A recent report from the Centers for Disease Control and Prevention (CDC) found that in 2021, among American adults currently using e-cigarettes, 40.3 percent had formerly smoked cigarettes. While this information is long overdue, it is welcome and adds more power to the efficacy of e-cigarettes (and other tobacco harm-reduction products) in enabling adults to quit smoking and remain smoke-free. It also comes on the heels of the Food and Drug Administration’s recent move to cease using the term “youth vaping epidemic.”
In a March Morbidity and Mortality Weekly Report, researchers at the CDC examined the smoking status among U.S. adults that were current e-cigarette users in 2021. Using data from the National Health Interview Survey (NHIS), the CDC found that 4.5 percent of adults were using e-cigarettes in 2021. Of those, 40.4 percent had formerly smoked, 30.3 percent had never smoked, and 29.4 percent used combustible cigarettes. Younger e-cigarette users, 18 to 24 years old, were more likely to never smoke than adults age 25 to 44.
The CDC annually conducts the Behavioral Risk Factor Surveillance Systems survey, which monitors adult e-cigarette use. The survey “completes more than 400,000 adult interviews each year,” compared to the NHIS, which interviewed 87,500 adults. In 2021 (according to the 2021 BRFSS), 6.7 percent of American adults (17.3 million) were using e-cigarettes. This represents a 45.6 percent increase from 2017, when 4.6 percent of American adults (11.6 million) were using e-cigarettes.
Meanwhile, between 2017 and 2021, the percentage of American adults using combustible cigarettes decreased by 15.8 percent. Examining the numbers even further, there were 5.7 million more American adults vaping in 2021 compared to 2017. Additionally, 5.8 million fewer American adults were smoking combustible cigarettes in 2021 than in 2017.
Opponents of alternatives to cigarettes used a supposed youth vaping epidemic to continue to push for banning flavored tobacco and vapor products and excessive excise taxes on these products.
There is no youth vaping epidemic. While it was correct to use the term to describe the rapid increase in youth vaping between 2017 and 2019, the percentage of youth currently using e-cigarettes (on at least one occasion in the 30 days prior) declined by 53 percent between 2019 and 2022. In 2019, according to data from the CDC’s National Youth Tobacco Survey, one in five U.S. middle and high school students were using e-cigarettes. By 2022, this had halved, with less than one in 10 using e-cigarettes.
Even the FDA is recognizing this. In a February webinar, Dr. Brian King (the director of the Center for Tobacco Products at the FDA) remarked that the agency “has not used that (youth vaping epidemic) terminology for the most recent estimates of youth use” as the “science has shown a decline in the number of youth users.”
Anti-vaping organizations are quick to point to the COVID-19 pandemic as a reason for youth vaping’s decline. More than 28,200 students participated in the 2022 NYTS, with 99.3 percent of those students “completing (the survey) on a school campus.”
The notion of “saving the kids” has long stood in the way of adult access to alternatives to smoking. In January, the FDA denied the marketing authorization of two menthol-flavored e-cigarette products. In the denial, Dr. King announced that the applications “did not present sufficient scientific evidence to show that the potential benefit to adult smokers outweighs the risks of youth initiation and use.”
The fact is that youth use is declining. Neither the FDA nor any other public health group has acknowledged the percentage of youth using new products is acceptable to allow adults access to the same products. Youth use all sorts of age-restricted products, yet vaping — and increasingly traditional tobacco products — seem to bear the brunt of regulatory scrutiny and calls for prohibition.
In 2021, according to the CDC’s Youth Risk Behavior Survey, 23 percent of high school students consumed alcohol, compared to only 18 percent who reported vaping. Yet, no one is crying afoul over newer alcoholic seltzers available in various flavors, from Faerie Fizz to Tangy Lemon Lime and Exotic Pineapple.
Amazingly, public health in America once relied on the U.K. Royal College of Physician’s 1962 report on smoking for its own 1964 surgeon general’s report that came to the same conclusion: cigarette smoking causes cancer. Yet, more than half a century later, the same public health organizations are ignoring the RCP, which has found vaping “unlikely to exceed 5% of the harm from smoking tobacco” and that e-cigarettes should be promoted “widely as a substitute for smoking.”
E-cigarettes (and other novel tobacco harm-reduction products) have shaken up the consumer marketplace and have not led to increases in smoking rates. Nearly half of adult e-cigarette users in America in 2021 had formerly smoked, and there is no youth vaping epidemic.
It’s time for American public health leaders to drop the alarmism and start embracing (and promoting) alternatives to smoking.
