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Mountain Vapor Blog

Welcome to the blog area of our site where we hope to keep you updated on the trends of the e-cigarette industry as well as product reviews.

Truth Initiative Stumbles in JUUL Study

It’s surprising how many fundamentally flawed e-cigarette studies are aggressively promoted by their authors and allied organizations as grounds for FDA regulatory action.  It is also concerning when authors refuse to acknowledge or respond to honest scientific inquiries about their research.  Here is a representative case involving researchers associated with Truth Initiative, a non-profit anti-tobacco organization. Researchers led by Donna Vallone, Ph.D., recently published a study in Tobacco Control on the “prevalence and correlates of JUUL [e-cigarette] use among a national sample of youth and young adults (here).”  While they reported that the overall prevalence of ever and current (past 30-day) JUUL use was 6.0% and 3.3% respectively, they failed to disclose information about the most important correlate of JUUL use – other e-cigarette use. The authors noted that among underage children (15-17 years), current JUUL use was 6% and current use of combustible tobacco was 7%.  They connected these, finding that children who were currently smoking were five times more likely to use JUUL than non-smokers.  However, 11% of children in that age group currently used e-cigarettes.  They ignored this important correlate in their analyses.  Instead, they inexplicably included e-cig use among other members of the youths’ households. There are other significant problems with this study.  First, youths and young adults were asked: “…on how many days did you smoke a Juul vape?” (emphasis added)  That wording likely confused participants.  Second, the authors didn’t define current use of e-cigarettes, nor did they even give any description of the question in their survey.  Third, the survey flow for JUUL and e-cigarette questions was not provided.  Were separate questions about these products asked of all participants, or did researchers ask first about e-cigarettes, and then only ask current e-cig users if they used JUULs?  Fourth, Vallone et. al. defined JUUL “regular use” as 10-30 days in the past month, and they reported that 25% of youth fell into this category.  That percentage is grossly inflated.  The CDC and other authorities use a more credible “frequent” category of 20+ days (hereand here), which would generate a lower percentage of users at risk.     In summary, Vallone et. al. produced an error-ridden study focused on JUUL “smoking,” while ignoring the effect of other e-cigarette use.  The obvious problems ought to have been resolved in peer review.  Additional questions remain, owing to the fact that the authors used a private dataset.  When Truth Initiative posted the study on the Society for Nicotine and Tobacco Research listserv, I asked the authors to resolve some of these problems; they did not acknowledge my listserv post. Original author: Brad Rodu
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CDC Data Reveal Many Far More Dangerous Teen Behaviors Than Vaping

In the hierarchy of teenage risk behaviors, government data shows that vaping pales compared to drinking-, driving- and weapon-related activities. It is remarkable that public health officials and the media focus so greatly on the former, to the detriment of teen safety and health.A report from the CDC earlier this year (here), based on the 2017 Youth Risk Behavior Survey (YRBS), allows us to put the data in context.The prevalence of past-month e-cigarette use in the 2017 YRBS was 13%.  That rate is higher than those for cigarettes (8.8%), cigars (8.0%) and smokeless tobacco (5.5%).  However, as I discussed recently (here), the vaping rate pales next to those for marijuana (19.8%) and alcohol (29.8%).  In fact, the e-cigarette rate is nearly identical to the rate for binge drinking (4 or 5 drinks within a couple hours). These rates of drug use are troubling, but there is much worse in the federal report for parents and policymakers to be concerned about.  Following is a list of other risky behaviors by high school students in the past 30 days..nobr br { display: none } td { text-align: center} Prevalence (%) of Risky Behaviors Among American High School Students (YRBS, 2017)Past 30 DaysRarely/never wore a seatbelt (as an occupant)5.9%Rode with driver who had been drinking16.5%Drove after drinking5.5%Drove after marijuana use13.0%Texted or emailed while driving39.2%Carried a weapon (e.g. gun, knife, club)15.7%Past 90 DaysHad sexual intercourse28.7%..…and used condom, 53.8% of previousPast YearInvolved in physical fight23.6%Physically bullied on school property19.0%Electronically bullied14.9%Felt sad or hopeless31.5%Considered suicide17.2%Made suicide plan13.6%Attempted suicide7.4%Media coverage of the CDC YRBS report (here) was largely confined to the sensational -- “Fewer teens having sex and using drugs, CDC says.” The absence of focus on the more prevalent and dangerous behaviors in part reflects the FDA-led public health community fixation on vaping.  This may stem from the fact that, of the many greater-risk categories outlined by the CDC, the FDA’s regulatory authority only extends to tobacco. To a federal agency with a hammer, everything is a nail.Original author: Brad Rodu
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Rethinking nicotine: FDA asks six questions about the future of nicotine regulation

