//BTH#4 – Are concerns of a teenage ‘vaping epidemic’ overblown?

Behind the Headlines is a regular feature taking a slightly deeper dive into a piece of recent media coverage of NGP research.

This edition’s story:

‘Are concerns of a teenage vaping epidemic overblown?’

When the US government first released the NYTS (National Youth Tobacco Survey), multiple media outlets – including CNN – reported a “surge in teen vaping”.

However, later in January 2020, New Scientist reported research by the New York University School of Global Public Health (NYUGPH) (study authors were Glasser et al.) suggesting concerns this “teenage vaping epidemic” may have been overstated.

The research, which re-analysed the NYTS, was published in the Nicotine & Tobacco Research journal. Reporting on the findings, The New Scientist concluded the data could in fact “be seen as good news for teenagers’ health”. They quoted study author David Abrams, who contended: “There has been a massive focus on teens, without making it clear that most of these teens would be smoking anyway.”

How was the research conducted?

Researchers analysed the 2018 NYTS in which 20,189 people were interviewed. The data survey analysed frequency of vaping, exclusive vape or EVP (electronic-vapour products) use, past 30-day poly-product use – defined as using an EVP and one or more tobacco product – and any past tobacco product use.

What did the study authors find?

• 81.4% of students “had not used any tobacco or vapor product in the past 30 days”.
• 86.2% “had not vaped in the past 30 days”.
• The authors concluded that vaping increased among US youth in 2018 over 2017. However, these increases were characterized by three patterns of use: 1) Low past 30-day vaping frequency; 2) High poly-product use (i.e. using vapes in conjunction with other products such as cigarettes); 3) Low prevalence of frequent vapers who had never used tobacco.
• Among all students, of the 13.8% who vaped in the past 30 days, just over half vaped on ≤5 days (7.0%). Roughly a quarter of the 13.8% vaped on 6-19 days (3.2%) and on 20+ days (3.6%)”.
• Most vapers (defined as someone with 60.0%-88.9% frequency of EVP use) had previously used tobacco, either in the past 30 days or ever. Only 4% of students had not used tobacco but had vaped in the past month, but of that 4%, very few (0.4%) vaped regularly on 20 or more days.

Our take on the research…

Imperial Brands is clear: Next Generation Products (NGP) should only be used by current NGP users (and former adult smokers) or current adult smokers.

The study results suggest that EVPs are often used by youth who either have used or currently use tobacco.

We refer to all-youth use of NGPs as “unintended”, regardless of whether they currently or have ever used tobacco. Demonstrating that an NGP does not incur significant intended use is part of our burden of proof for population public health benefit, forming a fundamental part of our scientific assessment framework. (link to sci research intro page)

The study illustrates that vape use in US youth is significantly more nuanced than some media and regulators might have us believe. As the study’s press release concluded: “while there has been fear that e-cigarettes are introducing nicotine to many young people who otherwise would not have smoked, the data show[s] otherwise – only a small proportion of tobacco-naïve youth report vaping.”

Did the study have any limitations?

• The study uses self-reported data

Survey data often relies on people self-reporting product use and lifestyle which can produce response bias. People often misreport answers to questions owing to inaccurate recall or they provide dishonest answers, providing what they believe the answer to a question ‘should’ be. We call this recall or response bias and it can lead to unreliable data.

• This study uses cross-sectional survey data

The study is cross-sectional as it’s collected at one specific time point, rather than continually. Cross-sectional data cannot determine initiation and cessation of products over time. The authors therefore cannot establish causation from the research.

• Product use was not biochemically verified.

The authors have relied on participants self-reporting product use, which is potentially open to both recall and reporting biases.

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