Category: Research

Vaping Down Among U.S. High School Students

Photo: Daisy Daisy
One in 10 U.S. middle and high school students reported using of any type of tobacco, according to data from the 2023 National Youth Tobacco Survey (NYST) that were collected between March and June 2023 and released today.
Among U.S. high school students, current overall tobacco product use declined during 2022-2023 from 16.5 percent to 12.6 percent, a development attributed primarily to reduced e-cigarette use, which dropped from 14.1 percent to 10 percent. Among high school students, declines in current use were also observed during 2022-2023 for cigars and overall combustible tobacco smoking, representing all-time lows.
“It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health,” said Brian King, director of the U.S. Food and Drug Administration’s Center for Tobacco Products, in a statement. “But we can’t rest on our laurels. There’s more work to be done to build on this progress.”
Among middle school students there was an increase in current overall tobacco product use (4.5 percent to 6.6 percent) and multiple tobacco product use (1.5 percent to 2.5 percent). However, among middle school students overall, no significant change was observed during 2022-2023 for current use of any individual tobacco product type, including e-cigarettes.

It’s encouraging to see this substantial decline in e-cigarette use among high schoolers within the past year, which is a win for public health. But we can’t rest on our laurels.
Brian King, Director, CTP
E-cigarettes remained the most commonly used tobacco product among both high school and middle school students for the 10th year in a row. Among youth who reported current e-cigarette use, approximately one-quarter reported using e-cigarettes every day. Disposable e-cigarette products were the most common product type used by youth who reported e-cigarette use. However, the most popular brands included both disposable and cartridge-based products. Among current youth e-cigarette users, the most commonly reported brands were Elf Bar (56.7 percent), Esco Bars (21.6 percent), Vuse (20.7 percent), Juul (16.5 percent) and Mr. Fog (13.6 percent).
Among youth who reported current e-cigarette use, nearly all used flavored products (89.4 percent), with fruit, candy, mint and menthol being the most commonly used flavors. For the first time in NYTS, the 2023 questionnaire asked about use of flavors that included the word “ice” or “iced” in their name, along with other concept flavor names—that is, names that imply flavor but do not explicitly indicate any particular flavor, such as “island bash.”
R.J. Reynolds Tobacco Co. said it welcomed the decline in overall youth tobacco use. “This is good news, and we agree with Dr. King that more needs to be done,” the company wrote in an e-mailed statement. “Future progress requires regulators—especially FDA—to seriously address the influx of irresponsibly marketed, illegal flavored disposable vapor products.”
In October, Reynolds filed a complaint with the International Trade Commission charging multiple manufacturers, distributors and retailers of disposable vaping devices with unfair importation.
November 2, 2023
Study Suggests One-Third of Irish Youth are Vaping

Photo: Timothy Donahue
More than a third of Irish people aged 13 to 16 years old currently vape without having smoked before, reports The Irish Times, citing new research commissioned by Foroige Sligo.
After questioning 900 young people aged 10 to 24, the study found that across all age groups, there is a link between appearing “cool” and vaping. It also found that vaping allows some young people to feel connected to their peers.
Many respondents felt that the marketing of vapes targets young people with a “toy-like” attraction and inventiveness of products in terms of flavor, color, and personalization.
Josephine Lally, an independent social researcher who conducted the study, said she was struck by how vaping served as a tool for participation in social groups.
“It has become a part of their day to day life,” she was quoted as saying. “If you mention conventional cigarettes they’d say, ‘no way, I wouldn’t smoke’. They perceive vaping to be safer and that is an issue,” she said.
To tackle youth vaping, the research recommended consistency in public health messaging and a direct campaign to inform young people and their families about vaping.
October 29, 2023
Study Finds Flavor Bans Boost Combustible Sales

