Is There a Vaping Epidemic Among Teens?: The Policy Implications of E-Cigarettes for Teenagers

Ever since smoking electronic cigarettes, also known as "vaping," emerged on the scene, it became quite the controversial practice. Much of the debate surrounds harm reduction versus the precautionary principle. Are e-cigarettes a safer alternative for people? Should we be safe rather than sorry? I have analyzed e-cigarettes on this blog on a couple of occasions (see here and here). My conclusion was that the harm reduction principle is the more convincing of the arguments, that is to say that e-cigarettes are the less harmful (and thereby less evil) of the options. Allowing people a safer alternative to traditional cigarettes sounds like a win-win (maybe not for tobacco companies, but surely the consumers).

It might not be a win for everyone, especially teenagers. Only yesterday did the federal government issue a press release on its findings from its Monitoring the Future survey. One of the main findings is that teen e-cigarette usage increased from 11 percent in 2017 to 21 percent in 2018. This is significant because it is the largest year-to-year increase for any adolescent substance abuse outcome in the 43 years the survey has been conducted.

That might not sound so bad since e-cigarettes are less harmful than traditional cigarettes. However, combine that finding with an article that research organization Rand Corporation released yesterday on teen vaping. The article argues that for this sub-segment of e-cigarette consumers, e-cigarettes are more harmful because e-cigarettes lead to increased likelihood to smoke traditional cigarettes. The Rand Corporation cited a meta-analysis corroborating their theory (Soneji et al., 2017). From a public health standpoint, this is something serious to consider. When looking at e-cigarettes for adults, the idea is the adults go from consuming something more harmful to something less harmful. If e-cigarettes are indeed a gateway to traditional cigarettes, the introduction of e-cigarettes could be harmful to future adults.

In order to understand the trends with vaping, we need to understand the trends of traditional cigarettes, as well, because e-cigarettes and traditional cigarettes are substitute goods. This is important because the question is whether e-cigarette usage among teens causes an increase of tobacco consumption, a decrease, or has no real effect. According to the Centers for Disease Control and Prevention's (CDC) and its most recent survey data of tobacco use among middle and high school students, overall tobacco use for high school students has actually declined.

The CDC found that tobacco consumption was on the decline for middle school students, as well (see below).

How do we deal with the seemingly contradictory findings between the CDC and the Rand Corporation? Through an article in Tobacco Control that was co-authored by Georgetown University public health researcher David Levy (Levy et al., 2018). While e-cigarettes smoked by youth are associated with "an increased risk of ever using [traditional] cigarettes (smoking) and moderately associated with progressing to more established smoking," the report also found that "recent increases in vaping have been associated with declining rates of youth smoking."

In short, what the data tell us is that although the introduction of e-cigarettes makes it likely for some teenagers to smoke, the overall trend is that e-cigarettes reduce the probability that teenagers smoke tobacco products. Combine that with the fact that the British government found that e-cigarettes are 95 percent less harmful than traditional cigarettes, and the argument of e-cigarette opponents go up in smoke. I hope that people take a closer look at the data instead of demonizing a product that has the ability to save hundreds of lives.