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Commentary By Charles Hughes

E-Cigarettes Not a Path to Teen Smoking

Economics Regulatory Policy

The rate of cigarette smoking among high school students continued to decline in 2016, according to new survey data from the Centers for Disease Control and Prevention. Tobacco use is one of the leading causes of preventable deaths and disease in America, so the reduction is welcome news.

Unfortunately, a person relying on the headline findings from the CDC report might not be aware of the good news because the agency draws no distinction between the different types of smoking.  Because e-cigarette use rose since 2011, the aggregation of cigarettes and e-cigarettes leads to the conclusion that current use of any tobacco product did not change significantly” from 2011 to 2016.

The aggregate rates of use across all products masks the divergent trends for most forms of combustible tobacco products, such as cigarettes and cigars, from the recent growth in e-cigarettes.

The report cites an increase in e-cigarette smoking since 2011 as part of the reason. In part because they are a relatively new technology, up until this recent survey e-cigarette use among high school students had increased each year, from 1.5 percent in 2011 to 16 percent in 2015. In 2016, the rate declined from to just over 11 percent.

The growing prevalence of e-cigarettes sparked fears in some corners that they would only become more popular, and they might serve as a gateway to traditional cigarette smoking for young Americans. As far back as 2013, then-CDC Director Thomas R. Frieden noted the “concerning trends” in increased e-cigarette use and emphasized the need to “make sure that e-cigarettes don't lead to another generation of kids becoming addicted.”

The most recent decline in both cigarette and e-cigarette use should allay both of those concerns to some degree. The proliferation of e-cigarette use has not led to a corresponding reversal in the long-term trends of falling cigarette smoking among high school students. The rate for cigarette smoking fell each year, from 15.8 percent in 2011 to 8 percent in 2016. The proportion of high school students using two or more types of products also fell, from 12 percent to 9.6 percent. These trends suggest that, at least so far and with the survey data available, youth e-cigarette use is not translating into combustible tobacco products with their noted links to health problems. 

Rate of Current Use by High School Students, 2011-2016

Source: Centers for Disease Control and Prevention, “Tobacco Use Among Middle and High School Students — United States, 2011–2016,” June 2017.

The continued decrease in youth smoking of traditional cigarettes also seems to indicate a lack of evidence of a gateway effect for e-cigarettes. While it is not really possible to know how the rate of traditional cigarette smoking would have evolved if e-cigarettes had never been introduced, the vast majority of youth e-cigarette users do not use any nicotine with them, eroding one of the main factors tying the two.  Michael Siegel, professor at the Boston University School of Public Health, wrote that the new survey “should put to rest the contention that electronic cigarettes are a gateway to smoking among youth.”

Over the medium term, the divergence between e-cigarette use and traditional forms of combustible tobacco products such as cigarettes has important health implications. The effect of e-cigarettes on health should be an area for further study, but an independent evidence review from Public Health England concluded that e-cigarettes were “around 95 percent less harmful than tobacco.”

For the first time since records were kept, e-cigarette use among high school students also fell, from 16 percent in 2015 to 11.3 percent in 2016. The Food and Drug Administration in August 2016 deemed e-cigarettes as subject to its regulatory authority, and as such, subject to a minimum sale age of 18, nationwide. While it is may be possible that this nationwide imposition had a marginal effect, only two states did not already have these minimum age laws, and 39 states had such a regulation in 2014. Furthermore, the use rate for middle school students also saw a decline from 2015 to 2016, and this population was less likely to be affected by recent intensifying of minimum age laws.

The release from the CDC lauded “The Real Cost,” the FDA’s first national tobacco public education campaign, which started in February 2014, for driving the reduction in youth tobacco use. While it is possible that the campaign had some effect on further reducing the rates, teen cigarette smoking has fallen substantially for years predating the national advertising campaign. Focusing exclusively on a public advertising campaign could leave undiscovered important insights into the relationship between smoking of traditional combustible tobacco products and e-cigarettes.

The preliminary data suggest that e-cigarettes are much less harmful, and the newest survey data again fails to show the increase in conventional cigarette smoking some feared would result from the introduction of e-cigarettes to the market. The proliferation of e-cigarettes has also coincided with reductions in the rate that youths report using other substances, such as marijuana or opioids. 

E-cigarettes could be making it easier for youths who had previously smoked to quit, or it could be preventing would-be cigarette smokers from ever starting as they opt instead for e-cigarettes.

While the enforcement deadline has been delayed, regulations in a recent rule would threaten to drive e-cigarettes from the market before the implications of that exit are fully understood. The FDA should avoid rushing to enforce rules that could derail or slow the substantial progress in diminishing youth smoking.

Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on twitter @CharlesHHughes

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