(New Section: Youth - Nicotine Use) |
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===2022: [https://onlinelibrary.wiley.com/doi/10.1111/add.15838 Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time–series analysis between 2007 and 2018]=== | |||
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*Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333 | *Citation: Saul Shiffman, PhD, Mark A Sembower, MS, Janine L Pillitteri, PhD, Karen K Gerlach, PhD, MPH, Joseph G Gitchell, BA, The Impact of Flavor Descriptors on Nonsmoking Teens’ and Adult Smokers’ Interest in Electronic Cigarettes, Nicotine & Tobacco Research, Volume 17, Issue 10, October 2015, Pages 1255–1262, doi: 10.1093/ntr/ntu333 | ||
*Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission. | *Acknowledgement: This work was supported by NJOY, a company that markets electronic cigarettes, but does not make or sell any combustible tobacco products. All authors work for Pinney Associates and provide consulting services to GlaxoSmithKline Consumer Healthcare on their stop-smoking medications and to NJOY, Inc. on electronic nicotine delivery systems (ENDS). SS and JGG also own an interest in a novel nicotine medication in development. The study sponsor was involved in discussion of the study design, but had no role in study execution, data collection, data analysis, or writing of the manuscript, nor did the sponsor review the manuscript prior to submission. | ||
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=Youth Use / Risky Behaviors / ACE’s= <!--T:31--> | =Youth Use / Risky Behaviors / ACE’s= <!--T:31--> | ||
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=Youth and Regulations / Preventing Youth Use= <!--T:56--> | =Youth and Regulations / Preventing Youth Use= <!--T:56--> | ||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37409355/ How do you solve a problem like youth vaping?] === | |||
* Gartner C. Drug Alcohol Rev. 2023 Jul;42(5):1298-1300. doi: 10.1111/dar.13666. Epub 2023 May 9. PMID: 37409355 No abstract available. | |||
* But the first step to "solve a problem like youth vaping" is to ''define'' the problem. The opening statement "concerns about youth vaping are rising globally" isn't really enough for a scientific discussion, unless it's a discussion about media/political perceptions. In my view, the problem of youth vaping is primarily an ''aesthetic or'' political problem (and I agree, no one wants to see this), rather than a public health risk that should really justify strong interventions that will likely harm adults. This is because there are really two types of youth vaping: (1) frivolous experience, faddish, transitory and of little current or lasting consequence; (2) the uptake of vaping by young people who would otherwise smoke or have a high propensity to use nicotine. For these adolescents, vaping is likely beneficial - a harm-reduction diversion from smoking. So youth vaping, in public health terms, is a mix of inconsequential and beneficial. We've already seen how that played out in the US in a [https://rodutobaccotruth.blogspot.com/2023/07/astounding-smoking-vaping-statistics-in.html recent blog] by Brad Rodu. So from a scientific and public health perspective, we need a clear-eyed public understanding of the (non-)problem, before we make trade-offs to solve this problem that may cause actual harm to adults. See Mendelsohn and Hall: [https://www.sciencedirect.com/science/article/abs/pii/S0955395923001123?via%3Dihub What are the harms of vaping in young people who have never smoked?] | |||
* "''Frequent vaping of nicotine by young people who have never smoked is uncommon and there is limited evidence so far that vaping has caused significant harms in this population. At a population level, the net benefits of vaping to adult and youth who smoke are likely to outweigh the feared harms of vaping to youth."'' | |||
** Gartner provides a good discussion of the costs and ineffectiveness of addressing non-compliance with Australia's Byzantine system for accessing vapes legally, and draws out the important point that people will often comply with laws without extensive enforcement if they think the laws are just and proportionate. Laws that allow cigarettes to be available everywhere, but greatly restrict access to far safer alternatives for people who want to use them to quit smoking using their own money ''may not meet this test''. | |||
** Gartner dismisses a 'responsible retailer' initiative (from BAT), not on its merits but because it is "unlikely to reassure public health advocates", as if public health advocate reassurance is some sort of goal of policy. In Australia, the public health community is unlikely to be satisfied by much short of outright prohibition, but governments are elected to find working proportionate solutions to actual problems. However, she immediately notes that ''irresponsible'' retailing provides illicit under-the-counter sales, including to children - but concludes that regularising the consumer trade would not reduce youth uptake. | |||
** She notes the pronounced anomaly in the availability of cigarettes and vaping products and recommends finding "new models of controlled supply for harmful products like cigarettes and NVPs" that