Raking the Coals

It seems there is no end to the shenanigans that a certain double-barreled researcher can get up to, especially when the majority of said research is (at least in part) funded by payouts from the Master Settlement Agreement. Something that should at least be mentioned (if only in passing) in the “disclosure” section of the paper. But then, why should it be necessary when a large proportion of funding from the National Cancer Institute at the National Institutes of Health, and the US FDA Center for Tobacco Products is mentioned? Natch.

It would seem, in the press associated with the release of this article, that low costs and convenience are major contributing factors for why teens vape instead of smoke. This is a bad thing? Well naturally, the policy makers don’t want teens vaping or smoking, but if teens want to do something – like go to that Frat party and get wasted when their folks forbid it – then they’re just going to go ahead and do it. End of story. It’s part of growing up. Teens can, and do experiment with stuff as I’ve written about before. Oddly enough, this same researcher I’ve come across recently, tries (and largely fails) to identify that mythical “gateway theory” which they are so fond of in the US, and Wales (basically anywhere without common sense), and like the previous attempt to stir up anti e-cig sentiment, uses the same data taken from the Children’s Health Study.

Boldly entitled “E-cigarettes, Cigarettes and the Prevalence of Adolescent Tobacco Use” the paper tries to say that e-cigarettes are not, as many say, merely substituting for cigarettes, and it even goes as far as to claim that there are some adolescents vaping who would not otherwise have used tobacco products. Well shit. That’s that argument blown out of the water. Or is it?

The Data

Taken from “The Children’s Health Study” – a longitudinal study of teens reaching 12th grade in three-year intervals from 1995 – with the exception of 2004 to 2014, that gap was 10 years. As with any study of this nature, the selection is key so when I see “selected communities” I immediately think “they’ve gone for the highest likelihood of teen smokers/vapers” – which as we know, and for reasons as yet shrouded in mystery, this tends to be at the middle to lower end of the socio-economic scale, but even then there is no one demographic that is “more susceptible” to smoking/vaping then any one other. In this case, the total number of participants ended up being 5490.

The Results

According to the abstract, the “combined adjusted prevalence” of current cigarette or e-cigarette use in 2014 was 13.7% – which as most headlines will tell you is a “rocketing rise” from 9% in 2004, but actually less than the 14.7% adjusted prevalence from 2001.

The Conclusion

Smoking prevalence among Southern California adolescents has declined over 2 decades, but the high prevalence of combined e-cigarette or cigarette use in 2014, compared with historical Southern California smoking prevalence, suggests that e-cigarettes are not merely substituting for cigarettes and indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products.

But how accurate are these budding researchers in their interpretations?

Let’s start with how they looked at “use”. Always a fun place to start.

participants were asked the number of cigarettes or packs of cigarettes that they had smoked in the past 24 hours, past week, past month, past year, and in their lifetime.

So a little better than most US surveys on smoking/vaping, but not by much. Especially when considering how they were classified:

participants were classified as current users if they reported smoking ≥1 cigarettes in the past 24 hours, past week, or past month; participants were classified as ever users if they reported either (1) use in the past year or in their lifetime or (2) listed an age at which they had first smoked. This classification was used for all prevalence estimates of cigarette use alone.

So falling back to the old “past 30 day” as being a current user. That doesn’t really give much in the way of detail for experimentation. But then, with the US they don’t really want to know about that, they just want to know how many teens are using cigarettes or e-cigarettes, even if it was “just one puff” – that makes you a user. Wonderful logic that.

To an extent “ever users” are experimenters but of course the US media don’t want you knowing that.

Here’s where it gets interesting (click to enlarge the image), the smoking prevalence rate has been going down – for a multitude of reasons – since 1995, yet the technicolour bar at the end of each chart would suggest that having e-cigarettes around is a bad thing – as it looks like the “prevalence rate” is higher in 2014 than it was in 2001. Until you take into account the fact that the US deems (rightly or wrongly) e-cigarettes to be a tobacco product (and no, I’m not getting into that debate). In the researcher’s own words:

Although the prevalence of current cigarette use was lowest among students in both grades in 2014, the combined prevalence of current cigarette and/or e-cigarette use was similar to or greater than that for cigarette use alone 10 to 15 years ago, before e-cigarettes were available.

So to make things sound worse than they really are, we’ll combine the use of both combustible cigarettes and e-cigarettes to come up with a figure that is roughly equivalent to a single product prevalence rate 10-15 years ago. Bingo! More cash please! But hang on a cotton pickin’ minute. Among those cheeky 12th grade students in 2014 the actual rates were:

  • 3.8% dual use
  • 3.9% cigarette only
  • 6.0% e-cigarette use

Somehow those figures are “similar to the 14.7% prevalence of cigarette use in 2001”. Only if you take three different figures and mash them together, and even then it only comes to 13.7 (basic mathematics people c’mon), and it’s also supposedly a whopping 5 points higher than the prevalence in 2004. Funnily enough, e-cigarettes only really came to market in the US in 2009, so comparing combined use in 2014 to single product use from 2001 or 2004 is like comparing Westeros to Essos, chalk and cheese.

These people should be celebrating the fact that actual smoking prevalence in this age group is now at 3.9% – not including dual users, but no they like to conflate smoking and vaping to make their numbers higher – all so they can get more grant money to do the self-same thing again. Once again the headlines aren’t supported by the paper, and the paper’s own conclusions aren’t supported by the data. But then, when has it ever been the case in tobacco control?

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