Will no-one rid me of this turbulent molecule? (after Henry II on Sir Thomas Beckett)

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The Answers to FDA’s Tobacco Questions Are Obvious, But Perhaps Unwanted

In his recent Nicotine & Tobacco Research commentary, “The Future of Nicotine Regulation,” FDA Center for Tobacco Products director Mitch Zeller listed five “challenging questions.”  I offer the following answers. 1. How comfortable are we with long-term, or possibly permanent, use of less harmful nicotine delivery mechanisms by adults, if they help keep currently addicted smokers from relapsing to combustible tobacco products? If addicted smokers stay smoke-free by using less harmful smoke-free alternatives, everyone who is not a tobacco prohibitionist is probably comfortable with long-term use.  The harm of permanent nicotine use is of the same magnitude as that of permanent caffeine consumption.  Most are comfortable with chronic consumption of caffeinated drinks, by adults and teens. While the FDA does now acknowledge tobacco harm reduction, the agency still does not adequately distinguish the harm differential between smoke and smoke-free products, nor does it promote smokers’ transition to vastly safer products that have been on the market during the nine years of FDA regulation.  2. How much weight should be placed on diminished interest in quitting nicotine altogether? None. 3. Given the potential health impacts of dual use of tobacco, how acceptable is a short period of dual use while transitioning to less harmful nicotine-containing products? What if many current smokers engage in dual use on a long-term or permanent basis? For smokers trying to quit, dual use of cigarettes and smoke-free products is a common practice which can occur over varying periods of time.  Currently, owing to nonstop campaigning by federal authorities and health organizations, most American smokers believe incorrectly that smokeless tobacco and e-cigarettes are as dangerous as cigarettes (hereand here).  Nine years ago I wrote in this blog: “In 2005, there were 1.4 million American men who were dual users of both cigarettes and ST [smokeless tobacco] products. These men consumed nicotine both from cigarettes and from ST, and the latter clearly resulted in lower consumption of the former. In both 2000 and 2005, every-day smokers who also used ST every day consumed significantly fewer cigarettes on average than exclusive smokers (13 cigarettes per day vs. 20 cigarettes). If these dual users knew that ST products were only 1% as hazardous as cigarettes, it is possible that many would have chosen to use only ST.” (here) 4. Can we revise labeling and indications for medicinal nicotine to increase quitting? Of course, but this question is unrelated to tobacco harm reduction.  Medicinal nicotine is regulated by the FDA Center for Drug Evaluation and Research, not the Center for Tobacco Products, and the former has been futzing and diddling around with medicinal nicotine for decades (here).  In 1995, the Pittsburgh Tribune-Review published my open letter to FDA commissioner David Kessler, urging him to make medicinal nicotine products more available to smokers (here). The FDA did nothing to make them more effective or more affordable. In February 2008, New York State Health Commissioner Richard Daines petitioned the FDA for revised package labeling and sales regulations for nicotine products – changes that would have greatly expanded product availability and consumer awareness. The petition was supported by numerous tobacco research and policy experts and organizations. The FDA failed to issue a response. 5. How might youth initiation be affected by the availability of different nicotine-containing products and how should we account for youth uptake of these products? Teenagers have always been attracted to adult-oriented products and adult behaviors.  Teens are drawn to tobacco and alcohol, which are illegal for those under 21; many teens use marijuana, which is illegal for all or age-restricted in the various states (here).  It is not uncommon for teens to drive cars and have sex, two adult behaviors that can be high-risk. Uniquely, tobacco use is regulated by a federal agency, the FDA, which now asserts that tobacco manufacturers are responsible for teen tobacco use.  Everyone has a role to play in limiting teenage risk-taking, but focusing blame on manufacturers while ignoring other regulatory and information-sharing solutions ill serves the entire population. October 24.  Clive Bates has just published his answers to Mr. Zeller's questions.  Please read them here. Original author: Brad Rodu
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Not All Teen Smokers & Vapers Are Lawbreakers

