’t due to “vaping” per se.

    2. I have never told any doctor I vape. The questionnaire only asks if I smoke, so the answer is no. I also use snus, but don’t even bother to mention that either, because frankly, it’s none of their business and not relevant to why I am seeking treatment. My health is pretty good for an almost 50 year old IMO…

  9. So you just sell a bottle of flavoring.

  10. Interesting that the authors of this study that refutes the hysteria over teen vaping have received funding from Pfizer, maker of Chantix.

  11. All this talk is about “flavored e-cigarettes”.
    What about just the liquid alone?

    1. That’s the thing, the liquid is glycerin and propylene glycol, which are GRAS for oral consumption, but there is very little literature on what deep lung inhalation of these substances might do, because these substances have such low vapor pressure and high boiling points, nobody could conceive of anyone having a deep lung exposure to their vapors until vaping came out. Vaping being approved by the FDA in the first place shows how broken the system is.

  12. A complete history of this movement would be interesting.

    As far as what I was exposed to, the anti-vaping movement started almost immediately as vaping became a viable alternative to smoking. And it started in California.

    They initially started by banning vaping in all locations that cigarette smoking had been banned. The stated reasoning for banning cigarette smoking in public was the danger of second hand smoke. Since no such danger exists with vaping, extending such bans to vaping was irrational.

    The response to the argument that the vaping ban was irrational was that vaping in public looks like smoking… and they had spent a lot of time making smoking socially unacceptable. They didn’t want to degrade this progress by allowing someone to puff on an electronic version of a cigarette. (at the time, many e-cigarette manufacturers were trying to make their devices look as much like cigarettes as possible too)

    Their arguments have expanded and morphed over the years, but at the core there has always been an anti-capitalist revulsion that people selling these products make money. This is also complicated by the fact that most of these anti-vaping activists were/are anti-smoking activists who get paid from the tobacco settlements. If tobacco goes away and is replaced by vaping, their jobs go away – because there are no more tobacco settlement payments.

    I haven’t seen anyone do a complete history and connect those dots, but it sure looks like that’s what is happening, from a 10,000 foot view.

    1. You don’t actually know that there is no danger to secondhand inhalation of vaping vapors. There hasn’t been much study of the chronic effects of lung exposure to propylene glycol and glycerin vapors, because these substances have such low vapor pressures and high boiling points until vaping came along nobody could ever conceive of a situation where someone could be chronically exposed to their vapors.

      1. There have been several studies on airway epithelial cells in culture and in mice or rats that show the PG liquid or glycerin by itself has little or no effect, but the addition of flavorings or nicotine make the vapor more toxic. Of course, the researchers who did these studies may have been trying to show a harmful effect (the control they use is filtered air, which is way cleaner that what the average non-smoker or non-vapes breathes in the first place), and the levels of nicotine or flavorings they use could be a lot higher than real world use. But, as with smoking, it may really depend too on how deeply one inhales, and this could also be why we are seeing the THC vapers getting sick, since you inhale that very deep in the lungs.

        1. “and this could also be why we are seeing the THC vapers getting sick, since you inhale that very deep in the lungs.”

          With the sudden onset of this event I don’t think that how deep you inhale matters. There is definitely something in the THC vapes. If there have been about 1K cases across 18 states then it is safe to assume someone shipped in liquid or ingredients. It could be something as simple as cheaply made juice created by the Mexican cartel and then sold around. If they can bring in 1 barrel on the back of a truck then that’s 1K sick right there.

      2. Tests have been done with smoke machines (propylene glycol) and worst-case-scenarios with rats. The only finding is that it may increase the likelihood of getting something like a virus. (Cold)

        1. We also know from epidemiologic studies that vaping is at a minimum 95% safer than cigarettes. That is from a study published in the Lancet. I’ll also refer you to the Royal Medical Society in England… they have published quite a bit on the topic. Last I read, they were saying that the 95% number was likely going to move to somewhere well north of 98% once they have more data.

          So there’s theory, and then there is reality.

          Second hand vape would be another couple of orders of magnitude safer than cigarette smoke, because of the absence of tar, etc. Vape dissipates much faster and residue is non-toxic.

          So no, all the fine detail is not in. But we know unequivocally that legal, name brand vape products are not going to be appreciably harmful to 3rd parties.

  13. This is EXACTLY what made lawmakers want to ban flavors in nicotine e liquids. Calling over four million kids “hysteria”. It’s equivalent to holocaust denial and makes the industry look predatory. Many including myself truly believe the vaping industry does in fact target kids. Also, I would like one pro-vaping idiot to explain why they felt it necessary to add benzoic acid. Benzoic acid, known as “nic salt” allows the manufacturers to crank nicotine levels ridiculously high from 3mg to 50mg. The SOLE reason is to make addiction as instantaneous and complete as possible. It speaks volumes about the actual nature of the nicotine vaping community. They must be stopped ASAP. Bring on the flavor ban!!!

Please to post comments