November 3, 2015
“The cross-sectional analysis does not allow direct estimation of flavoring’s role in initiation of tobacco use among youth.”
Flavored tobacco products appeal to youth. That’s the FDA’s message in a new report published in JAMA on Oct 26.
“The majority of youth ever-users reported that the first product they had used was flavored … including 81.0% of e-cigarette users.”
“For past 30-day youth tobacco use, the overall proportion of flavored product use was 79.8% among users of any product and … 85.3% among e-cigarette users.” [Emphasis mine]
Of course the media feeding frenzy started within minutes of JAMA’s publication. Note the headlines:
U.S. News and World Report: Kids Drawn to ‘Gateway’ Flavored Tobacco Products, FDA Finds
Medical News Today: Is flavored tobacco to blame for teen smoking?
Los Angeles Times: First-time tobacco users lured by flavorings, report says
99% of the public reading this report will respond with alarm. Exactly what the FDA intended. The problem is that 99% of the public will not actually read the report. Instead, they will read the biased interpretation of portions of the report carefully crafted by the FDA, CDC, ALA and the media.
The findings of the report are based on an analysis of the 2013-2014 “Population Assessment of Tobacco and Health (PATH) Study”. The PATH study includes adults and youth. The total number of youth (ages 12-17) surveyed was 13,651. The report includes two tables created by the authors.
Table 1 includes figures for “Ever Product Use” and “Past 30 Day Product Use”. The following numbers are taken directly from that table.
Ever Use of Any Tobacco Product:
2,900 or 21.4%. Out of 13,651 youth surveyed, one in five had ever used any “tobacco product”. Almost 80%, or four out of five, had never used any tobacco product.
Ever Users reporting their first product was flavored:
2,256 or 80.8%. Of the 2,900 ever users of a “tobacco product”, four out of five used a flavored product.
Ever Users reporting their first product was an e-cigarette:
1,452 or 10.7% of 13,651 youth surveyed. One in ten ever users, of any tobacco product, chose an e-cigarette.
Ever Users reporting their first use of an e-cigarette was flavored:
1,154 or 81.0% of the 1,452 ever users of an e-cigarette. Four out of five first time youth e-cigarette users chose a flavored e-cigarette.
Notice how the percentages fluctuate dramatically, in a pattern. Low, high, low, high. Why? For two of the comparisons in the table, the authors reported percentages of the total 13,651 youth surveyed. Resulting in lower percentages. When they wanted to report alarmingly high percentages, they used the much smaller subsets of 2,900 and 1,452. That’s how you generate headlines.
Now compare the Ever Use numbers, to the Past 30-Day Use numbers. The definition of Past 30-Day Use – using a product, on 1 or more days, during the past 30 days.
Past 30-Day Tobacco Product Use
1,152 or 8.5% (of 13,651). The number of Past 30-Day Users of any product – 91.5% of all youth surveyed did not use any product, even one day, in the preceding 30 days.
Past 30-Day E-Cigarette Use
418 or 3.1% (of 13,651). The number of Past 30-Day Users who used an e-cigarette. 96.9% of Ever Users of an e-cigarette did not use an e-cigarette, even one day, in the preceding 30 days.
Table 2 examines the reasons Past 30-Day Users indicated for using each of the products studied in the survey. The survey offered eleven reasons as possible options. I’ll limit the information here to the responses for e-cigarettes, and to the three reasons most often cited.
Before we look at the reasons, keep in mind that Past 30—Day Users of e-cigarettes, 418 in total, represent 3.1% of all youth surveyed. They are included if they used a product on 1 or more days during the past 30 days. “Use” defined as even a single puff.
I used an e-cigarette because they come in flavors I like.
338 or 81.5% (of 418 individuals).
I used an e-cigarette because they might be less harmful to me than cigarettes.
331 or 79.1%
I used an e-cigarette because they might be less harmful to people around me than e-cigarettes.
327 or 78.1%
As of Fall 2014, 3.1% of youth used an e-cigarette on at least one day within the past 30 days. That’s what the survey determined and that’s what the tables in their report show.
U.S. News and World Report (HealthDay) concludes:
“Candy, fruit and other flavorings are hooking America’s next generation of nicotine addicts, a new U.S. government study finds.”
The American Lung Association:
“This confirms our worst fears,” said Dr. Norman Edelman, senior scientific advisor for the American Lung Association. “Young people are being hooked on tobacco products through the use of flavoring that appeals to them.”
This in spite of the statement, in the report, by the investigators – “The cross-sectional analysis does not allow direct estimation of flavoring’s role in initiation of tobacco use among youth.”
Medical News Today starts with an undisputed fact and then just transitions to an outright lie:
“It is a well-known fact that cigarette smoking carries with it significant health risks, but the younger a person starts smoking, the more problems it can cause. Now, a new study suggests flavored tobacco products may be the main culprit in attracting young people to start smoking.”
Suggesting that electronic cigarettes attract youth to smoking is like saying soft drinks are a gateway to alcoholism.
The response by California’s Los Angeles Times is – typically California:
“Since 2009, the FDA has had sweeping powers to regulate tobacco products in the interest of the public’s health. New evidence that flavorings play a key role in easing a would-be tobacco user’s introduction to the product is sure to spark renewed debate over outlawing flavorings.”
This analysis was funded by FDA’s Center for Tobacco Products and administered by the National Institutes of Health. Four of the seven report analysts are “affiliated” with the FDA. Including the two lead investigators.
Clearly this an attempt by the FDA to build public support for regulating flavors. The fact that the report was released for publication at the same time that the FDA’s final deeming regulation is being reviewed by the OMB is hardly coincidence.
Electronic cigarettes are an opportunity to reduce smoking related death and disease. Opportunity, comes with risks. And benefits. Appropriate regulations maximize benefits. While minimizing potential, but as yet undefined, risks.
The FDA and the media would have everyone believe that the use of e-cigarettes by 418 youth should be the basis for FDA regulations. Regulations that as proposed, will eliminate electronic cigarettes as an alternative to combustible tobacco. Federal regulatory policy based on their ability to make electronic cigarettes the villain. And the FDA the hero.
Public health’s campaign is not about promoting health. It’s about promoting fear. And It’s working. But who or what should we fear the most?
The villain? Or the hero?
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Dave Coggin has a Master’s Degree in business and spent 35 years in corporate America. He is a co-founder and partner in DIYELS. He has spent the last five years actively researching and following the evolution of the e-cigarette industry. He is a strong proponent of e-cigarettes as the most promising option currently known for tobacco harm reduction. He may be contacted directly at firstname.lastname@example.org .
The opinions presented here are exclusively those of the author. Vaper’s Vortex is offered as a service to our customers and followers. Anyone considering e-cigarettes as an alternative to tobacco cigarettes should seek qualified advice from a medical professional.