CDC Report on Youth Tobacco Use is Misleading

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The CDC has just released a report on tobacco use by youngsters in middle and high school, and the results are disturbing — not just because of the number of kids reporting tobacco use, but because of the way the agency has defined it.

The data were reported in the CDC's Morbidity and Mortality Weekly Report (MMWR). Since tobacco use is still the leading cause of preventable disease and death in the U.S., it is important to understand its incidence and prevalence. Most smokers begin the habit during youth and early adulthood, so tracking the occurrence in teens is one way to better understand how to target prevention strategies.

Led by Dr. Tushar Singh of the CDC, the researchers analyzed data from the 2011-2015 National Youth Tobacco Surveys. These data come from questionnaires administered to middle and high school students yearly that asked about use of tobacco products in the 30 days prior to the questionnaires administration. The results indicated that during that four-year period there was no increase in use of conventional tobacco products such as cigarettes, and cigar use decreased. What did increase during that period was the use of hookahs and e-cigarettes. In particular, they report, during 2015, e-cigarettes were the most commonly used "tobacco" products among both middle and high school students.

Curiously, rather that celebrating the fact that fewer teens reported smoking cigars and cigarettes (and hookah use declined), the researchers focused on the supposed dangers of e-cigarettes, in particular the possibility of nicotine addiction. Yet, there was no information gathered on the reason behind the uptick in e-cig use. Might it be possible that some of the students questioned had actually switched from using regular cigarettes? And wouldn't that have been an example of harm reduction?

Finally, we must quibble with the definition of e-cigarettes as "tobacco products." All the other products addressed by these questionnaires — cigarettes, cigars, pipes, hookahs used with tobacco, bidis, and smokeless tobacco — actually contain tobacco. And, of course, they contain the carcinogenic chemicals that make inhaling tobacco smoke so dangerous. But e-cigarettes contain no tobacco — none. Certainly the nicotine they do contain is derived from tobacco, but defining them as tobacco products applies a different standard to e-cigs compared to the others.

The focus on nicotine addition secondary to e-cig use is likely a red herring, since as we have noted in the past, users are less likely to become addicted to nicotine from e-cigs than from, for example, nicotine gum. Of course we'd rather have young people not be addicted to anything, but using that scary term is, in this case misleading.

For more information about the effects of nicotine on human health, see the ACSH publication which is available here. The fact that e-cig use increased as tobacco use decreased is certainly not something to be mourned.