Attitudes towards E-Cigarettes

We all know that attitudes towards e-cigarettes are slowly being eroded in the UK by the near constant barrage of churnalism. That’s right The Sun I’m looking squarely at you, crass fuckwits that you are. I might even look towards The Telegraph too. Not for the usual reason of their “science” editor this time, though that could be considered one big reason.

Now we have an actual study, funded by the National Cancer Institute and the FDA CTP, and performed by some researchers deep in the bowels of Stanford. Well, we know how the last one turned out don’t we?

Well this one is examining the attitudes of adolescents towards e-cigarettes. No doubt in the hopes of finding a way to erode public confidence even further. The introduction doesn’t bode well.

Electronic cigarettes (also known as vapes, vaporizers, or vape pens) were introduced into the US market in 2007. They are generally battery-powered products that heat liquid into an aerosol that is inhaled by the user. These devices are designed to deliver nicotine and flavors; they also contain chemicals such as propylene glycol, glycerin, and many other constituents. Use of e-cigarettes has dramatically increased over the past 4 years, tripling among high school students from a rate of 4.5% in 2011 to 27.4% in 2014 (CDC, 2015; 2016). Further, 27.4% of adolescents in the U.S. have ever used e-cigarettes (CDC, 2015), with 30% of California youth reporting ever using an ecigarette (California Department of Public Health, 2015).

Although research on the health effects of e-cigarettes is nascent, studies show that use of e-cigarettes likely increases lung inflammatory markers (Lerner et al., 2015; Wu et al., 2014) and impacts cardiovascular health (Dwyer et al., 2009; Lippi et al., 2014). Certain flavorants in e-cigarettes, when inhaled, cause toxicity, respiratory disease, and respiratory flow resistance (Barrington-Trimis et al., 2014; Behar et al., 2014; Farsalinos et al., 2015; Gardiner, 2013; Wu et al., 2014); and there are concerns about the impact of nicotine on the developing adolescent brain (Dwyer et al., 2009; England et al., 2015). There are also broader public health implications concerning adolescent e-cigarette use, with several studies showing that adolescents who use e-cigarettes are more susceptible to smoking combustible cigarettes (Barrington-Trimis et al., 2016; Bunnell et al., 2015; Leventhal et al., 2015; Moore et al., 2014; Primack et al., 2015; Wills et al., 2015; 2016)

Well, not much to really say here except perhaps they should really read the data being published by the CDC where it is pretty damn clear that the use of combustible tobacco is in rapid decline. Even more than that, the MTF survey also reports that over half of teen e-cigarette users don’t in fact use nicotine. As for citing Barrington-Trimis, well I’ve written about her before. She’s one that will regurgitate data in new, and useless ways to fit a particular narrative.

Despite studies showing the health effects of e-cigarettes, adolescents harbor misperceptions, including believing that e-cigarettes are safer than cigarettes, help people quit smoking conventional cigarettes, and do not contain any or just limited amounts of nicotine

May as well just come out and say it people. Folks think that e-cigarettes are a good thing despite your continued attempts to consider them “as harmful as tobacco”. Otherwise, how do you explain the continued slush fund directed at useless “research” such as this? (or any of the other well documented “research” on this humble blog)

The rest of the introduction is pretty standard fare with the caveat of “no substantial research done in this area” but you can already tell which way these researchers are leaning can’t you? Ideology doesn’t belong in science, yet you can find it prevalent in all walks of “public health science”.

Approximately 4,000 students learned about the study, of whom 1,299 returned signed forms. Of these, 405 (31.1%) students were withdrawn from the study due to invalid contact information, ineligibility (wrong grade) or did not respond to subsequent contact by the researchers. Overall, 786 (87.9%) of eligible consented students completed the survey. The sample had fewer males and more females and a higher percentage of Asian students than schools from which we recruited. However, mother’s education did not vary between those who did and did not complete the survey, and neither sex nor race/ethnicity had a significant main effect on the study outcomes. Further, rates of tobacco use among study participants were consistent with rates of use for California youth (Tamika et al., 2016).

So. Let me get this straight. Tobacco control don’t want teens to know about e-cigarettes, yet here are some public health researchers talking to the very same teenagers about e-cigarettes. Just can’t make it up! But of course, it’s OK when they do it (huge thanks to master blogger Dick Puddlecote for that one). Even worse is that 4,000 impressionable youth were ‘exposed’ to e-cigarettes just so these researchers could do a study, did they not for a second think of the potential consequences of such an action? Well of course not, you see, indoctrinating the youth is all part of this game for these researchers. They want a never-ending supply of impressionable youth so they can convince those in some semblance of power that The Children™ are at risk, which will of course mean Orwellian measures to keep the Proles in line.