will command enough public support to be self-enforcing. But what is the evidence that controlled supply doesn't have massive unintended consequences? Or that the use of coercive supply-side measures and enforcement are ever an effective and respectful way for the state to address demands for a substance? In this case, an almost benign and innocuous substance? | |||
** Worth noting the FOIA release of internal papers of the Australian National Advisory Council on Alcohol and Other Drugs (ANACAD) assessing the Australian government's quasi-prohibition policies. Like a voice of sanity. See Colin Mendelson's blog summarising: [https://colinmendelsohn.com.au/anacad/ Expert committee’s advice on vaping is dynamite to Butler’s prohibition model] | |||
* "''Further restrictions will likely only make the problem worse and we’ll end up criminalising more people. Regulation that is too severe risks making smoking more attractive"'' | |||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37364525/ An experimental evaluation of the effects of banning the sale of flavored tobacco products on adolescents' and young adults' future nicotine vaping intentions.] === | |||
* Dunbar M, Setoji CM, Martino SC, Jensen D, Li R, Bialas A, Shadel WG. Addict Behav. 2023 Jun 19;145:107784. doi: 10.1016/j.addbeh.2023.107784. Online ahead of print. PMID: 37364525 | |||
* An experimental purchasing study of youth (11-20 years old) in a mock convenience store, examining different conditions with different flavor availabilities: | |||
** ''Methods: The display of flavored tobacco products in the store was manipulated with these conditions: 1) tobacco, sweet, and menthol/mint flavors displayed; 2) only tobacco and menthol/mint displayed; and 3) only tobacco flavors displayed.co flavors displayed.'' | |||
** Results: Study condition was not associated with intentions to use menthol/mint- sweet-flavored, or any flavor. Compared to the condition in which all flavored products were displayed, removing menthol/mint- and sweet-flavored products significantly increased future intentions to use tobacco-flavored vaping products (OR = 3.97, 95 % CI [1.01, 15.58], p < .05). This effect was only observed among adolescents with history of vaping (OR = 11.30, 95 % CI [1.42, 89.96], p = .02). | |||
* The assumption behind flavor bans is that flavor availability will causally deter use among youth (especially non-using youth), which stems from the unproven assumption that because youth often use flavors, that flavors caused youth use. However, there is no evidence for this causation – youth might otherwise use tobacco flavor, as evidenced by youth using no-added-flavors cigarettes for decades previously. This is one of the first studies that evaluates the causality of flavor availability on youth use (another one was a Pinney paper finding that youth interest did not vary across flavor descriptors). | |||
* The results are notable in their lack of causal associations, except in increasing the intention to use tobacco-flavored products among youth who already use e-cigarettes if there are no flavors available (i.e., migrating to the remaining available products). Especially notable is that flavor restrictions did not change intentions to use among non-users (which were already low), which calls into question the fundamental motivation behind flavor bans. | |||
* I would be nice to have seen the overall levels of intentions to use in each condition to evaluate the magnitude of the effects (for those results, only adjusted odds ratios are presented) | |||
===2021: [https://www.tandfonline.com/doi/full/10.1080/17538068.2020.1860671 Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign]=== <!--T:57--> | ===2021: [https://www.tandfonline.com/doi/full/10.1080/17538068.2020.1860671 Content analysis of the use of fear in the real cost youth e-cigarette prevention campaign]=== <!--T:57--> | ||
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=Youth - Nicotine Use= | =Youth - Nicotine Use= | ||
=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37263111/ What are the harms of vaping in young people who have never smoked?] === | |||
* A comprehensive rebuttal of the concerns about youth vaping from Drs. Mendelsohn and Hall, covering several different angles. | |||
* How common is frequent vaping in never-smokers? | |||
** Frequent vaping by young people who have never smoked is uncommon in western countries with a prevalence mostly under 2%. | |||
** Measures of lifetime vaping (“even a puff”) or current vaping (at least once in the past 30-days) overestimate the prevalence of frequent vaping by those who have never-smoked because they include experimental and infrequent vaping which is the most common pattern of use in this group. | |||
* Does vaping increase the risk of taking up smoking? | |||
** Increases in youth vaping have been accompanied by an accelerated decline in smoking since vaping became popular in the US, UK, and New Zealand, suggesting either no overall gateway effect or at most, a small gateway effect that is outweighed by the much larger number moving from smoking to vaping. | |||
* What are the known health effects of vaping by never-smokers? | |||