Sixteen percent of high school exclusive vapers in the 2017 National Youth Tobacco Survey (NYTS), or 184,000 out of 1.15 million, were 18 years of age or older, meaning that they could buy tobacco products legally.   Legal-age students also constituted one-quarter of high school smokers and 23% of dual users, according to the NYTS and shown on the chart at left.Legal-age students are themselves the most common source for e-cigarettes among underage students, as the following table shows.  The majority of underage students (74%) obtained e-cigarettes from family members, friends and others.  The next biggest source was vape shops (12%).  The Internet, which was singled out by FDA Commissioner Gottlieb in his recent announcement, was the source for fewer than 5% of underage vapers.   .nobr br { display: none } td { text-align: center} E-Cigarettes Sources for Underage High School Users, 2017SourceFriend64.0%Family member5.8%Other person4.0%Vape shop11.8%Internet4.7%Other retail3.6%Gas station/convenience store3.4%Mall kiosk1.4%Drugstore1.2%Grocery storeUnder 1%  Retailers must stop selling e-cigarettes to underage youths, and the FDA is responsible for enforcing that rule.  However, it is critical that regulators and the public address the fact that friends and family are the biggest contributors to underage use. N.B.  Thanks to Bill Godshall for suggesting this assessment.Original author: Brad Rodu
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The FDA’s Teen E-Cigarette-Addiction Epidemic Doesn’t Add Up

Commissioner Scott Gottlieb on September 12 announced an agency initiative to “address [the] epidemic of youth e-cigarette use” (here) and a teen-vaping-related “epidemic of addiction.”  He promised to use the FDA’s “civil and criminal enforcement tools” to reign in e-cigarette marketers. Dr. Gottlieb based his assessment on non-public data, but publicly available data from the 2017 National Youth Tobacco Survey (NYTS) does not show an epidemic.  The table at left displays the percentages of the estimated 14.9 million high school students who were “currently” using cigarettes and e-cigarettes, by number of days in the past month.  The numbers in each box represent the percentages of all high school students.  For example, 84.3% of students used neither product (boldtext, upper left).  Current users of e-cigarettes are in the red-bordered boxes.  The majority (60%) of current vapers used the products 5 or fewer days (green text) – the equivalent of trying products at a party.  In contrast, a minority (20%) of vapers used them 20-30 days (red text), which is suggestive of dependence.  Half of those were not using cigarettes (bold red text).  This means that in 2017, only 184,000 high schoolers (1.24% of 14.9 million) constituted the FDA’s e-cigarette-addiction epidemic. Original author: Brad Rodu
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Over 70 experts call on WHO to embrace technology innovation in the fight against diseases caused by smoking

October 1st, 2018

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FDA’s New Anti-Vaping Campaign Is a Misguided Clone of “Reefer Madness”

FDA Commissioner Scott Gottlieb on September 12 announced an FDA initiative to “address [the] epidemic of youth e-cigarette use.” (here)  Dr. Gottlieb misbranded teen vaping an “epidemic of addiction.”  The commissioner asked manufacturers of JUUL, Vuse, MarkTen, blu and Logic e-cigarettes to respond “to the FDA in 60 days with robust plans on how they’ll convincingly address the widespread use of their products by minors, or we’ll revisit the FDA’s exercise of enforcement discretion for products currently on the market.” Dr. Gottlieb added: “Let me be clear: Everything is on the table. This includes the resources of our civil and criminal enforcement tools.” The commissioner’s rationale and targeting for the threatened enforcement action appear to be grossly flawed. Dr. Gottlieb said he used “the word epidemic with great care,” but his statement that teen e-cigarette use is “almost ubiquitous” is simply wrong.  The chart at left, based on University of Michigan Monitoring the Future data, shows that e-cigarette use among high school seniors is only marginally higher than cigarette use, which has been declining for decades.  E-cigarette use pales in comparison with marijuana and alcohol, which are far more dangerous (hereand here). In his remarks, the commissioner used the word “danger” three times to describe teen nicotine and e-cigarette use.  This characterization is reminiscent of the “reefer madness” propaganda of the 1930s and beyond, which is well-chronicled in Mark Hay’s article, “A Brief, Paranoid History of Anti-Weed PSAs” (here).  Dr. Gottlieb’s attack on the four e-cigarette marketers may be misdirected, as FDA data show that only 10% of current teen users purchased e-cigarettes for themselves; the vast majority obtained them from social sources (here) – older siblings, friends and parents.  While elimination of underage tobacco use is an important objective, focusing the full force of the agency’s civil and criminal enforcement tools on manufacturers and retailers misses the target almost entirely. Original author: Brad Rodu
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“Third-Hand Vapor” Precautions Are Not Justified. Guest Post by Dr. Roberto Sussman

