E-cigarette vaping in United States

US Government Funding Roundabout

- Burning Issues: The Global State of Tobacco Harm Reduction 2020

The US Government relies on a complicated cascade of financial assistance for its various departments. Money flows downwards from the Department of Health and Human Services (HHS), who in turn have to compete with all the other departments in convincing Congress of the value of their services in the fight for a share of the Federal budget. However, once a budget is secured, agencies within the HHS like the FDA, CDC and National Institutes of Health (NIH) are in competition for a slice of the pie. They all understand there is nothing more effective at loosening the public purse strings than declaring an epidemic that must be tackled.

But these agencies need to prove their case – and this is where a co-dependency cascade begins. The hottest health topic before COVID-19 was the outbreak of vaping-related deaths, which helped solidify the dangers of the alleged epidemic of youth vaping. This was the subject most likely to attract HHS budget holders.

Agencies like the FDA and CDC often consult with and take briefings from a number of long-established, well-funded and influential health advocacy groups. To the public, these groups appear to be generating advice that is based on medical and scientific expertise, in the service of public well-being and absent of any bias. However, groups like the Campaign for Tobacco Free Kids, backed by advocacy-driven research, are in fact acting as moral entrepreneurs. They are generating the marketing and press releases which stimulate public concern.

While the media provide the public megaphone, NGOs engage in the kind of political activism forbidden to government agencies, putting pressure on politicians and legislators to act in the face of public clamour. In fact, politicians and government officials need external allies to give the impression they have responded positively to community concerns; proof they are listening to the people. As Franklin Roosevelt famously said, “OK. You’ve convinced me. Now go out there and bring pressure on me.”

See also p.81 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020

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Changes in the Prevalence of Smokers and Vapers Among American Youth

- Burning Issues: The Global State of Tobacco Harm Reduction 2020

Cigarette smoking has been falling in the US for many years including among young people. When vaping products began to appear on the market, it was inevitable that some young people would want to experiment. This led to claims from the U.S. Food and Drug Administration (FDA), the Campaign for Tobacco Free Kids (CTFK) and others that vaping was a gateway to smoking as the industry tried to compensate for falling numbers of younger smokers by promoting new products. Yet as the graph shows, cigarette smoking among young people has continued to fall, even while experimentation with vaping devices has been increasing. The goalposts shifted; the claim now from the same bodies is of a vaping “epidemic” among young people which would lead to a future generation of nicotine “addicts”. JUUL certainly attracted a lot of interest from some young people when it launched during 2018-19, while the company itself faced accusations of marketing the device to young adults and selling flavours that appeared to be targeting that same younger audience.

The public, the media and legislators continue to be misled over the prevalence of vaping among young people by the simple trick of conflating ‘ever use’, which could be just once or very infrequent, with ‘use’. However, a study by Allison Glasser and colleagues from New York University (NYU) College of Global Public Health looked at the 2018 National Youth Tobacco Survey of 20,000 middle and high school students and concluded that:

» Over 80 per cent of youth do not use any tobacco product.

» Over 86 per cent don’t vape.

» Most youth who do vape are current or former smokers and many are also vaping THC.

» While youth vaping has increased, this was driven by infrequent use.

» Only very few students vaped who had never smoked.

See also p.81 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020

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Prevalence of Current Smoking Cigarettes and Current Vaping

- Burning Issues: The Global State of Tobacco Harm Reduction 2020

Overall, as a percentage of the total adult population, current use of vaping devices in different countries ranges between 1% and 7%. As shown by this graphic there are eight countries where the prevalence of vaping is 3% or more including the UK, United Arab Emirates (UAE), US, France, Iceland, Belgium, the Russian Federation and Malaysia. The average prevalence of current vaping product use is 1.6 % of the adult population in the EU, as found in the EU Eurobarometer survey. A further 13% “used to use them, but no longer do so” or “have tried them once or twice”. 85.6% “have never tried or used them”. Levels of sometime vaping experience range up to 27% of the adult population in Greece, and 20% or above in Estonia, Czech Republic, France, Cyprus, Latvia and Austria. Clearly, there are many smokers who are interested in these products. But there is also a large gap between those who have shown enough interest to have tried vaping at some time, and those who have gone on to currently vape.

See also p.50 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020

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