But I digress. Out of those 4,000 impressionable young Proles, only 32% of those that “learned about the study” which is a fairly poor performance by normal standards, but this is for tobacco control so if only 10% returned signed forms it’s still all systems go. A further 405 were withdrawn, leaving 786 impressionable young minds for these researchers to indoctrinate. I’m not concerned about the fundamental demographics, but I did find it interesting that more females responded than males – but then, men are more likely to ignore such studies anyway – especially the young ones. Incorrigible little grunts they are.

Curiously, the number of smokers among the 786 was only 38, 87 had only used e-cigarettes, 57 had used both while the rest didn’t use either. Of course, the “use” question was slanted, as it always is in US research:

Participants were asked, “During your entire life, how many times have you EVER used [e-cigarettes/cigarettes], even 1 or 2 puffs.” Response choices include: never, 1-2 times, 3-10 times, 11-19 times, 20-30 times, 31-99 times, 100 or more times

Other questions included the perceptions of others using e-cigarettes/cigarettes – specifically parents, siblings and friends – to “evaluate how many teens out of 100 who were the same age, gender and ethnicity were using e-cigarettes/cigarettes”; this is the infamous “peer pressure” type question meant to try and lend credence to the statement “if parents smoke/vape, kids will think it’s OK to do it to”. These people are so far removed from reality it can hardly be called a joke anymore.

Participants were asked if they agree or disagree with specific statements about e-cigarette ingredients, safety, and addictive properties

In which the scale is of course a four point scale – strongly agree, agree, disagree, strongly disagree – with only the extreme measurements being used by the media as “evidence of fact”. That’s how it works.

Participants were asked about their perceived acceptability of e-cigarettes and cigarettes

Ah of course. This is all about possible policy options that the researchers have been “guided” to investigate. Which of course include the usual suspects:

  • Raising taxes on e-cigarettes or cigarettes
  • Regulations
  • Age restrictions
  • Indoor space restrictions
  • Outdoor space restrictions
  • General accessibility of the product

You get the idea. Of course, the fact that it’s The Children™ answering these questions lends a lot more weight to the sock puppet organisations in the US that claim “our kids want” doesn’t it? Nasty hobbitses.

Analysis (theirs, not mine!)

Descriptive statistics including means, standard deviations, and percentages were used to describe the data. Within and between participant comparisons were tested by a generalized linear model using Proc Genmod in SAS 9.4. A linear regression model was used for continuously distributed dependent measures, and a logistic model was used for dichotomous measures. For analyses concerning tobacco  use, given that few participants only used e-cigarettes or cigarettes (see Table 1), we collapsed the data as follows: individuals who had ever used an e-cigarette or cigarette were labeled as “ever users,” (told ya PB) and those who had never used either e-cigarettes or cigarettes were labeled as “never users.” Covariates in the models included age category (13-15, 16-19), race (White, Asian, Latino, Other) and sex. All models accounted for clustering by school. Missing data, which varied item to item, were left as missing.

As with any US study, if you so much as take a single puff of a cigarette or an e-cigarette you are classed as an “ever user” – you only get moved up to “current user” if you did so in the last 30 days, even if that was your one and only puff. These scientists politicians.

Interestingly, the perceived prevalence lends some credence to the “peer pressure” theorem, though as we’ve seen before it’s more a social dynamic than peer pressure. Especially if those “ever users” are in fact former smokers (which I suspect some of the participants in this study were, though it isn’t clear).

Knowledge & attitudes

This is the part of the results I’ve been waiting for. This is where the grandiose claim of “adolescents harbor misperceptions, including believing that e-cigs are safer than cigarettes” comes from. It does also highlight a rather worrying knowledge gap of our own which will be difficult to fill.

Almost one out of five participants (19.05%) agreed or strongly agreed that smoke from e-cigarettes is water, 23.03% felt e-cigarettes aren’t a tobacco product, 26.38% believed e-cigarettes don’t contain tar, and 18.98% believed e-cigarettes don’t produce smoke. Almost two thirds (66.72%) of adolescents agreed or strongly agreed that e-cigarette vapor is dangerous to babies and kids. Approximately 43.99% and 43.13% of participants believed that e-cigarettes feel cleaner and safer than smoking cigarettes, and 40.36% felt e-cigarettes help people quit cigarettes. 49.70% of participants agreed that teens use e-cigarettes to get the same buzz they get from tobacco cigarettes

The devil is in the details here. Users of e-cigarettes are more likely to agree that e-cigarettes don’t contain TAR, aren’t a tobacco product, don’t produce smoke, feel cleaner, safer than smoking and help people quit smoking. These users also agree that e-cigarettes just produce water [vapor]. On the flip side, the non-users were more likely to agree that e-cigarette vapour is dangerous to babies and children. It is clear from the discussion of this section that the researchers got the data they needed:

While some adolescents in our study had correct general knowledge (you mean they’ve swallowed the daily propaganda from the Tellybox PB)of e-cigarette ingredients and risks, many did not. Our findings are particularly concerning considering that positive perceptions of e-cigarettes may be increasingly common among teens (natch, can’t have the precious kiddies knowing the truth now can you PB)

It gets better.