BR note.  Readers of this blog know that anti-tobacco activists greatly exaggerated the risks of second-hand smoke (here and here). Unfortunately, the scaremongering has expanded to include third-hand smoke (discussed here), third-hand smokeless (here) and third-hand vapor (here).   Two weeks ago another exaggerated “third-hand vapor” study was published by University of California activists.  For a perspective on this study, I am happy to introduce Dr. Roberto Sussman, a scientist (physics) in the Institute for Nuclear Research at the National Autonomous University of Mexico. Dr Sussman is also the director of Pro-Vapeo México AC, an all consumer non-profit association representing Mexican vapers and consumers of non-combustible nicotine delivery products, and an active member of INNCO.“Third-Hand Vapor” Precautions Are Not JustifiedBy Dr. Roberto Sussman  A recently published article (abstract here) seems to suggest potential health hazards from what could be called “third-hand vapor” in parallel to analogous studies on third-hand smoke. Specifically: the estimated exposure to electronic cigarette exhaled aerosol residues (ECEAR) deposited on surfaces and fabrics in rooms that are adjacent to a vape shop.   While it is worrying that the study of such extremely minute potential exposures to vapor residues may contribute to justify extensive vaping bans, the present comment only deals with strictly scientific (not political or activist) issues. Specifically, the following three issues are worth commenting: (1) E-cigarette vapor vs PM2.5.The article provides some background on possible health hazards from e-cig vapor. The following texts appear in the introductory section: Significant amounts of 1,2-propanediol, glycerin, nicotine and PM2.5 particles were present indoors during 2 hours of vaping. Moreover, an indoor air quality study showed that a large room with active EC users contained PM2.5 at concentrations that were higher than in hookah cafes and bars that allow cigarette smoking. .   The text conveys a sense of alarm, as it alludes to “PM2.5”  (particulate matter of diameters smaller than 2.5 microns) allegedly present in the e-cigarette aerosol. These particles are found in aerosols produced by combustion mechanisms, for example in air pollution or tobacco smoke. However, the text quoted above hints the existence of an equivalent concern on health effects from exposure to PM2.5found in environmental e-cigarette vapor.  This seems to be completely unwarranted, since the “particles” in electronic cigarette exhaled aerosol are liquid droplets, not proper particulate matter, even if “particle” counts and diameters are of the same order of magnitude as in environmental tobacco smoke. This is clearly stated in various reliable sources (for example, “Public Health Consequences of E-Cigarettes: a Consensus Report”,  National Academies of Sciences Engineering and Medicine, see page 72 of the report here.) I wonder why an article whose task is to look at potential exposures to pollutants in electronic cigarette vapor does not mention, as relevant background information for the readers, the fact that “particles” in the EC aerosol are chemically distinct (liquid droplets) from solid PM2.5 found in second hand smoke. It is an important fact, yet it is omitted.  (2) Accumulated fabric exposures are not realistic exposures in humans. The article mentions the possibility of potential exposure to toxicants by ingestion or dermic contact with ECEAR (electronic cigarette exhaled aerosol residues) deposited in cotton towels, paper towels and air filters.  However, no actual human exposures are measured or even estimated; only short and long term accumulated concentrations of deposited ECEAR in fabrics and filters placed in various fixed positions that can be in the path for continuous ECEAR deposition, for short and long term periods specified in Table 1. The results of this accumulated deposition are given in figures 2 and 3 in terms of dimensionless  quantities proportional to “1 ng (nanogram = 10-9 gm) per 1 gm of a fabric”, analogous to ppb (particle per billion) figures for concentrations in a gaseous medium.  To estimate actual human exposures to ECEAR, it would be necessary to estimate the time and fabric surface area in which human subjects are actually exposed (under realistic assumptions) to these accumulated concentrations. Under normal circumstances exposure times to pollutants by dermic manipulation or ingestion of these items is not continuous nor prolonged: people may ingest or dermically manipulate these items for brief intermittent time periods and along reduced mouth or skin contact surfaces.  The accumulated deposits of nicotine, alkaloids and nitrosamines can only be translated into actual human exposures under the extreme maximalist assumption of continued ingestion or dermic interaction for the same period in which the toxicants accumulated in the filters and fabrics that were placed to collect the substances in fixed spots. Realistic total human exposure will be much less because the actual ingestion or dermic interaction is short timed and intermittent and contact or mouthed surfaces contain few grams of fabric.  