Policy-makers in the U.S. have been making decisions based on incorrect assumptions according to a new study, which has concluded that the vast majority of U.S. youth vapers are using e-cigs for flavours not nicotine.
The study by academics from the University of Michigan is the first in the U.S. to try and determine what substances student vapers actually use in their e-cigs. Around two-thirds (65-66%) of those surveyed reported vaping just flavouring compared to 16.5% using nicotine.
Around 6% said they used marijuana while roughly 9% said they did not know what substance they were using. This means that the combined total of all students using all other substances was overshadowed by the number only using flavouring, said the study, published in the journal Tobacco Control.
“Nicotine is assumed by many to be the predominant substance that youth vape, although, to the best of our knowledge, this assumption is not based on the scientific data,” the academics said.
“This finding challenges many common assumptions and practices, and points to the need for vaporiser-specific research to assess and ultimately regulate the public health threat of vaporisers. Taking into account this finding now, while the field is young, will help ensure that future vaporiser science and regulations are built on a solid footing.”
For example, the current assumption of e-cig use as synonymous with nicotine use leads to a doubling of past 30-day tobacco/nicotine prevalence in 12th grade and nearly triples the number in 10th and 8th grades as compared to estimates based on conventional cigarette use alone, the researchers said.
But if e-cig users are considered nicotine users only if they vaped with nicotine in the last 30 days, then national estimates of nicotine prevalence increase by a much smaller percentage of 23% to 38% across the three grades. This is still an increase in tobacco/nicotine prevalence, but it’s not nearly as large as has been stated recently, they added.
These results indicate that while taking into account vaporiser use does indeed increase tobacco/nicotine prevalence, the impact of e-cigs is not as large as it might be suggested by their recent increase in use among adolescents.
This has significant implications for policy makers. For example, if youth are not using nicotine in their e-cigs and scientists have been unable to conclusively show vaping itself impairs health, then it becomes difficult to regulate e-cigs on health grounds. This is particularly true if devices and e-liquids are considered as separate categories, the scientists said.
Future policy may have to draw more on alternative reasoning such as e-cigs leading to renormalisation of smoking or arguments that children are more at risk of unintentionally vaping harmful substances, the scientists added.
The study used data collected by the Monitoring the Future survey, an annual, nationally representative survey of USA 12th-grade, 10th-grade and 8th-grade students (roughly aged 18, 16 and 13) in 48 states (excluding Alaska and Hawaii).
Students were asked whether they had ever used an e-cig, with around one third of respondents saying they had tried an e-cig at some point in their lives.
Those that had were then asked how frequently and what substance was used the last time they vaped. The options they could select were: nicotine, marijuana, just flavouring, some other substance, and do not know. This enabled the researchers to answer one of the requests for further research they asked last year.
Nicotine use was lowest among students in the 8th grade, which also had the highest percentage of respondents that did not know what they vaped.
The highest level of nicotine use was to be found among 12th graders that vaped 6+ times a week, although in no case did the prevalence of nicotine vaping exceed 50%. This was also the group with the least amount of ‘don’t know’ answers (2%). This is presumably because they are more intentional in the substances that they vape, the researchers said.
However, further longitudinal studies will be needed to determine whether the increase in nicotine use is as a result of younger vapers progressing to nicotine or due to an influx of new vapers at older ages – presumably moving from conventional cigarette use, the researchers added.
“This result indicates that the importance of the cut-off between vaping 1-5 as compared to 6+ times in the past 30 days – a threshold highlighted by previous research – extends to substances vaped,” they said.
However, the 6+ vaping group was too small for real in-depth analysis. The paper cannot establish whether they are vaping exclusively or dual using. Further, more detailed questions to collect better data on all the substances vaped in the recent past by all age groups would also help provide clearer analysis, the academics added.
What This Means: It’s surprising to see such a conclusion from a U.S. study. A few UK studies have found very similar results but until now all U.S. papers have concentrated on the rise in youth e-cig use without questioning what was actually being vaped.
It is unlikely that the study on its own will have much of an impact on U.S. vaping policy but it is good to see academics are trying to address the very questions e-cig proponents have raised with so many of the previous American youth vaping papers.
Interestingly the Associated Press, about as unbiased as media can get, seemed unimpressed by replies to the study from the Centers for Disease Control and Campaign for Tobacco-Free Kids – both typically stiff opponents of e-cigs.
– Freddie Dawson ECigIntelligence staff
Photo: Valentin D.