Credit: Balint Radu
A new study has found that flavor bans boost sales of traditional combustible cigarettes. The study, E-cigarette Flavor Restrictions’ Effects on Tobacco Product Sales, concluded that restrictions on the sale of flavored nicotine vaping products could lead to significant increases in traditional cigarette sales.
“Given that combustible cigarettes are widely recognized as more harmful than vaping, the study’s findings raise pressing questions about the public health implications of such policies, according to a release from the Canadian Vaping Association (CVA). The group “urges Canadian governments to review the study’s findings and ensure that vapor product regulations are inline with harm reduction and Canada’s Drugs and Substances Strategy.”
Key Highlights from the study include:
Substitution to Cigarettes: For every 1 less 0.7 mL pod sold due to flavor restrictions, there’s an increase of 15 additional cigarettes purchased.
Rise in Cigarette Sales Over Time: While the short-term effects are less clear, the long-term correlation between vaping flavor policies and a surge in cigarette sales is robust. This surge occurs especially when such policies have been in place for a year or more.
Young Population at Risk: The relation between vaping flavor restrictions and increased cigarette sales isn’t limited to a particular age group. Alarmingly, there’s also a surge in sales for cigarette brands popular among underage youth.
The research firmly underscores the unintended consequences of restricting flavored product sales, according to CVA. While the research indicated that these policies do achieve their goal of reducing flavored product use, they inadvertently boost the sales of traditional cigarettes across all age groups.
Given the stark difference in health risks between cigarettes and vaping, the study contends that the overall health benefits of such policies may be minimal or even potentially harmful in the broader perspective.
October 2, 2023
More Vapers Could Save U.K. Half A Billion Pounds

Image: Tobacco Reporter archive
The U.K. National Health Service (NHS) could save over GBP500 million ($636.9 million) annually if half of England’s adult smokers switch to vaping, according to a Brunel University London report.
“If smokers transitioned to RRPs [reduced-risk products], it would significantly reduce the pressure on the NHS and free up much-needed hospital resources for other treatments,” said Francesco Moscone, professor and business economics expert at Brunel University London and study author. “Under a 50 percent conversion scenario, with half of smokers turning to RRPs, the NHS would save an estimated [GBP]518 million in an average year. If the conversion rate was just 10 percent, the NHS would save [GBP]103 million.”
“We are delighted that this new research from Brunel University London reinforces the findings of our own economic impact report,” said John Dunne, director general of the U.K. Vaping Industry Association, in a statement. “The potential savings to the NHS from smokers switching to vaping are enormous, and at a time when the NHS is desperately crying out for more funding and government budgets are squeezed so tightly, this is an opportunity we cannot afford to miss.
“I sincerely hope that these two reports will give the government more impetus to really push the positive impacts that vaping has for the health of our nation and the finances of our country.
“Only last week, ASH [Action on Smoking and Health] revealed shocking data, which showed that four in 10 smokers wrongly believe vaping is as or more harmful than smoking—up from one in five in 2019.
“Misinformation in the mainstream media about the relative health risks of smoking and vaping was one of the reasons given for this increasing lack of knowledge, and unless the government acts to educate smokers about the real risks, then lives will continue to be needlessly lost.”
“Cancer, heart disease, stroke, chronic bronchitis and emphysema are the five main disease categories caused by smoking cigarettes. Such illnesses put significant burdens on the NHS, which we know is already under increasing pressure,” said Moscone. “Although the long-term effects of RRPs are still unknown, we know from previous research that alternatives to traditional cigarettes result in a 90 percent reduction in the exposure to chemicals that are major contributors to health risks.”
The study was published in the British Journal of Healthcare Management.
August 9, 2023
Study Linking Vaping and Liver Disease Retracted