As an example, the article reports that “After 35 days in the field site, a cotton towel collected 4.571 micrograms of nicotine. If a toddler mouthed on 0.3 m2 [squared meters] or about 1 squared feet of cotton fabric from suite #1, they [sic]would be exposed to 81.26 mg [micrograms]of nicotine”.  From Table 1 and figure 2B this corresponds to sample SF35D, the quantity in the figure is 4571 ng per fabric gram, though 0.3 m2 is not a square foot but 3 square feet (3000 cm2). The reported area of 1 gm of cotton towel is 13.4 X 12.5 = 168.75 cm2, so that 3000 cm2 corresponds to 3000/168.75 = 17.8 gm of fabric, which multiplied times 4.571 mg per fabric gram yields the reported 81.25 mg of exposure to nicotine. However, this estimation is extremely unrealistic:  a toddler does not mouth a cotton towel for a long time, and 3 square feet is a huge fabric surface for a toddler to mouth! To understand how the authors obtained this quantity, we assume a constant deposition rate for 35 days in which the fabric sample SF35D was exposed to ECEAR. This means 135 ng per 1 gm of fabric per day, hence the total deposition for 0.3 m2 is 2.314 mg per day, and thus 81.25 mg of nicotine just exactly corresponds to 81.25/2.314 = 35.11 days of exposure to a continuous 35 days of ECEAR deposition. Hence, the authors assume that the 81.25 mg exposure to nicotine by a toddler mouthing 3 square feet is equivalent to a continuous 35 days exposure to nicotine by a 3 square feet surface area of the cotton fabric. This is wholly unrealistic and highly exaggerated; toddlers don’t mouth cotton fabric in this manner.    If we follow the authors’ estimate of nicotine exposure but apply more realistic toddler-mouthing times and fabric surface area, we get far smaller exposure figures. For example, a toddler mouthing only 1 gm of fabric (168.75 cm2) for one hour per day – still a gross exaggeration – is exposed to 5.41 ng of nicotine (130 ng per day/24). For 35 days we get 189.35 ng, not the suggested 81,250 ng.  Moreover, the assumption of one hour contact with 1 gm of fabric every day during for 35 days is still unrealistic. Under normal conditions the exposed items (towels and filters) do not sit statically in homes, shops and offices for such extended time periods, and their chemistry will change by interaction with multiple external agents, necessarily altering the deposited ECEAR amounts.  Filters are designed to trap pollutants, thus it is not surprising that they contain more ECEAR, but are touched and manipulated only for maintenance or for normal control/replacement operation (which takes seconds). Paper towels are disposable and cotton towels are periodically washed, so 81.25 mg of nicotine will never accumulate. As far as I am aware, the tobacco-specific nitrosamines (TSNAs) are the most worrying compounds in ECEAR, yet the detected exposure by fabrics and filters collecting ECEAR is really minute. Even long term, it is below 15 ng per 1 gm of cotton fabric, or about 0.42 ng per day. Assuming daily exposure comparable to this deposition rate and one hour of dermic manipulation of the towel yields a very minute exposure to TSNAs of 0.0175 ng.  I doubt that such a small hazard signal can be separated from the background noise.     (3) Does exhalation of large clouds release more nicotine?. The article states that 94-99% of nicotine is retained by the vaper (citing reliable sources), yet the authors mention that  “... the extent of nicotine exhalation depends on the user’s propensity to produce clouds of aerosol. In our real world study, nicotine generated by vape shop occupants reached suite #1 and contributed to ECEAR"    It is not evident that exhaling larger clouds releases more nicotine into the environment. True, a large cloud contains more mass of aerosol, and thus more nicotine, but exhaling large clouds also requires deeper inhalation, which would likely produce larger nicotine deposition in the respiratory system. It is not obvious that this could compensate the larger mass of exhaled aerosol + gas phase.   Excessive usage of the precautionary principle. The article concludes with this statement: “Building codes will need to be developed and enforced to protect those who do not wish to be exposed to ECEAR. Vape shop air quality is not currently regulated nor has it been thoroughly studied. Regulatory agencies should exercise authority over malls to ensure that employees and tenants do not receive unwanted exposure to EC aerosols and its residues”. The results and actual measurements in this report were from exposures to static fabrics and filters, not realistic exposures to real people.  So the authors’ recommended regulations are excessive and unfounded.Original author: Brad Rodu
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Vaping Plays a Role in Young Adults’ Low Smoking Rate

