A new report from CDC about middle- and high-school students’ motivations for vaping contains some interesting results, as well as one meaningless result that will be used in attacks on vaping. The study, which included coauthors from the FDA, reported results from from the 2016 National Youth Tobacco Survey. As with most CDC reports, the new report is potentially informative so long as one only looks at the tables of results and is not distracted by the accompanying propaganda in the prose.
Within hours of publication, the FDA was sending out tweets trying to spin the results as dire or policy-relevant. They tried to suggest the results were somehow alarming, even though they were fairly predictable. Moreover, whatever students’ expressed motivations, they do not change the prevalence of vaping or any harms the FDA claims it causes. The study had to produce some result, and it is apparent that the FDA would have offered the same spin for any result. In terms of policy relevance, the only solid results show that some popular anti-vaping policies are misguided.
Subjects who had ever tried an e-cigarette were given eight possible reasons for vaping, along with a “some other reason” option.
Eight percent of the students who had ever tried vaping indicated they vaped “to try to quit using tobacco products, such as cigarettes.” The figure was 19 percent among the group that matters, current vapers (defined as having vaped at least once in the last 30 days) who smoke. While this is not as high as the same answer would be for adult vapers, it is still substantial and indicates that many teenagers are using vaping for smoking cessation. This means the policy goal of keeping vapor products out of the hands of teenagers means causing some of them to keep smoking, just as it would with adults.
Almost no students cited access or costs as a motivation. This suggests that policies designed to increase costs (taxes) or further reduce availability — to protect the children! — are misguided. Only 3 percent of those who had ever tried vaping affirmed “they cost less than other tobacco products such as cigarettes” as a motivation (unfortunately, this comparison was the only question about cost). The results were so low for current vapers that they were not even reported. This is not surprising since most teenagers who can afford any tobacco product have enough income, all disposable, that the cost difference is not important to them. This contrasts with adult smokers, many of whom are motivated to switch by the cost advantages of vaping. Only 5 percent of those who had ever tried vaping affirmed “they are easier to get than other tobacco products such as cigarettes” as a motivation (again, too few current vapers affirmed this to even report the result). This is also not surprising given the ease with which teenagers can get cigarettes.
The FDA will presumably fixate on this result: That “they are available in flavors, such as mint, candy, fruit, or chocolate” was affirmed by 31 percent of those who had tried vaping, 41 percent of current exclusive vapers and 46 percent of current vapers who smoke. This is presumably going to be used as rationalization for policies that restrict flavor choices, claiming that doing so would be targeting vaping by minors. But what does it really mean?
To answer this, it is important to consider the question actually asked: “What are the reasons you have used e-cigarettes? (Select one or more).” A careful scientist or philosopher might observe “reasons” implies causation (though it is somewhat ambiguous). This would mean the question is saying, “I would not vape (or have tried vaping) were it not for this.” This interpretation is how the results about flavors will probably be spun. But most respondents will read the question as meaning merely “does this make it more substantially attractive to you?” or even merely “do you like this characteristic?”
Consider that one of the options is “famous people on TV or in movies use them” (unsurprisingly — though in contrast with some of the hysteria — affirmed by a mere 2 percent). While someone might see vaping as more attractive because of some celebrity vaper, it is difficult to imagine anyone giving up vaping if there were no vaping celebrities. By including this option, the survey authors are both signaling and effectively acknowledging that the question is not about causation. Rather, it is merely about having some degree of appreciation, and each subject is left to decide their own threshold for how intense the appreciation must be.
Thus, the very few affirmations for the questions about cost and access mean that the students really do not care about these. This further strengthens the conclusion that policies that target those factors are misguided. But for the flavors question it means that it is impossible to conclude banning particular flavors would substantially reduce teenage vaping. Yes, many of them — though still a minority — express that they like the flavors, but that is not the same as saying that the flavors cause them to vape (and thus that removing the flavors would cause them to stop).
Moreover, if an exclusive vaper would give up vaping just because of limited flavor choices, chances are she is not using nicotine. At a minimum she at does not care much about consuming nicotine. Since the scaremongering about teenage vaping focuses on nicotine “addiction,” this is an additional reason why this statistic does not support the policies it will be used to rationalize.
Perhaps most important, the preference for flavors was strongest among the smokers. This suggests that interesting flavors play the same role for teenager smokers as they do for adult smokers: offering an affirmative advantage of vaping over smoking, making switching to the low-risk alternative more attractive.
The response “friend or family member used them” was affirmed by 39 percent. This is another fairly meaningless response that might be intentionally misinterpreted. If someone knows anyone who vapes, he is more likely to feel positive about vaping. But this does not mean that observing vaping, let alone peer pressure, caused him to vape when he was otherwise negatively disposed to doing so. Yet there is a good chance the result will be misinterpreted that way. Interestingly, this statistic was only 27 percent among the current vapers who smoke, indicating that most of them discovered the option of vaping even without a friend to guide them.
Only 17 percent of ever-triers and 24 percent of current vapers affirmed the response “they are less harmful than other forms of tobacco, such as cigarettes.” This might indicate that anti-vaping propaganda has been successful, and that few teenage vapers even realize it is low risk. But it might just be that few of them care much. Indeed, among the nonsmokers, it might even reflect a deeper wisdom: They might realize that any risk is trivial, and care about that, but do not affirm this particular phrasing. Merely being less harmful than smoking, which still includes a wide range of very harmful, would not be good enough. In any case, responses to this question are far too ambiguous to interpret.
Among smokers, 16 percent affirmed “they can be used in areas where other tobacco products, such as cigarettes are not allowed” (unsurprisingly few or no exclusive vapers affirmed this response). It is actually a bit surprising how high this is given that teenagers are unlikely to be allowed to vape with impunity in places where smoking is not allowed.
Notably absent from the options was anything about nicotine. There was nothing about wanting to consume nicotine (except obliquely in the question about quitting smoking). There was nothing about liking vaping because of the nicotine-free option. Subjects affirmed “some other reason” 32 percent of the time. Were they motivated by the benefits of nicotine, or something else? We are never going to learn that from this survey.
On a more technical note, that “some other reason” option makes clear that the survey authors did not intend the question to be interpreted as causation, and that subjects did not interpret it that way. If it were interpreted that way, then 100 percent would have indicated that there are other necessary causal characteristics (e.g., “I would not vape if an e-cigarette were the size of an elephant”). This further demonstrates that spinning the results as a reason to ban flavors is a willful misinterpretation of the results.
As with most survey research about tobacco use, the survey design was simply abysmal. The question was extremely ambiguous in terms of how respondents would interpret it, a fatal flaw. In this case it means that when very few subjects affirmed a response we can conclude that it was an unimportant motivation. But if more subjects affirmed the response we have no idea what they were actually saying. In addition, the list of possible responses omits several important possible motivations. Given their enormous resources, it is pathetic that the FDA and CDC could not conduct a more competent survey.