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The US Food and Drug Administration (FDA) recently highlighted the success of its Real Cost public health campaign in preventing youth e-cigarette uptake.
The FDA said its campaign had prevented almost 450,000 kids from trying an e-cigarette in one year. It based this information on a study performed by researchers from RTI International – a scientific research institute – and the agency itself.
The results were published in the peer-reviewed American Journal of Preventive Medicine. They were based on a survey of around 3,400 respondents under the age of 18 which was then extrapolated to apply to the near 450,000 nationally. It found that as exposure to Real Cost ads went up, the chance of initiation went down. This was the first study to consider the impact of the Real Cost campaign on e-cigarettes specifically.
Is the study bias-free and science-based?
Researchers said they controlled an array of variables previously shown to be associated with vaping use, including income, parental communication and social media use. Respondents were also told to exclude cannabinoid vaping products in answering questions about whether they had every tried vaping nicotine.
However, the sample was created by the use of address-based sampling to identify households for inclusion which were then sent invitations via post for an adult to complete a screening survey before being asked to provide permission for their child to participate.
This suggests a risk of self-selection bias. After all, only parents interested in this issue would respond to the survey, go through the screening process and then give permission for their children to participate.
Beyond that, there are questions about how much of the science gets mixed up in promotional messaging for the FDA. Is it possible for there to be both a youth vaping crisis and a really successful public health awareness campaign on youth e-cigarette uptake prevention? Surely the existence of one negates the other.
It was also interesting to note that the press release promoting the success made sure to mention that the Real Cost campaign was expanded to include e-cigarettes for the first time in 2018 during the first administration under president Donald Trump, highlighting his “leadership” on the issue. Probably a smart move to make at a time when federal employees are attempting to justify their jobs.
Experimentation with nicotine pouches on the rise
Overall youth vaping numbers have been continuing to fall throughout the timeframe of the addition of vaping to the Real Cost public health campaign – something the researchers do acknowledge. They say they cannot rule out the impact of tobacco control strategies implemented during the same time period, including the increase of the minimum purchasing age for all vaping and tobacco products to 21 or various state-level actions.
And at the same time, current use of nicotine pouches has risen over the past two years from 280,000 in 2022 to 480,000 in 2024, now representing 1.8% of US middle and high school students (ages approximately 11 to 18). For 2024, the US National Youth Tobacco Survey also found that almost 900,000 had at least tried a pouch – the sort of initiation behaviour the Real Cost campaign is said to be stamping out in youth vaping.
This all but confirms that US officials will start to look at addressing youth use of pouches in the near future. But for the time being, there is also a question of whether some of that desire to experiment has simply led to a switch in initiation from vaping to pouches. One obvious play now is to add pouches as well to future iterations of the Real Cost campaign. Perhaps this would lead to a decline in youth initiation the way it has potentially done for vaping. But then will kids simply move on to the next product? If so, what is that likely to be? And what does it mean for adult users?
Still trying to find a balance to benefit adults and protect kids
The FDA still has a fine line to walk for the best public health outcomes. It wants to discourage youth experimentation and uptake with nicotine products, including e-cigarettes and pouches. But it has also – some would say, grudgingly – started to admit to the cessation potential of reduced-risk products.
In the most recent press release, for instance, the FDA does state: “Adults who smoke should also know that different types of tobacco products exist on a spectrum of health risk, with smoked products such as cigarettes being the most harmful. Adults who fully switch from cigarettes to a lower-risk alternative tobacco product can generally reduce their health risks and exposure to toxic and cancer-causing chemicals.” But it then adds the caveat: “There is no safe tobacco product. Those who do not currently use tobacco products, especially youth, should not start. Additionally, there are medications that have been approved by the FDA to be safe and effective for adults who want to quit smoking.”
And it highlights entities such as the Vaping Prevention and Education Resource Center with no suggestion that prevention should only be for young people or non-smokers. It all still suggests the FDA is very slow and somewhat reluctant to embrace market-driven innovations in nicotine products. And that is unlikely to change quickly, regardless of a Trump presidency.
– Freddie Dawson ECigIntelligence staff
Photo: Patrick Buck
