The Centers for Disease Control and Prevention (CDC) concedes there is no “definitive, concrete link” between youngsters using e-cigarettes and smoking tobacco cigarettes.
The CDC was unable to confirm a credible link between e-cigarette use and teen smoking in a series of communications with The Daily Caller News Foundation.
E-cigarettes have long been subjected to a barrage of attacks. They have been accused of being a gateway to tobacco and “renormalizing smoking.” The CDC gave these allegations a new lease on life when it released a report showingseven in 10 young people had seen an e-cigarette advertisement.
Combined with the rising number teens taking up vaping, the CDC concludes, “the same advertising tactics the tobacco industry used years ago to get kids addicted to nicotine are now being used to entice a new generation of young people to use e-cigarettes.”
These tactics, according to the CDC, include using themes centered around “independence, rebellion, and sex.” The principal reason the CDC is worried about the growing number of youngsters seeing e-cigarettes ads is the fear that more teens will start vaping and transition to cigarettes.
On Jan. 5, when the report was released, CDC Director Tom Frieden said e-cigarettes are addictive and “they may well result in changes in the adolescent brain and increase the chances that a kid will smoke regular cigarettes and have to deal with all of the suffering and disability and cost that that causes for a lifetime.”
Back in 2014, Frieden claimed, “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.”
Given the director of CDC’s prominent position in the world of public health, the suggestion that e-cigarettes could lead to tobacco smoking is serious one. Asked by TheDCNF to provide the evidence behind Frieden’s claim on Tuesday, the CDC cited two studies.
The first is a study on school students in LA showing those who use e-cigarettes are 2.7 times more likely to report using conventional tobacco over the next year. On the face of it, this seems a pretty damning evidence.
The only problem, or rather one of the several problems, is the study’s own authors say “we cannot conclude that e-cigarette use directly leads to smoking.”
This is because the study had several major drawbacks that make it null and void when trying to draw a cause and effect relationship between vaping and smoking.
Dr. Michael Siegel, a professor in the Department of Community Health Sciences, Boston University School of Public Health, points out in a blog post from August 2015, “the study did not measure ‘e-cigarette use.’ It merely asked kids whether they had ‘ever’ tried an e-cigarette. Kids who had ever tried an e-cigarette, even a puff, were compared with all kids who had never even puffed on an e-cigarette.”
The immediate problem with this, says Siegel, is that “kids who would not even try an e-cigarette, despite their popularity, represent a different population than kids who would try a puff on an e-cig.”
The study doesn’t even record whether any of the subjects were regular vapers and had a nicotine addiction before they experimented with cigarettes.
The definition of smoking will also strike most people as an extreme interpretation. Smoking is defined in the study as any use of a cigarette – even a single solitary puff. The research also fails to tell us how many people used a regular cigarette and then became regular smokers.
The editorial that accompanied the study says as much:
Because the only outcome measure was any use of a tobacco product during the past six months, the analysis could not distinguish students who had just tried a few cigarettes from those who progressed to regular smoking during follow-up. The latter is the greater concern, and the current study cannot determine whether e-cigarette exposure was associated with that outcome.
Clive Bates, a leading anti-smoking campaigner and former director of the United Kingdom’s Action on Smoking and Health, writing in August last year, agrees:
It is not possible to conclude that smoking is caused by prior e-cigarette use from this data (and the authors are clear about that) so no-one should be stating that this establishes a gateway or even hints at it.
From Frieden’s statements, both past and present, it is hard to deny he is attempting to establish that e-cigarettes are a gateway to smoking.
The second study the CDC cites falls into exactly the same traps. Using two questionnaires a year apart sent to 728 young people, the study’s press release reads: “e-cigarettes serve as smoking gateway for teens and young adults.” But once again, the reality was a world away from the hype.
Just 16 subjects tried an e-cigarette at the beginning of the process. One year on, six of the sixteen reported trying a cigarette. But the study claims they progressed to “traditional cigarette smoking.”
Nowhere in the study is it known whether these six are regular smokers or whether they have even had more than one puff of a cigarette. The study didn’t say whether the 16 who tried e-cigarettes were regular vapers or addicted to nicotine but classified people who had ever tried e-cigarettes as regular users.
It is true, according to the study, those who had tried e-cigarettes were more likely to try the real thing. But the crucial part is not to confuse cause and effect.
The researchers also found the people who were most likely to try tobacco were those who were the most open to experimenting with risky behaviors. The subjects who tried e-cigarettes before trying tobacco were found to be more open to risk than their peers.
Responding to the research, Britain’s National Health Service Choices said, “this type of study can never prove that one thing (in this case trying e-cigarettes) causes another (trying tobacco cigarettes). Young people try lots of things while they grow up, and some people are more likely than others to take risks. It is perhaps not surprising that those who try e-cigarettes are also more likely to try tobacco.”
Siegel wrote on his blog Tobacco Analysis, “the study simply cannot infer that these young people became regular users of e-cigarettes, that they became addicted to e-cigarettes, or even that they ever tried an e-cigarette again.”
When the gaps in these studies were put to the CDC, Brian King, Ph.D., deputy director for research translation at the CDC’s Office on Smoking and Health, responded:
Further research is still needed, but these initial findings suggest e-cigarette use might lead to the subsequent initiation of cigarette smoking among youth and young adults.
The words “suggest” and “might” are a big giveaway. Pressed again as to whether there was a “definite, concrete link,” between using e-cigarettes and picking up smoking, King replied:
Further longitudinal studies of this nature are currently underway by both government and non-government researchers, which have the potential to provide further scientific clarity on this issue. However, these initial studies are a cause for concern, as they suggest e-cigarette use might lead to the subsequent initiation of cigarette smoking among youth and young adults.
So, in other words, no.