The anti-tobacco Truth Initiative tweeted that the smoking rate among young adults (18-24 year old) in the U.S. is “just 10.4%,” based on the 2017 National Health Interview Survey (NHIS) (here).  But the Initiative didn’t tell the whole tobacco “truth.”  Using the same NHIS data, I prepared the chart at left which confirms that smoking is way down among young adults, continuing a decline I reported previously (here).  Nearly 85% of young adults have never smoked, including 2.7% who currently vape, 13% who tried e-cigarettes and 69% who never used either product.  Among the 5% who are former smokers in this age group, over half were current vapers or had tried vaping products.  Even more impressive, 7 out of 10 current smokers were either current vapers or had tried e-cigarettes, meaning they could eventually make the switch to smoke-free. Advocates of greater tobacco control make a specious boast when they celebrate lower smoking rates while ignoring the positive impact of vaping.  Original author: Brad Rodu
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Letter to WHO’s DG against prohibition and for risk-proportionate regulation

Dr Tedros Adhanom GhebreyesusDirector GeneralWorld Health OrganisationAvenue Appia 201202 Geneva

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Innovation for Consumers: E-cigarettes and novel tobacco products – Part of the problem or part of the solution?

September 5th, 2018

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Slight Teen Vaping Increase and A Continued Smoking Decline in 2017

Despite the rhetoric, there is no “Juul epidemic” among high school students.   The purported epidemic has been widely cited in the media.  Just last week, an article in the New England Journal of Medicine (here) asserted that “use of these products is rampant among young people.”  The authors based their claim on “Media stories about Juul … [that] highlight anecdotal reports from students, parents, teachers, and school superintendents.”  This falls far short of normal journal standards.  (The NEJM commentary also included the confounding contentions that “Pod mods are easy to conceal from authority figures” and “Juul vaporizers measure 93.98 cm,” or an astounding 37 inches.) Campaign for Tobacco-Free Kids president Matt Myers has been a cheerleader for the mythical epidemic: “Everyone was asleep at the switch.  And by the time we woke up, we had an epidemic on our hands.  I've never seen a tobacco-related product spread across this country as fast among young people as this product.” (here)     In fact, no one else has seen it.  Claims of a Juul epidemic are baseless.  Government data show that while e-cigarette experimentation increased among American high school students from 2011 to 2015, the year Juul was introduced, vaping stabilized in 2015 and smoking rates continued to drop.  In 2017, 1.15 million (7.7%) American high school students were current (past 30 days) e-cigarette users, 556,000 (3.7%) smoked, and 632,000 (4.2%) used both products, according to the Centers for Disease Control and Prevention’s 2017 National Youth Tobacco Survey (NYTS). Comparing those numbers to 2016 (here), smoking and dual use declined marginally, by about 0.2 percentage point, while vaping increased by 0.5 point.  While Juul sales may have surged, neither they nor any other e-cigarette brand produced a youth vaping epidemic. *The apparent spike in e-cigarette use increased among high school students from 2013 to 2014 was partially due to what researchers term an artifact, related to a change in the survey design.  Questions about e-cigarette use were bundled with those for “other” tobacco products until 2014, when they appeared in a separate section, after cigarettes, cigars and smokeless tobacco. Original author: Brad Rodu
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FDA Tobacco Center Exaggerates Number of Youth Tobacco Users

The FDA Center for Tobacco Products published an inaccurate graphic in June (the “Most Used Tobacco Products in 2017” Venn diagram here) and tweeted it on August 8 (here), asserting that 2.1 million U.S. middle and high school students in 2017 were current (past 30-days) users of e-cigarettes, 1.4 million were current cigarette smokers, and 1.3 million were current cigar smokers. The graphic, which mischaracterized data from the 2017 National Youth Tobacco Survey, would lead most to believe that nearly 5 million youth used the three products. That conclusion would be grossly off the mark. In fact, NYTS data indicate there were only about 3.3 million current users of these three products, with a 40% overlap. (This is not surprising, as research shows that use of one tobacco product is associated with use of others here, hereand here.) The next chart breaks out exclusive and multiple users of e-cigarettes, cigarettes and cigars, based on my analysis of the 2017 NYTS data.  Over 50% (1,125,000) of the 2.1 million e-cigarette users didn’t smoke at all, 22% smoked both cigarettes and cigars (red font), 15% smoked cigarettes, and 12% smoked cigars (yellow font).  These distinctions are important, as they are associated with different levels of e-cigarette use, shown in the following chart.  A large majority (74%) of exclusive vapers used e-cigarettes infrequently (1-5 days in the past month); only 12% reported frequent use (20-30 days).  Vapers who smoked cigarettes or cigars were much more likely to be frequent e-cigarette users (20-21%); frequent use was 38% for users of all three products.   Using a misleading graphic, the FDA exaggerates the number of teens who use tobacco.  Original author: Brad Rodu
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UK Favors E-Cigarettes, Scores Major Smoking Reduction; Anti-Vaping Ireland Sees Smoking Rates Unchanged