** Nicotine itself represents minimal risk of serious harm in the doses commonly used in vaping. Nicotine does not cause cancer or lung disease and it has only a minor role in cardiovascular disease. | |||
* Do never-smokers who vape become dependent on nicotine? | |||
** Vaping can cause nicotine dependence in some young people who have never smoked. The evidence suggests, however, that this is a minority of cases, not, as the media often claim, “a new generation addicted to nicotine.” | |||
* What about the risks for young smokers who take up vaping? | |||
** Modelling studies suggest a net benefit from vaping to population health under all plausible scenarios. These models take into account harms from vaping (uptake by never-smoking youth and adults, the potential to increase smoking, inhibit smoking cessation and promote relapse) and benefits (cessation of smoking and diversion of those who would have otherwise taken up smoking). | |||
* Policy measures to reduce youth vaping | |||
** We need to recognize that overly restrictive policies intended to reduce youth vaping can have counterproductive results. | |||
* Mendelsohn CP, Hall W. Int J Drug Policy. 2023 May 30;117:104064. doi: 10.1016/j.drugpo.2023.104064. Online ahead of print. PMID: 37263111 (No abstract available) | |||
=== 2020: [https://onlinelibrary.wiley.com/doi/10.1111/add.15099 Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018] === | |||
* Electronic cigarettes may have offset conventional smoking among US adolescents between 2010 and 2018 by maintaining the total nicotine use prevalence and diverting them from more harmful conventional smoking. Additionally, electronic cigarette users appear to initiate at older ages relative to conventional smokers, which is associated with lower risk. | |||
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: [[File:PeterHajek1.jpg|Hajek quote]] | : [[File:PeterHajek1.jpg|Hajek quote]] | ||
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<gallery widths="300" caption="US Vaping and smoking trends (youth and adult)"> | |||
File:Vaping and smoking trends.png|US nicotine vaping and smoking trends | |||
</gallery><gallery widths="300" perrow="2" caption="Vaping trend data 2011 to 2023"> | |||
File:Past 30 day e-cig use.png|vaping trend data | |||
File:Past e-cig use frequent and infrequent.png|'''Past e-cig use frequent and infrequent''' | |||
File:Past 30 day e-cig and any tobacco use.png|'''Past 30 day e-cig and any tobacco use''' | |||
File:Past 30 day e-cig and any combustable tobacco use.png|alt=Shows an increase in the linear combustible trend decline since the onset of the "youth vaping epidemic" in 2018. (Note that the expected trend would be more likely to have geometric characteristics, so this is impressive)|'''Past 30 day e-cig and any combustable tobacco use''' | |||
</gallery> | |||
=Suggested studies to add to this page= <!--T:94--> | =Suggested studies to add to this page= <!--T:94--> | ||
=== 2023: [https://www.mdpi.com/1660-4601/20/19/6866 Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes] === | |||
* These findings suggest dramatic successes in reducing youth smoking since the late 1990s, with more rapid declines in prevalence in the past decade. | |||
* Healthy People’s 2030 goal for youth cigarette smoking, which uses the NYTS as its benchmark, has already been achieved and exceeded, years ahead of schedule. | |||
* Concerns about a potential rise in adolescent cigarette use following the introduction of e-cigarettes to the U.S. market in the early 2010s are not supported by the data. In fact, the emergence of e-cigarettes has coincided with the most rapid declines in cigarette use over the past thirty years. | |||
* Importantly, an emerging body of evidence suggesting that initiation of cigarette smoking is shifting from adolescence to young adulthood. However, the prevalence of cigarette smoking has also dramatically declined among young adults aged 18–24 from 26.8% in 2000 to 7.4% in 2020 | |||
* Cristine D. Delnevo, Andrea C. Villanti Int. J. Environ. Res. Public Health 2023, 20(19), 6866; <nowiki>https://doi.org/10.3390/ijerph20196866</nowiki> | |||
* Funding: C.D.D. and A.C.V. were supported in part by a grant from the National Cancer Institute of the National Institutes of Health and the FDA Center for Tobacco Products (U54CA229973 and U01CA278695. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NCI or FDA. | |||
===2022: [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796834 Association of e-Cigarette Advertising, Parental Influence, and Peer Influence With US Adolescent e-Cigarette Use]=== | |||
===2022: [https://pubmed.ncbi.nlm.nih.gov/35862070/ Correlates of vaping among adolescents in Canada]=== | |||
===2022: [https://pubmed.ncbi.nlm.nih.gov/35852452/ Young Adult Responses to Taxes on Cigarettes and Electronic Nicotine Delivery Systems]=== | |||
===2022: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9287473/ Impact of existing and potential e-cigarette flavor restrictions on e-cigarette use among young adult e-cigarette users in 6 US metropolitan areas]=== | |||
===2022: [https://pubmed.ncbi.nlm.nih.gov/35861282/ Peer sexual harassment, affect, and substance use: Daily level associations among adolescents]=== | |||
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