Category: Research

Survey Shows Youth Vaping has Reached Potential Plateau

Photo: Aliaksandr Barouski – Dreamstime.com
The increase in U.S. teenage vaping seen from 2017 to 2019 has halted in 2020, according to new research published by the JAMA Network. The study also found that there was a significant decline in the use of Juul products, countered by increases in the use of other vapor brands.
In 2020, Monitoring the Future surveyed 8,660 students in 10th and 12th grade. Nicotine vaping prevalence in 2020 was 22 percent for past 30-day use, 32 percent for past 12-month use and 41 percent for lifetime use; these levels did not significantly change from 2019. Daily nicotine vaping significantly declined from 9 percent to 7 percent over 2019 to 2020.
The authors of the study speculate that the rise of youth vaping has slowed because of “noteworthy events” during late 2019 and early 2020. The e-cigarette and vaping–associated lung injury epidemic that received considerable media attention in the second half of 2019 may have deterred use by increasing adolescent perceptions of harm from vaping.
What’s more, on Feb.7, 2020, the U.S. Food and Drug Administration (FDA) began enforcement against the sale of e-cigarette cartridges with flavors other than tobacco or menthol. This FDA action came after the decision by market leader Juul Labs to voluntarily stop selling most of their its cartridges preferred by youth.
In addition, the federal minimum age for legal e-cigarette purchase changed from 18 to 21 years on December 20, 2019, thereby potentially reducing youth access to vaping products.
“We are encouraged that according to the paper in JAMA Pediatrics underage use of Juul products, ‘dropped dramatically,’ which shows the importance of evidence-based interventions,” Juul said in a press release.
“We will continue to combat underage use of vapor products, which is unacceptable, by working with states toward full implementation and enforcement of Tobacco 21 and supporting [the] FDA’s [U.S. Food and Drug Administration] active enforcement against illicit and illegally marketed products, such as disposables, that jeopardize the category and its harm reduction potential for adult smokers.”

December 16, 2020
Covid-19: Study Finds 32% of Youth Ended E-Cigarette Use
E-cigarette use among teens and young adults decreased dramatically during the Covid-19 pandemic. Nearly two-thirds of e-cigarette users reporting that they’ve either cut back or quit, according to a new study.
Credit: Tomkohhantsuk
About 32 percent of e-cigarette users said they quit this year and another 35 percent reported cutting back, according to survey results published Dec. 3 in JAMA Network Online.
Concerns about lung health were a major factor in their decision, the results indicate. One in 4 respondents who cut back or quit said they were motivated by concern that vaping could weaken their lungs.
Research has shown that smokers have a higher risk of severe COVID-19 infection, noted senior researcher Bonnie Halpern-Felsher, a developmental psychologist and professor of pediatrics at Stanford University in California.
Vapers’ worries were probably also motivated by the 2019 nationwide outbreak of EVALI, which involved thousands of lung injuries related to e-cigarette use, she added.
“One of the main reasons they quit is that they were worried about lung health, and we think that’s important, that they thought they could hurt their lungs,” Halpern-Felsher said. “This really provides an opportunity to talk about and provide education about lung health.”
December 3, 2020
New Report Urges Global Tobacco Harm Reduction
A new report urges regulators to scale up tobacco harm reduction (THR) around the world to help smokers make the switch. Burning Issues: The Global State of Tobacco Harm Reduction 2020 (GSTHR), the recently released second edition of a major biennial report produced by Knowledge-Action-Change, found that smoking-related death and disease disproportionately impact poor and marginalized groups, especially in low- and middle-income countries.
Credit: Kevin Phillips
Author Harry Shapiro, coins new terms in the report, calling e-cigarettes “safer nicotine products” (SNP) and EVALI (E-cigarette or Vaping Lung Injury) is now “Vitamin E-Related Lung Injury” (VITERLI).
The report found that there are only nine SNP users for every 100 smokers globally; most live in high-income countries. Overall, 98 million people are estimated to use SNP worldwide. Of those, 68 million are vapers, with the largest vaping populations in the US, China, the Russian Federation, the UK, France, Japan, Germany and Mexico and 20 million are heated tobacco product users—most of whom live in Japan, where cigarette sales have dropped by 32 percent since 2016.
Shapiro also criticizes bad science in the vaping industry, such as studies by discredited researcher Stanton Glantz. GSTHR examines two of his studies that were severely criticized by leading tobacco experts and one study that was retracted. It compares Glantz to Harry Anslinger, the former head of the Federal Bureau of Narcotics who used fear-mongering and moral panics to enact cannabis prohibition.
“SNP is one of the most startling public health success stories of modern times … THR offers a global opportunity for one of the most dramatic public health innovations ever to tackle a non-communicable disease,” Shapiro writes. “In a time of COVID-19 when global health and public finance systems are stretched to breaking point and may not recover for some time, the imperative to drive forward with THR has never been more urgent.”
The report makes several conclusions, including:

SNPs have the potential to substantially reduce the global toll of death and disease from smoking, and to effect a global public health revolution.

Many US and US-funded organizations have manufactured panics about young people and vaping, about flavors and the outbreak of lung disease, overshadowing the real public health challenge, which is to persuade adult smokers to switch.

The increasingly prohibitionist emphasis risks many consequences, including that current smokers may decide not to switch, current users of SNP may go back to smoking, and the growth of unregulated and potentially unsafe products.
December 3, 2020
Vaping CBD, THC May Cause ‘Modest’ Driving Impairment
Drivers that have vaped a combination of THC and CBD or THC alone show signs of “modest” impairment up to four hours later, a study published Tuesday by JAMA found.
Credit Eugenio Cuppone
The impairment from vaping compounds containing the main ingredients of marijuana is equivalent to that seen in drivers with blood alcohol concentrations of 0.05 percent, or roughly half the legal limit for driving under the influence in most states, the researchers said.
“[Our] study shows that cannabis-induced driving impairment varies with cannabis strains,” said study co-author Dr. Johannes Ramaekers in an interview with United Press International news wire service. “The implication for the general public is that the cannabis-induced driving impairment should be acknowledged as a public health risk while taking into account that impairment may differ between cannabis strains and depends on time after use.”
Compounds containing higher amounts of tetrahydrocannabinol, or THC, “are typically used for intoxication,” while those with cannabidiol, or CBD, which are not intoxicating, are prescribed for the treatment of epilepsy, anxiety, psychosis and neurological disorders, they said.
December 3, 2020
Vype Nicotine Levels Comparable to Combustibles

Photo: BAT
Vype ePen 3, British American Tobacco’s (BAT) flagship vapor product, can provide smokers with similar levels of nicotine as standard cigarettes, according to new research. If used exclusively, ePen3 could help smokers avoid many of the risks associated with smoking, BAT said in a statement.
The Scientific Reports study compared both Vype ePen 3 and Vype ePen 2 to combustible cigarettes. It assessed a variety of e-liquids and nicotine strengths for each product and how nicotine concentration and delivery device combined to affect user preference.
Results from the study show that Vype ePen 3 was superior to Vype ePen 2 for nicotine delivery and ranked significantly higher for user satisfaction, with the newer device scoring nearly double for likability compared to its predecessor.
The study showed that the maximum concentration of nicotine in the blood after using the Vype ePen 3 (18 mg/mL protonated nicotine) was on average twice that achieved using Vype ePen 2 (18 mg/mL unprotonated nicotine).
David O’Reilly
“We know that for many smokers, nicotine levels are an important factor in choosing a vaping product, particularly when initially switching,” said David O’Reilly, BAT’s director of scientific research.
“They want it to work for them, delivering the nicotine they want in a device they like. We think we have achieved this with Vype ePen 3 and hope that through continued product innovation we can encourage and enable those who would otherwise continue to smoke to switch to a reduced-risk alternative which has been scientifically substantiated.”
This study is a part of a comprehensive program of scientific research designed to assess and substantiate the reduced-risk potential of noncombustible products.
December 1, 2020
Consumer Group Suggests Ways to Lower Youth Vaping
The Consumer Choice Center has released a new report that considers existing age restrictions on the sale of vaping products and then suggests several policies to reverse low enforcement rates of current rules.
Fred Roeder – Credit: Consumer Choice Center
To reduce the rate of vaping by youth, the Consumer Choice Center report recommends four actions:

Enforce strict age restrictions on vaping devices and liquids at the point of sale.

Use modern age-verification technology for online sales.

Learn from other industries such as alcohol and fireworks on how to improve compliance rates.

Retail and industry should be encouraged to be more proactive with the enforcement of rules.

Don’t punish legal adult vapers for the lack of enforcement of age restrictions.
Fred Roeder, health economist and author of the report, stated in an email that most countries have already drawn a line of when it is legal to vape (enacted age-to-purchase laws).
“We don’t face a lack of legislation but a lack of compliance with existing rules and regulations. We looked at similarly regulated industries such as alcohol and gambling and found that these tend to have smarter enforcement mechanisms,” he wrote “There are many innovative tools out there to ensure only adult customers can buy vaping products. Digital ID checks and industry initiatives to ID customers that look young are better ways to solve the problem than additional laws such as flavor bans.”
November 25, 2020
Looking Back: SHEER Report ‘Fundamentally Flawed’
A scientific report on e-cigarettes prepared for the European is fundamentally flawed, according to the Independent European Vape Alliance (IEVA).
As part of the European Commission’s forthcoming review of the Tobacco Products Directive, the Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) Committee was tasked with producing a scientific review of the health effects of e-cigarettes. On Sept. 23, SHEER adopted its preliminary opinion. The public consultation on the preliminary opinion closed on Oct. 26.
“While we welcome the initiative from the European Commission in taking a view on the science of electronic cigarettes, the draft report it has produced is fundamentally flawed,” IEVA wrote. “What is most striking about the draft scientific review is its failure to compare the risks of electronic cigarette use with the risks of smoking.”
In its response to the preliminary opinion, IEVA cited several areas of concern:
The Committee has concluded that there is insufficient evidence that e-cigarettes are not a useful tool for smokers seeking alternatives, despite quoting two randomized control trials stating precisely the opposite.
In its risk assessment, the Committee has not taken a risk-based approach at all, but rather a hazard-based approach. It states the potential risks of using e-cigarettes without even attempting to compare these with the risks from cigarette smoking, which are exponentially higher.
The Committee has concluded that there is strong evidence that e-cigarettes act as a “gateway” to smoking. However, it has done so based almost exclusively on data from the United States, where an entirely different regulatory regime exists. The Committee also fails to acknowledge that smoking among young people has declined significantly: if vaping leads to smoking, then why are there not more smokers observed during the period where the e-cigarette market grew rapidly?
According to IEVA, the poorly founded conclusions undermine the utility of the report as a document upon which EU decisionmakers can make policy decisions in the best interests of Europeans.
Earlier this week, British American Tobacco voiced similar concerns about the SHEER report.
November 24, 2020
Mayo Says Young Adult Vaping Down, Alcohol Use Rising
There have been significant shifts in substance abuse among young adults during the pandemic, according to a new Mayo Clinic study. Mayo officials surveyed over 1,000 adults ages 18-25, and roughly 34% of them reported changes in substance abuse patterns.
Credit: Elevate
Of those, vaping and smoking rates decreased for nearly half of those who responded, according to a news report by wqow.com.
“However, the most staggering finding was that nearly 70 percent of respondents increased alcohol consumption. Roughly half of them self-reported having depression or an anxiety disorder, which doctors believe contributed to the spike in drinking,” according to the story.
“We thought that with COVID-19, loneliness is a real thing,” said Dr. Pravesh Sharma, a substance use researcher at Mayo Clinic Health System in Eau Claire. “School and colleges are closed, gatherings are limited, and that creates a negative mood state in a lot of people, and young adults often indulge in drinking behavior to cope with those negative mood states.”
Sharma said as news spread about lung damage caused by vaping in early 2019, as well as COVID-19 affecting lung health, more young adults turned away from vaping and smoking.
November 21, 2020
Study: E-Cigs May Reduce Harm in Black, Latinx Smokers
Switching to electronic cigarettes (e-cigarettes) may be a useful strategy for reducing harm caused by combustible cigarettes in Black and Latinx smokers, according to a study.
Photo: Vchalup | Dreamstime.com

