The Centers for Disease Control and Prevention (CDC) doubled down on what’s still being touted as a youth vaping “epidemic” when releasing new data on October 6. Its annual National Youth Tobacco Survey found that youth vaping rates have modestly increased since 2021, but are still substantially down from a few years ago.
In 2022, according to the agency, 14.1 percent of high school students and 3.3 percent of middle school students reported “current e-cigarette use”—which can mean vaping just once in the past 30 days. Disposables remain the number one choice among youth, with 57.2 percent of those “current” e-cigarette users reporting that they used those products most often.
In 2021, CDC data showed “current” use of e-cigarettes at 11.3 percent and 2.8 percent for high schoolers and middle schoolers, respectively. Those figures were a marked decrease from 2020—when they were 19.6 percent and 4.7 percent. But the agency discouraged comparisons to past years, because many students completed the surveys at home as opposed to in school as they had previously.
Although this year’s numbers partially reverse that fall, they remain significantly below past peaks. In 2018, for example, the CDC said that 20.8 percent of high schoolers were “current” users.
Even then, tobacco harm reduction proponents objected to the widespread depiction of a youth vaping “epidemic,” when “current use” can often mean just occasional social vaping and daily use rates have always been much lower. They have pointed out that rates of teenage smoking, the obvious public health concern, have fallen to record lows in recent years. That is something the CDC and the Food and Drug Administration (FDA) rarely, if ever, acknowledge.
“This study shows that our nation’s youth continue to be enticed and hooked by an expanding variety of e-cigarette brands delivering flavored nicotine.”
While the agencies did not issue such dire warnings over the new data as they have in the past, they framed the numbers, once again, as problematic.
“This study shows that our nation’s youth continue to be enticed and hooked by an expanding variety of e-cigarette brands delivering flavored nicotine,” said Dr. Deirdre Lawrence Kittner, the director of the CDC’s Office on Smoking and Health, in a press statement. “Our work is far from over. It’s critical that we work together to prevent youth from starting to use any tobacco product—including e-cigarettes—and help all youth who do use them, to quit.”
“Adolescent e-cigarette use in the United States remains at concerning levels, and poses a serious public health risk to our nation’s youth,” Dr. Brian King, the director of the FDA’s Center for Tobacco Products, said in a press statement. “Together with the CDC, protecting our nation’s youth from the dangers of tobacco products—including e-cigarettes—remains among the FDA’s highest priorities, and we are committed to combating this issue with the breadth of our regulatory authorities.”
Ignoring the statistics that the CDC has deemed incomparable, the data are actually relatively flat when you compare the rates of students who took the survey in school: 15 percent of those high schoolers reported current e-cigarette use in 2021, and 14.1 percent in 2022.
Nonetheless, the 2021 data deserve some caveats. A May 2022 article in the International Journal of Environmental Research and Public Health found that those who took the survey in school had higher odds of reporting current e-cigarette use than those who completed the survey at home, and students who “had nearly entirely in-person learning had the highest odds of e-cigarette use compared to students whose learning model was nearly all at-home.” As Dr. Cris Delnevo, the director for the Center for Tobacco Studies at Rutgers University and lead author on the paper, told Filter, those findings suggest that “setting and magnitude of peer interaction were associated with e-cigarette use.”
“The CDC is correct in cautioning that comparisons should not be drawn between 2021 and 2022,” Delnevo said. “Attempts to do so ignore important methodological artifacts in the administration of the 2021 data. An earlier data point—pre-pandemic—would be better if someone wants to draw conclusions about trends.”
These versions of the numbers seem rather less dramatic than the ones the CDC is emphasizing.
The new data show that among “current” vapers, “frequent e-cigarette use”—defined as vaping on 20 or more days out of the past 30—stood at 42.3 percent, “including 46 percent of high school students and 20.8 percent of middle school students.” Meanwhile, 27.6 percent of all “current” e-cigarette users vaped daily (on all of the past 30 days)—“including 30.1 percent of high school students and 11.7 percent of middle school students.” (The CDC notes that “these estimates are not mutually exclusive.”)
That breaks down to 6.49 percent of all high schoolers surveyed using “frequently,” and just 0.69 percent of all middle schoolers doing so. For daily use, it works out at 4.24 of all high schoolers and 0.39 percent of all middle schoolers. These versions of the numbers seem rather less dramatic than the ones the CDC is emphasizing.
“The bad news is that too many kids are still using e-cigarettes,” Dr. Jasjit Ahluwalia, a professor at Brown University, told Filter. “But the good news is that high school students using e-cigarettes regularly—20 to 30 days a month—the absolute number in 2022 is 980,000, a dramatic decline from 2019.”
Other experts are more relaxed about the fluctuations. “We should be aware that increased use of a recreational product should be expected if the main deterrent to using it (harm) is largely eliminated, all other things being equal,” Clive Bates, the former director of Action on Smoking and Health (UK), told Filter. “We need to see nicotine as part of a pattern of recreational drug use (with some functional and hedonistic benefits to users) or largely frivolous experimentation. We should recall that prohibitions don’t really work other than to create an ugly mess, parallel markets, and perverse (but foreseeable) consequences.”
“Nicotine is and will remain a popular recreational drug, young people will use it, and demand is likely to rise if it is available in a safer and less intrusive form. To me, that changes nothing.”
The CDC and the FDA have, of course, come under fire from tobacco harm reductionists and the vape industry, who have repeatedly criticized their policies as overemphasizing youth vaping rates over the power e-cigarettes have to help adults who smoke quit vastly more harmful cigarettes. Public health authorities in the UK responded very differently to a recent uptick in youth vaping there.
“The repeated failure by CDC to include smoking data along with vaping data is a very serious problem,” Cliff Douglas, the director of the University of Michigan Tobacco Research Network and the American Cancer Society’s former vice president for tobacco control, told Filter. “E-cigarette use by youth, as well as adults, should never be considered in a vacuum, which misleads people about the full picture and the actual risks and benefits involved.”
“I think it is more reliable from a public health perspective to expect that nicotine is and will remain a popular recreational drug, that young people will use it, and that demand for it is likely to rise if it is available in a safer and less intrusive form that attracts less stigma to the user,” Bates said. “To me, that changes nothing. The key challenge is to move the market as rapidly as possible to low-risk (i.e. smoke-free) nicotine products through regulation, fiscal policy and truthful communications—and to do this in a way that does not criminalize the behavior or the commerce.”