There is, as I have noted (here), a stark contrast between British government and medical authorities’ support for e-cigarettes and vaping, and the demonization of same by most of the American public health community.  A similar clash of positions exists between the United Kingdom and Republic of Ireland. The British blogger Dick Puddlecote observes (here) that the UK and Ireland are “nearest cultural neighbours, so closely aligned [that] we that we don't even enforce passport requirements between the two countries.  The British and the Irish are about as good a comparison for ecological purposes as there can possibly be.  And, as [British Member of Parliament Sir Kevin] Barron said, the only difference between UK policy and Irish policy is that over here our government cautiously welcomes new nicotine products whereas in Ireland they don't.” Puddlecote underscores: “In the UK smoking rates have nosedived, while in Ireland they have barely shifted.” I have verified that statement by reviewing government data.  The UK’s Office for National Statistics reported that smoking prevalence was 20% in 2012, after stalling during the six previous years (here).  However, between 2012 and 2017, the rate fell to 15% (here).  Ireland started out in 2012 at nearly the same prevalence, 22% (here).  But five years later it was unchanged (here), according to the Ireland Department of Health. The difference in smoking reduction in these neighboring countries is extraordinary.  As Puddlecote observes, “this deserves more attention…You just have to wonder why the tobacco control industry and other politicians, both sides of the Irish Sea, have been so silent about it.” Indeed.   Original author: Brad Rodu
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South Africa draft tobacco Bill – protects cigarette trade and denies smokers options to quit

August 8th, 2018

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More Vaping Facts, Not All Good, from 2017 CDC Data

CDC and other U.S. government agencies rarely publish straightforward numbers and conclusions about adult e-cigarette use; their focus is usually on underage use.  Last month, by re-analyzing the federal data, I demonstrated that the number of American vapers declined in 2017 (here); following are additional insights. As seen in the table below, the number of every-day e-cigarette users increased between 2014 and 2016.  However, in 2017 the number dropped by almost a quarter-million.  The proportions of current, former and never smokers in 2014 were 50%, 46% and 4%.  By 2016 the proportions were 32%, 58% and 10%, indicating that more every-day e-cigarette users were former smokers.  In 2017, the proportion of former smokers inched up again: 32%, 60% and 8%..nobr br { display: none } td { text-align: center}Number (in millions) and Prevalence (%) of Every-Day and Some-Day E-Cigarette Use in the U.S., 2014 to 2017Every-DaySome-DayAll20142.71 (1.1%)6.20 (2.6%)8.91 (3.7%)20152.94 (1.2%)5.40 (2.2%)8.34 (3.4%)20163.03 (1.2%)4.77 (2.0%)7.80 (3.2%)20172.79 (1.1%)4.09 (1.7%)6.88 (2.8%)  The number of some-day e-cigarette users declined in 2017 for the third consecutive year, to 4.09 million – over 2 million fewer than in 2014.  Most were current smokers in all years, but the proportions shifted:  In 2014, they were 80%, 12% and 8% for current, former and never smokers.  By 2016, the proportions were 68%, 18% and 14%; and in 2017, they were 62%, 15% and 23%. In 2017, there were 1.17 million never smokers who were current vapers, and 80% of this group (933,000) were using e-cigarettes some days.   The vast majority of some-day users were either 18-24 years of age (68%), or 25-34 (23%), suggesting that vaping is displacing smoking in these younger groups. It is unfortunate that the number of daily and some-day U.S. vapers is declining, as the facts demonstrate that tobacco harm reduction can only be successful if smoke-free tobacco consumption increases among inveterate smokers. Note: Thanks to Bill Godshall for requesting these additional insights. Original author: Brad Rodu
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More Proof from FDA Population Data Showing E-Cigarettes As Popular Quit-Smoking Aids

