On September 9, the Centers for Disease Control and Prevention (CDC) published their latest findings on vaping prevalence among youth. The total number of US youth who vape has declined by almost 2 million, with an estimated 3.6 million middle or high school students now vaping.
The CDC found that 19.6 percent of high school students and 4.7 percent of middle school students reported “current” e-cigarette use. But the large majority of use is not daily: Only 38.9 percent of high school vapers and 20 percent of middle school vapers reported vaping on at least 20 out of the previous 30 days.
According to CDC Director Robert Redfield, the decline in the number of youth who use e-cigarettes is an “achievement.” However, he quickly pivoted to a negative tone.
“Although the decline in e-cigarette use among our Nation’s youth is a notable public health achievement, our work is far from over,” said Redfield in a press statement. “Youth e-cigarette use remains an epidemic, and CDC is committed to supporting efforts to protect youth from this preventable health risk.”
David Sweanor, professor of law and chair of the Advisory Board of the Centre for Health Law, Policy and Ethics at the University of Ottawa, Canada, believes the CDC has misbehaved. “The CDC has become politicized in recent years, due to pressure from the administration but also by choice of CDC officials who have prioritized personal moralistic views in place of objectivity,” he told Filter.
Despite Redfield’s and the CDC’s official position on the recent data, a harm reduction perspective would note that frequent use and nicotine dependence remain rare among youth who have never smoked. And a focus on vaping in isolation ignores its potential relationship with a much more harmful form of nicotine consumption.
“Smoking—by far the more dangerous behavior—has been dropping rapidly during the era of vaping’s popularity among kids,” Kenneth Warner, professor emeritus and dean emeritus at the University of Michigan’s School of Public Health, told Filter.
With David Mendez, Warner published a study in the journal Nicotine & Tobacco Research last year that compared the potential public health benefits of vaping with potential costs—and examined the claim that vaping among youth who have never smoked is a “gateway” to cigarettes. They concluded that “potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation.”
“Public messaging and policy should continue to strive to reduce young people’s exposure to all nicotine and tobacco products,” Mendez and Warner wrote. “But, they should not do so at the expense of limiting such products’ potential to help adult smokers to quit.”
“There is good evidence that the rise of youth vaping is associated with an accelerated decline in smoking. We don’t know that the reverse would be true, though it is certainly a risk that smoking may rise if vaping falls.”
Clive Bates, a consultant and former director of Action on Smoking and Health (UK), said the CDC had omitted a crucial area from its datasets.
“The key missing data is what happened to youth smoking,” he told Filter. “That data has been held back, so we don’t know if the decline in vaping was accompanied by a rise in smoking. Given smoking is likely to be at least 20 times as harmful as vaping, small rises in smoking can easily offset the large decline in vaping.”
To Bates, the youth vaping figures might represent bad news, but not for the reasons the CDC presented.
“There is good evidence that the rise of youth vaping is associated with an accelerated decline in smoking,” he said. “We don’t know that the reverse would be true, though it is certainly a risk that smoking may rise if vaping falls.”
In August, the CDC did also release the results of its most recent iteration of the Youth Risk Behavior Surveillance System survey, which serves as a significant source of information about the most common risky behaviors among youth.
It found that nearly one-third of surveyed high school students vaped. Meanwhile, only 6 percent smoked cigarettes, while a similar number smoked cigars. Given that vaping is about 95 percent safer than smoking, according to an oft-cited evidence review from Public Health England, the recent comparative prevalence of the former among young nicotine consumers is significant. It remains to be seen whether the US public health establishment’s concerted efforts to drive down youth vaping rates will have a nasty unintended consequence.
The author has previously been supported by a scholarship from Knowledge-Action-Change. The Influence Foundation, which operates Filter, has also received scholarships from KAC to support tobacco harm reduction reporting.