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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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Center for Tobacco Products (CTP) Map

- No Fire, No Smoke: The Global State of Tobacco Harm Reduction

The FDA in the USA has long held the authority to regulate nicotine replacement therapies such as gum, patch, and lozenges through the Center for Drug Evaluation and Research (CDER). In 2009, with the passage of the Family Prevention Smoking and Tobacco Control Act, the FDA gained the authority to regulate tobacco products and marketing for cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. On May 10, 2016, the FDA published a final ‘deeming rule’ allowing the agency to begin regulating all tobacco products, including cigars, pipe tobacco, waterpipes (or hookahs), dissolvable products, e-cigarettes, and other electronic nicotine delivery systems.

The deeming rule requires that any new product (any tobacco product not commercially marketed in the US as of February 15, 2007) must go through a Pre-Market Tobacco Application (PMTA) process to stay on the market (the deadline to submit a PMTA was August 8, 2022 for non-combustible products and August 8, 2021 for combustible products), and a Modified Risk Tobacco Product Application (MRTPA) in order to make any health claims about relative risk compared to continuing to smoke cigarettes. Products that have been subjected to small changes from the original “grandfathered product” (products on the market before February 15, 2007) must submit a Substantial Equivalence Report (SE) or an Abbreviated SE report so the product can stay on the market without a PMTA. This infographic maps the pathways a nicotine containing product can take to get to market). The PMTA pathway requires that the applicant proves that the product would be appropriate for the protection of the public health. The statute does not define that standard further. The FDA has released draft guidance documents, however, at the time of writing, none of them have been finalised meaning that they are not enforceable and the agency can change them at any time. To date, only eight PMTA orders have been granted for Swedish Match’s General Snus products.

See also p. 93 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)

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