Participants were generally more accepting of e-cigarette use in both indoor and outdoor spaces (well of course they would be, they don’t like nanny anymore than I do PB), compared to cigarettes, with 28.27% agreeing or strongly agreeing that e-cigarettes should be allowed in outdoor spaces such as parks, compared to 13.51% who agreed/strongly agreed that cigarette smoking should be allowed in those spaces.

In the discussion:

Overall, adolescents in our study are more accepting of e-cigarette use in both indoor and outdoor settings, compared to cigarette use. One out of 10 adolescents believe that e-cigarettes should be allowed indoors, 3 out of 10 felt that e-cigarettes should be allowed in outdoor spaces, and 1 out of 5 adolescents felt it was okay to use e-cigarettes in their house. These numbers may reflect a shift in perceptions regarding e-cigarette use in public places (could that be something to do with folks learning on their own and not from Big Brother? PB), compared to perceptions of indoor and outdoor cigarette use.

It’s pretty clear that these researchers are bewildered by the seeming positive attitudes towards e-cigarettes and their use where smoking is prohibited. After all, research has given them all the right answers to impose draconian measures that has led to a number of public places being closed down – an intended consequence I might add.

I’ll bet this annoyed them:

11.34% of participants agreed e-cigarettes should be allowed in indoor spaces, while only 5.21% agreed cigarettes should be allowed indoors (good! let proprietors decide, not the Government! PB)

I do wonder how that kind of attitude in those kids will be in a few years time after being bombarded with mainstream media nonsense.

Participants who used e-cigarettes and/or cigarettes generally had more favorable views towards e-cigarette and cigarette use in indoor and outdoor spaces compared to those without such use experiences

Well no shit sherlock.

Among participants, 64.33% and 65.53% agreed/strongly agreed that the age for buying e-cigarettes and cigarettes should be raised (pah I say, pah! PB); 64.37% and 71.28% favored e-cigarette and cigarette regulation respectively (proportionate regulation natch. PB); 23.13% and 15.22% felt that raising e-cigarette and cigarette taxes was a bad idea (They’d be right about that PB); 38.87% agreed/strongly agreed that cigarettes were easier to get than e-cigarettes (you only need to look at the estimated illicit trade values. PB); 47.47% thought that cigarettes are cheaper; 49.63% and 54.84% of participants felt that e-cigarettes and cigarettes cost too much; and 69.79% and 73.21% felt that if e-cigarettes and cigarettes were more expensive, teenagers would be less likely to use them

Good grief! These kids have just handed an excuse for legislators to raise taxes to raise revenue persuade smokers to quit. A fact that the researchers were obviously quick to pick up on:

This statement was particularly endorsed among adolescents who have not used cigarettes or e-cigarettes. A majority favored raising the age for buying e-cigarettes and cigarettes. This finding is important, especially given the recent IOM report showing the health effects of raising the minimum purchase age of tobacco to 21, as well as several states and localities raising their minimum purchase age to 21.

Well we know what the whole Tobacco21 thing is about don’t we?

Further, it is important to understand the perspectives of adolescents who grew up in a state with strong tobacco-free policies and anti-smoking social norms. The increased acceptability and positive attitudes towards e-cigarettes by adolescents in California may be magnified in states with less stringent anti-tobacco laws.

Don’t you just love it when researchers unwittingly admit that the anti-tobacco laws have never really been about health?

Cue the veiled “proposal”:

In sum, these findings suggest that we need to provide adolescents with messages concerning e-cigarettes, including their ingredients, nicotine content, addictive properties, and risks. In addition, health care providers need to understand basic facts concerning e-cigarettes as well as adolescents’ attitudes towards these products since e-cigarettes are becoming a more predominant tobacco product amongst adolescents. Healthcare providers need to regularly screen for e-cigarette use, and educate patients and parents about misconceptions associated with e-cigarettes.

The only misconception here is the fact that anyone with a grain of sense would give this “study” any credence, or even call it “science”.

But then, this crusade by the US public health industry has never been about health. It’s been about money. Money and control.

(image credit – Dawn Gilfillan/shutterstock.com)