The CDC has released their 2015 estimates of the US prevalence of vaping, smoking and other tobacco product use. As expected, the messaging they pushed to the mainstream media in their press release focused on the policy preferences of the CDC’s and the FDA’s anti-tobacco units. That message, a call for more aggressive actions, would have been the same no matter what the data showed. However, it is possible to learn from both the actual study results and the press release.
The data came from the National Health Interview Survey, which historically has given lower usage estimates than alternative methodologies, so the results should be seen as lowball estimate. The new results are for questions that ask “do you now use…” and answers of “every day” and “some days” are combined.
About 3.5 percent of the US population vaped in 2015, including those who also still smoke cigarettes or use another product. This rate had solidly surpassed the 2.3 percent who used the other major low-risk product, smokeless tobacco. The rates were basically the same for men, at 4.3 percent for e-cigarettes and 4.4 percent for smokeless tobacco (vaping is considerably more common among men than women, but smokeless tobacco users are almost all men).
These rates were eclipsed by the 17.6 percent who used combustible products, which also skewed toward men (21.0 percent versus 14.4 percent for women).
As previously reported based on NHIS data, vaping rates closely tracked smoking rates across most demographics, the inevitable result of vaping being used as a replacement for smoking. Only African-Americans fell substantially behind. The new report shows that among the youngest adults, vaping was more popular than the previous numbers suggested, both in absolute terms and in comparison to smoking. The smoking rate for 18-24 year olds was the same as for the population as a whole, but vaping was considerably more common at 5.2 percent.
The press release included a statement by FDA Commissioner Scott Gottlieb which mentioned “efforts to encourage innovation of potentially less harmful products.” However, the presentation of the statistics suggest that other influential government officials do not share this view, and perhaps the statement is just cheap talk on Gottlieb’s part.
The statistics presented make it impossible to estimate the success and potential of tobacco harm reduction, presumably intentionally. In particular, the report lumps together a meaningless “use of two or more products” (3.9 percent). This includes people who vape and still smoke, but also smokers who use both cigarettes and cigars. It is not possible to determine how many vapers were ex-smoking exclusive vapers. Nor is it possible to know how many users of more than one product both smoked and used a low-risk product (making them good candidates to encourage to use only the low-risk product).
All that information is available in the data, but reporting those numbers will have to wait for other analysts who do not share the government’s agenda.
Moreover, the headline of the press release was “One in five US adults still using tobacco products in 2015.” This refers to the 20.1 percent who reported using any product. The CDC and FDA consistently present this overall rate when making claims about population health, conflating low-risk and high-risk products. This helps the agencies seem more relevant, and protects their budgets and political support. It hides the fact that the tobacco use that has substantial health effects – smoking – continues to trend downward.
The FDA is using the fairly steady rate of any-product use to justify an increasingly extreme anti-smoking agenda despite the drop in smoking rates, especially among young people. At the same time, the conflation of products also gives them an excuse to wage war on low-risk products: If they trick people into thinking the overall use statistic is actually a measure of population health risks, then they can justify attacking vaping and smokeless tobacco use too.
The 20.1 percent rate is interesting because statistics across time and populations suggest it is the soft floor for combined product use in any population where people can afford tobacco products and their use was ever established. Except in cases of extremely draconian policies (e.g., in Australia where e-cigarettes and smokeless tobacco are banned and smoking is heavily punished with taxes and other policies), this total rate does not drop below 20 percent.
Presumably CDC and FDA are aware that the natural level of tobacco product use, in a population where there is not social condemnation and there is little worry about health effects, is in the range of 50 or 60 percent. This seems to be the portion of the population who like the experience of using nicotine or other aspects of tobacco use. Historically, and in much of the world today, the “little worry about health effects” condition meant that people smoked but did not realize the health effects, or were rationally more worried about more immediate threats. In the future the condition will be met because many people realize that vaping poses approximately no risk (and perhaps they will learn that about smokeless tobacco also).
This means it is quite likely there will be an upward trend in the misleading “total product use” statistic even as smoking continues to decrease. As long as these US government agencies, and others, can get away with conflating smoking and low-risk product use, they will be able to demand more resources and justify increasingly illiberal tactics.