A study linking nicotine vapes to liver disease was retracted from Gastroenterology Research after the authors failed to reply to concerns about the researchers’ methods and findings, reports Filter.
The retraction stated that “concerns have been raised regarding the article’s methodology, source data processing, including statistical analysis, and reliability of conclusions.” The study was published in June 2022.
A letter was sent to the editor raising concerns, and the authors were given time to respond but failed to do so. “As is our journal and publisher’s policy, because there was no response or rebuttal from the authors, the manuscript was retracted, and the letter to the editor was not published,” said Robert Wong, editor-in-chief of Gastroenterology Research. “Typically, if there is an author response or rebuttal, we publish both the letter to the editor and the response.”
“This is a greater problem than just one study,” said Gregory Conley, director of legislative and external affairs for the American Vapor Manufacturers Association, noting a 2020 retraction by the Journal of the American Heart Association of a study connecting vaping to heart attacks. The 2020 retraction letter to the journal was made public, but the issue with the Gastroenterology Research paper is less clear because “there is silence around why it was retracted,” said Conley.

It’s gratifying that the journal took the step to retract the paper. There’s just a lot of things going on with this study that make it seem kind of weird.
Ray Niaura, epidemiology professor at New York University’s School of Global Public Health
The 13 co-authors of the study drew from the National Health and Nutrition Examination Survey and analyzed participants’ responses for associations between liver disease and the use of cigarettes or vaping products.
They claimed the results showed “e-cigarette users … were associated with higher odds of having liver disease compared to nonsmokers.”
“I already have a bunch of questions just off the top of my head, basically, just looking at this paper,” said who studies tobacco dependence and treatment. He said there were issues with the data, noting that the only survey question on vaping is broad, asking “Have you ever used an e-cigarette?” Questions on combustible tobacco included “Do you now smoke cigarettes?” and if someone has smoked “at least 100 cigarettes” in their life.
“That’s kind of a weak variable,” Niaura said. “What does it mean? It doesn’t mean much.”
The data also didn’t allow for analysis around timing, which means it’s not possible to tell whether liver disease was developed before or after smoking/vaping. “What’s the resolution of the information in studies like this?” Niaura asked. “It’s tricky.”
“It’s gratifying that the journal took the step to retract the paper,” he said. “There’s just a lot of things going on with this study that make it seem kind of weird.”
July 24, 2023
Call for Proposals to Improve Doctors’ Understanding of THR

Image: Tobacco Reporter archive
The Foundation for a Smoke-Free World (FSFW) has issued a call for proposals to further analyze the findings of its Sermo survey on doctors and propose programs that would help improve doctors’ fluency about smoking cessation and tobacco harm reduction (THR), according to a press release.
The FSFW funded research carried out in 2022 by Sermo, an independent platform and leader in actionable healthcare professional insights that surveyed more than 15,000 doctors online in 11 countries, including China, Germany, Greece, India, Indonesia, Israel, Italy, Japan, South Africa, the United Kingdom and the United States. A significant majority of the surveyed doctors mistakenly attributed the negative health effects of smoking to nicotine.
An average of 87 percent of doctors agreed, at least moderately, that helping patients quit smoking is a priority; however, 74 percent mistakenly believe nicotine causes a range of illnesses, including lung cancer and chronic obstructive pulmonary disease (COPD).
The misperception about nicotine could account for an average of 55 percent of the doctors recommending over-the-counter nicotine-replacement therapies to help patients reduce or quit smoking.
“It is imperative that doctors get the proper training to learn the facts about nicotine and tobacco harm reduction options that can help their smoking patients quit,” said Muhammad Ahmed, director of health and science research at the FSFW. “With more than 7 million smokers dying annually from smoking-related diseases worldwide, many lives can be saved if doctors become more knowledgeable about the cessation tools available.”
“Patients look to doctors for trusted health advice,” said Jed Rose, president and CEO of Rose Research Center and co-inventor of the nicotine patch. “Therefore, it is vital that doctors provide accurate, current advice to smokers about the health risks of smoking cigarettes compared to using products that deliver nicotine without combustion.”
The survey on doctors showed that 74 percent of doctors on average at least moderately agree that nicotine causes lung, bladder and head/neck/gastric cancer; in the United States, this figure is 70 percent; in Germany, this figure is 78 percent; in China, this figure is 86 percent; in Japan, this figure is 85 percent; 78 percent of doctors on average at least moderately agree that atherosclerosis is caused by nicotine; and 76 percent of doctors on average at least moderately agree that COPD is caused by nicotine.
On average, 81 percent of the physicians surveyed are at least moderately interested in training focused on smoking cessation and tobacco harm reduction.
The survey also found that while doctors’ conversations with patients who smoke focus on the health benefits of cutting down or quitting (73 percent on average globally) and the health risks of continuing (73 percent on average globally), a comparatively small number of physicians—just over half (56 percent on average globally) on average—recommend cutting down on the amount of smokable tobacco products, and less than half of doctors (48 percent on average globally) help patients develop a plan to quit.
Researchers interested in submitting a proposal to further analyze these findings should contact support@smokefreeworld.org.
July 20, 2023
Study: Support with Flavors Helps Smokers Quit