While the number of American vapers declined over the last three years (as I reported here), e-cigarettes were still far more popular quit-smoking aids than medicinal nicotine or other drugs, according to researchers at the University of California San Diego (here). Tarik Benmarhnia and colleagues used information from Waves 1 and 2 of the FDA-funded Population Assessment of Tobacco and Health (PATH) Study to evaluate “the influence of [e-cigarettes] and pharmaceutical cessation aids [varenicline, bupropion and nicotine medicines, NRT] on persistent abstinence (≥30 days) from cigarettes, and reduced cigarette consumption” during the period 2013 to 2015.  They concluded: “Our results indicate that [e-cigarettes] are a more popular choice than approved pharmaceutical products as a smoking cessation aid among US quit attempters, over three quarters of whom were daily smokers.  In the future, as [vapor] products continue to evolve to make nicotine delivery more similar to that obtained from a cigarette, it is possible that they may play a bigger role in assisting smokers to quit combustible tobacco.” This study confirms my research group’s earlier analysis of Wave 1 PATH data: E-cigarettes are among the most commonly used quit aids for American smokers, and they are the only aid more likely to make one a former smoker (i.e., a successful quitter) than trying to quit cold-turkey (here). Original author: Brad Rodu
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CDC Data Shows That E-Cigarette Use Declined Again in 2017

About 6.9 million Americans were current users of e-cigarettes in 2017, according to data in the 2017 National Health Interview Survey, the source for CDC national smoking estimates.  That’s a million fewer vapers than the prior year, and over two million fewer than in 2014, the first year NHIS surveyed for vaping.     The number of current vapers who were former smokers had increased through 2016, but dropped in 2017, from 2.62 to 2.3 million.  This is not good news for tobacco harm reduction. Another fascinating detail from 2017 is that 1.17 million never smokers currently used e-cigs, and over two-thirds of those were 18-24 years old.  This may be an extension of the recent increase in high school vaping (here), but it’s important to note that smoking in this age group is way down (here).  Vaping has been portrayed as a menacing new epidemic by tobacco and nicotine prohibitionists in government and elsewhere.  It now appears that the misinformation in their anti-vaping messages has been effective (here).  The number of vapers has tragically declined.  Original author: Brad Rodu
  909 Hits

FDA: You Can Run Models, But You Can’t Hide Facts About Smokeless Tobacco

In a recent New England Journal of Medicinearticle, FDA researchers went to great lengths to conceal the fact that smokeless tobacco (ST) use has an entirely negligible impact on life expectancy. The article, “Potential Public Health Effects of Reducing Nicotine Levels in Cigarettes in the United States,” (here) by Benjamin Apelberg and colleagues, was the centerpiece of FDA Commissioner Scott Gottlieb’s March 15 announcement of a radical nicotine reduction rule for cigarettes.  Drawing from the research, an FDA press announcement (here) declared that if cigarettes were minimally- or non-addictive by 2020, approximately 5 million additional adult smokers would quit smoking within just one year; only about 1.4 percent of the U.S. adult population would smoke cigarettes by 2100, in part, because more than 33 million people would avoid becoming regular smokers; more than 134 million years of life [would be] gained among the U.S. population. While it is entirely unclear how nicotine reduction would produce the first two results, there is a fundamental flaw in Apelberg’s model that mainly affects the third, years-of-life, claim.  Correcting for that error, the model would likely confirm that ST products are nearly risk-free. Apelberg estimates excess deaths among smokers by linking participants from National Health Interview Surveys (NHIS, 1997-2004) to the National Death Index (NDI) through 2006.  He also estimates deaths among users of ST, but uses an entirely different dataset – smokeless users who were enrolled in 1982 in the American Cancer Society Cancer Prevention Study II. Apelberg’s use of two data sets -- NHIS for smokers and CPS-II for ST users – violates a basic rule of modeling: all inputs should be from the same or similar sources.  NHIS should have been used for analysis of both groups.  That was the procedure, for example, when Michael Fisher and colleagues used NHIS and NDI to produce a stable estimate for all-cause mortality among smokers and ST users (here).  Apelberg may have used CPS-II because it shows that ST users’ mortality rate was 18% higher than that of never tobacco users.  Had he used NHIS, he would have had to acknowledge that smokeless users had no significant risks, as Fisher documented only a 5% excess that was not significant (HR= 1.05, CI = 0.90 – 1.23) (here). The FDA analysis was biased through the use of exaggerated risks from an American Cancer Society study that has never been evaluated by independent researchers (here, hereand here).  In this way, the FDA hid the negligible health impact of ST use. A letter I submitted to the New England Journal of Medicine describing the flaw was not accepted. Original author: Brad Rodu
  640 Hits

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