Vaping’s effect on young smokers debated
WASHINGTON — In almost any other year, it would be hailed as a public health victory: The smoking rate among U.S. high schoolers took its biggest hit ever this year, federal figures show, falling to a new low.
Instead, the milestone was relegated to a lone figure at the bottom of a government news release and went unremarked by anti-tobacco groups that have spent decades working to stamp out youth smoking.
It’s a new era in the tobacco wars — one in which the alarming rise of underage vaping has almost completely overshadowed a parallel drop in traditional smoking. And the pivotal question of whether electronic cigarettes are inadvertently helping to wipe out smoking among young people has become a polarizing topic: embraced by some experts, dismissed by others.
“Smoking is disappearing among young people, and it’s a great public health triumph that we are failing to celebrate, much less even note,” says Kenneth Warner, professor emeritus at the University of Michigan’s school of public health.
E-cigarettes typically heat a solution that contains nicotine, the drug that makes tobacco addictive. They are generally considered less harmful than cancercausing traditional cigarettes. But there is little long-term research on the health effects of vaping.
With 1 in 4 teenagers now using e-cigarettes, underage vaping is universally condemned, and the federal government considers it an epidemic.
But Warner and some other researchers believe that recent trends continue to show vaping’s promise as a tool to steer millions of adults away from cigarette smoking, the nation’s leading cause of death.
That potential makes the case for keeping e-cigarettes readily accessible for adults — even if a certain level of teen use persists.
But that approach is a nonstarter for many tobacco opponents.
“When adults make policy gains on the backs of children, that’s bad, and that’s what the argument boils down to here,” said Dave Dobbins, an attorney with the anti-tobacco nonprofit Truth Initiative.
Even if e-cigarettes were responsible for the smoking decline among teenagers, which Dobbins says is unlikely, allowing young people to get hooked on vaping nicotine is not a solution.
“I don’t buy the argument that these things showed up and magically changed the world,” Dobbins
said. Instead, he thinks the vaping industry has increasingly pursued young people as smoking has fallen out of fashion.
But no one disputes the decline.
The percentage of high schoolers who reported smoking fell to 5.8 percent in 2019 from the prior year, a 28 percent drop and the largest since the U.S. government began surveying teens, according to preliminary numbers released in September. The trend isn’t limited to one year or one survey.
A similar study conducted by the University of Michigan shows that smoking among 12th graders has plummeted 50 percent since 2015, the largest drop of its kind in the survey’s 40-year history.
The smoking rate for adults is roughly 14 percent and has been falling slowly for decades.
The decline among teens has been seized upon by vaping proponents, who argue that it undercuts the gravest argument against the nicotine-emitting devices: that they act as a “gateway” to traditional smoking.
That’s the conclusion of a number of short-term studies that followed young people and surveyed their use of tobacco and nicotine. The prestigious National Academies found “substantial evidence” for the gateway effect in a 2018 consensus paper. And the Food and Drug Administration even uses the concept as the tagline in its anti-vaping video ads: “Teens who vape are more likely to start smoking cigarettes.”
For now, experts on both sides acknowledge that there is no definitive evidence linking e-cigarettes to the decline in youth smoking. The question is clouded by too many long-term trends and complicating variables. Teen smoking has been decreasing since the late 1990s and is influenced by government policies, public opinion, changing products and tobacco industry marketing.
But for researchers who believe that vaping is benefiting public health, the falling numbers make one thing clear: E-cigarettes are not driving large numbers of young people to smoke. The numbers suggest the exact opposite.
“The key point here is that it seems we have seen a drastic reduction in smoking,” said Dr. David Levy, a tobacco researcher at Georgetown University. “That’s clearly a good thing, and it’s not something that we want to mess with.”
Brian King of the Centers for Disease Control and Prevention emphasized that survey data cannot prove a cause and effect between vaping and smoking rates. Therefore, it’s impossible to know which teens avoided or quit smoking because of vaping, versus those who would never have picked up cigarettes anyway.
Additionally, the data suggest that many of the estimated 5.3 million underage students who vape were never at risk to become smokers.
“So that reflects an on-ramp to nicotine use that we otherwise would not have had without ecigarettes,” said King, a deputy director in the CDC’s Office of Smoking and Health.
With local, state and other authorities cracking down on e-cigarettes — particularly kid-friendly flavors — public sentiment has increasingly been turning against vaping. Last week, the influential American Medical Association called for a “total ban” on all ecigarettes and vaping products.