Teen Tobacco Use - Is it real?

Almost everyone in America is now firmly convinced that nicotine vapes (“e-cigarettes”) have created a “whole new generation addicted to nicotine.” Click-bait media helpfully reminds the public almost daily. Is it true?

The answers can be found in two surveys: the US Centers for Disease Control and Prevention’s (CDC’s) National Youth Tobacco Survey (NYTS; 1999–2022), and the US National Institutes of Health’s (NIH’s) Monitoring the Future (MTF) survey (for years prior to 1999).

These surveys are super easy to access online (see references below). They are also published as narratives each year by CDC in its Morbidity and Mortality Weekly Report (MMWR). So let’s do a quick run-through of what the surveys actually show.

US high school nicotine “current use,” 1972–2022:

1972: 27.6% smoked
1982: 20.5% smoked
1992: 21.2% smoked
2002: 22.5% smoked
2012: 16.8% smoked or vaped
2022: 14.7% smoked or vaped*

What just happened?

For three decades, from 1972-2002, pretty much nothing happened. No progress. Then, during the first decade of the new century, teen nicotine use dropped 25%. And then it dropped further over the past decade.

So, obviously, US teen nicotine use is lower today than at any time in the past 50 years. Why, then, do public health “experts” continue to claim that nicotine vapes are creating a “whole new generation addicted to nicotine”?

I think the answer starts with the massive change in use over the past decade. In 2011, 15.8% of high school students were “current smokers” and 1.5% were “current users” of nicotine vapes. By 2022, those numbers had reversed. CDC’s NYTS in 2022 shows 2.0% smoked and 14.1% vaped. Taking dual use into account to avoid double-counting, the 2022 total is 14.7%.

To believe that there is a “whole new generation addicted,” you need to believe that high school smoking would have suddenly dropped 90% over the past decade (as it did), all on its own, if nicotine vapes did not exist. You need to hold in your mind, as a matter of faith, that product substitution did not just happen.

It helps if you believe that nicotine vapes are a “gateway to smoking.” Then — obviously — product substitution would be impossible. You may then say, “smoking dropped BUT nicotine vape use increased.” But the alternative, “smoking dropped BECAUSE vaping increased,” is no longer on the table.

“Teen smoking dropped, but teen vaping increased”

This phrasing seems to be part of a standard narrative. Imagine if a journalist wrote, “COVID-19 infections dropped, but the number of Americans immunized against COVID increased.” Or try this: “rates of sexually transmitted disease dropped, but condom use increased.”

Both statements would be correct. But at the same time, they are nonsensical. Now let’s consider another statement: “Sales of combustion engine cars dropped, but sales of electric cars increased.”

In this case everyone would know exactly what is really happening. This is because everyone knows that these two different automobile alternatives are obvious product substitutes. There would be no confusion.

What the heck does “current use” mean?

This is tricky. For reasons known only to itself, public health defines “current use” in two entirely different ways: one for adults and the other for teens.

The adult definition is consistent with common sense (it means you probably self-identify as a smoker or vaper, and you buy products). In contrast, teen “current use” casts a wider net.

Teen “current use” is “past 30-day ever-use” (≥ once/month). So, imagine you’re a teen, and you took one puff off a friend’s nicotine vape device at a party 30 days go. According to the CDC, you are a “current user.”

Most of the public assumes that teen “current use” measures the number of kids who are ‘hooked.’ But here is a breakdown of US middle and high school student nicotine vape use in 2022:

· 9.4% “current use” (this is mostly infrequent experimentation)

· 4.0% frequent use (≥20 days/month; this implies you may buy products)

· 2.6% daily use (this implies you may be ‘hooked’)

Out of 27 million US middle and high school students, less than 1 in 10 vape nicotine. 1 in 25 vape nicotine frequently. 1 in 38 vape daily.

At the risk of “what about-ism,” let’s compare that to teen alcohol use. According to the CDC, 14% of all binge drinkers in America are teens. And US teen binge drinking causes 3,900 deaths and 119,000 emergency room visits every year. US teen frequent nicotine vaping is 4%, causing no deaths.

What about adult use?

The short answer is that US adult use of nicotine vapes dwarfs teen use. In fact, adult use of any consumer tobacco or nicotine product utterly dwarfs teen use of any tobacco or nicotine product. Who knew?

Adult use is measured in the CDC’s National Health Interview Survey (NHIS). The 2022 adult numbers can be found here (the data are provided as percentages, so you need to know there are 258 million adults).

There are now 17 million US adult nicotine vapers and 2.5 million US teen nicotine vapers. But, as noted above, this comparison is apples and oranges because the teen definition of “current use” is far more expansive than the adult definition of current use.

Let’s explore adult use further in two different ways: (1) how did adult use change over the past decade? And (2) what is the total breakdown for all US use of consumer nicotine products in 2022?

Changes: In 2011, about 2 million US adults used nicotine vapes, and 44 million smoked cigarettes. By 2022, the number of adults vaping nicotine had increased to 17 million, while the number of adults still smoking had dropped to 28 million.

These are dramatic changes. Strangely, almost no US media reports mention that the number of US adult nicotine vapers increased by 15 million, and number of US adult smokers dropped by 16 million, over the past decade.

This is problematic because 100% of all tobacco-related deaths are among adults; 99% of those deaths are among adults over the age of 50; and 79% are among adults over the age of 70. Unlike alcohol, even deadly combustible cigarettes (much less ecigs) don’t cause teen deaths.

Total use: Finally, let’s do a quick break down of total US consumer tobacco/nicotine use, drawing on both the CDC National Health Interview Survey (adults) and CDC National Youth Tobacco Survey (teens) in 2022. In total, 49 million Americans use such products.

Of that total, 46 million are adult current users and 3 million teens are “current users.” But as you now know, that’s apples and oranges.

What if we compare adult current use to teen frequent use? It’s yet another way to parse this: “who actually buys these products?”

That would be, very plausibly, adult current users + teen frequent users. In that case, the total number of Americans who actually purchase consumer nicotine products is 47.3 million, of which 46 million are adults and 1.3 million are teens.

The surprising conclusion we can draw here is that the consumer nicotine industry does a much better job keeping its adult products out of the mouths of teens than the consumer alcohol industry.

GRAPHS and REFERENCES

Please visit https://medium.com/@tchad49/is-us-teen-nicotine-use-increasing-cfb9b5e5b21e for more information!!