According to Urban Health Today, cigarette smokers may switch to e-cigarettes in an attempt to kick the habit, although it is not yet clear whether this strategy is actually associated with less harm, notably whether exposure to nicotine is reduced. Here, researchers compared the harm incurred from the use of nicotine salt pod system (NSPS) e-cigarettes—the most common type on the market currently—versus combustible cigarettes in Black and Latinx smokers.
The researchers found that switching to e-cigarettes did not increase nicotine exposure, and they further observed that it was associated with short-term urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) concentration reduction.
They randomized Black and Latinx participants in San Diego, Calif., and Kansas City, Mo., who smoked at least five combustible cigarettes a day on at least 25 of the past 30 days for at least six months to either e-cigarettes or combustible cigarettes (control group) for six weeks.
The e-cigarette group had a choice of pod flavors, which were 5% nicotine, and underwent education, training, and action planning to make the transition from combustible cigarettes to e-cigarettes; the control group continued smoking as usual. The main outcome measure was NNAL concentration at the end of the intervention.
Other outcomes included change in urinary cotinine, expired carbon monoxide (CO), respiratory symptoms, lung function, blood pressure, and seven-day history of combustible cigarette consumption. The e-cigarette group was also evaluated for two- and six-week switching rates. and switching rates (e-cigarette group only) at weeks 2 and 6. The study took place between 2018 and 2019, with data analyzation performed between Sept. 18, 2019, and Sept. 4, 2020.
November 21, 2020
Looking Back: 2020 NYTS Showed Decline in Youth Use
AS recently reported, data from the 2020 National Youth Tobacco Survey (NYTS) found that 1.8 million fewer U.S. youth are currently using e-cigarettes compared to last year. The NYTS, conducted by the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC), data shows an alarming increase in the number of youth who use disposable e-cigarettes.
Compared to 2019, the number of youth using e-cigarettes is down 1.8 million. However, the number of youth using disposable e-cigarettes has risen: 26.5 percent of high school users are using disposables, up from 2.4 percent in 2019, and 15.2 percent of middle school users are using disposables, up from 3 percent last year.
The FDA did not include disposable products when it announced its flavor ban for closed-pod systems in February of this year. The 2020 NYTS showed that more than 8 out of 10 youth e-cigarette users report use of flavored products and the majority of those used a disposbale product.
The study states that almost 40 percent of high school users are using an e-cigarette on 20 or more days out of the month and almost a quarter of them use e-cigarettes every day.
Last week, the FDA issued warning letters notifying three companies who sell or distribute unauthorized ENDS products to remove those products from the market. The regulatory agency issued a warning letter to XL Vape LLC (doing business as Stig Inc.), warning the company to remove their disposable e-cigarettes from the market because they do not have the required premarket authorization.
The additional warning letters were issued to Flavour Warehouse LTD (doing business as Vampire Vape) and Pretty Women UK LTD (T/A Coil2oil and Mad Kingdom Liquids) for illegally marketing unauthorized menthol-flavored e-liquids. “The labeling and/or advertising of these products also features cartoon images, such as vampires and kings, that are commonly marketed and/or appeal to youth,” according to the FDA.
November 20, 2020