Told You So

This week saw another release of the CDC Morbidity and Mortality Weekly Report (MMWR) with more information on ‘Reasons for Electronic Cigarette Use Among Middle and High School Students’.

Given that Scott Gottlieb made a big thing in his speech about youth, it is hardly surprising the route that this is going to take.

Those figures are, in fact, accurate. At least as far as the survey data goes. Remember, this is from the National Youth Tobacco Survey. As previously mentioned, the NYTS did change its questions on e-cig use which, unsurprisingly, led to a “shocking rise” in the use of said product.

What is sad about this particular tweet from Gottlieb is the harm perception figure. Only 17% of those e-cig users (including those that experimented) questioned correctly believe that they are less harmful than other tobacco products.

Again, unsurprisingly the FDA, and Goettlieb in particular, is trying to spin the results into something else. When asked the reason why they have used e-cigarettes, 8% of them reported they were using them to “try to quit using tobacco products such as cigarettes”. The important figure, as reported by Carl Phillips, is among the ‘current users’ where the rate is 18%.

This rate, as Phillips states, is substantial and suggests that many teenagers are using e-cigarettes to not smoke cigarettes. Therefore, any policy to arise from the results of this survey would result in some of them to continue smoking or to go back to smoking.

As clearly indicated here, Gottlieb wants to restrict access to e-cigarettes (along with all nicotine-containing products), which means that any policy to restrict access; such as taxation, are fundamentally flawed. This would also have the unintended consequence of driving the black market, which in the US stands between 8.5 percent and 21 percent of the total market.

But, that isn’t the key aspect at all. The target, which as I mentioned after Gottlieb gave his inaugural speech, would be: flavours. According to the survey data, 46 percent of dual users (those who use e-cigarettes and cigarettes), 31 percent of e-cig experimenters and 41 percent of exclusive vapers cite flavours as the reason they used, or tried, e-cigarettes.

It has long been known that flavours would be the “next logical target” of the FDA and the like. But, it is impossible to say with any certainty that banning flavours; either all or in part would have a significant impact on teen vaping rates. While it is true that many of them cite flavours as a reason for trying (or using) e-cigarettes, it is not the same as declaring that flavours cause them to vape.

Furthermore, the data shows that the preference for flavours is strongest among smokers, suggesting that flavours play a significant role for both adults and teens; which as I have previously discussed is one of the key factors why vaping is, ultimately, so successful.

It is pretty clear that the design of the NYTS, even despite its modifications, is skewed in favour of supporting specific policy goals. As is any other survey.

In total, 31 percent of respondents that had tried e-cigarettes cited “some other reason”, 34 percent of exclusive vapers and, 33 percent of dual users also cited “some other reason” for using e-cigarettes. This, as Phillips explains, makes it clear that the survey authors did not intend for the question “What are the reasons you have used e-cigarettes” to be interpreted as causation. Yet that is exactly what the FDA spin machine is doing.

Having read the questionnaire, notably absent was mention of nicotine. Unlike the Monitoring the Future survey which specifically asks if e-cig users are using nicotine, the absence of this in the NYTS is a glaring flaw as demonstrated by the “some other reason” figures. If the respondents weren’t motivated to use an e-cigarette because a friend or family use them, to quit using other tobacco products, because of lower cost, ease of access, famous people use them, they are less harmful, are available in a variety of flavours or can be used where the use of other tobacco products isn’t allowed, then what exactly was the motivation?

Sadly, the true motivations for use will never be discovered using the NYTS survey. But that doesn’t stop the usual suspects from trying:

Well. That didn’t take long, did it?

I told you so.