Image: Tobacco Reporter archive
A new study has found that smokers who get help picking flavored e-cigarettes and receive supportive text messages are more likely to quit smoking, reports The Guardian.
The study was led by London South Bank University (LSBU), and it explored in what settings vapes could help smokers quit. After three months, about 25 percent had quit and a further 13 percent reduced cigarette consumption by more than half.
Those who received help choosing a vape flavor and got supportive texts were 55 percent more likely to quit smoking in three months.
“Smoking kills approximately 8 million people worldwide every year, and even some of the often most effective treatments have little effect on reducing the number of smokers,” said Lynne Dawkins, professor of nicotine and tobacco studies at LSBU. “From this treatment, 24.5 percent were smoke-free after three months and a further 13 percent had reduced their cigarette consumption by more than 50 percent.
“The simplicity of tailored support through flavor advice and supportive messages could have a huge impact in helping people lead smoke-free lives.”
The research examined: tailored advice on which product, nicotine strength or flavor to buy; brief information on vaping harms relative to smoking; and text message support. Some people received all of these, others received none and some received some but not all.
July 18, 2023
FDA Grants $3.9 Million to Study Effects of Flavors

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The U.S. Food and Drug Administration has given the Center for Tobacco Research at The Ohio State University Comprehensive Cancer Center a $3.9 million grant to evaluate the effects of e-cigarette flavors on smoking behaviors of current adult smokers, according to News Medical Lifesciences.
The study will be co-led by Theodore Wagener, director of Ohio State’s Center for Tobacco Research, and Tracy Smith from the Medical University of South Carolina Hollings Cancer Center.
Wagener says, “the FDA must decide how to balance its goals of protecting young people and offering harm-reduction options to adults. This new trial will generate critical data to help make more informed public health decisions that have a lasting impact.”
“The FDA is currently making regulatory decisions about e-cigarette flavors with incomplete scientific data,” Wagener said. “Existing data show that smokers also prefer flavored e-cigarettes, and while there are a few survey studies suggesting that flavored e-cigarettes may be more helpful for switching to vaping, these studies are not rigorous enough for the FDA to base its regulatory decisions on. Our study will be the first to provide the FDA with definitive information as to the benefit, if any, of e-cigarette flavors to adult smokers.”
The national, randomized, controlled trial will recruit up to 1,500 cigarette users from across the country, and researchers will measure e-cigarette flavor impact on product uptake and appeal, cigarette craving, symptoms, dependence and smoking behavior. Combination nicotine-replacement therapy will be used as a comparator to determine potential increased benefit of e-cigarettes versus nicotine-replacement therapy.
“If our study demonstrates no significant improvements in switching with flavored e-cigarette use, then the continued sale of these products is likely indefensible; however, if improvements are significant, these findings will provide a critical counterweight to the current FDA regulations and will aid future decision-making,” Wagener said.
July 13, 2023
U.S. CDC Makes Confusing Statements in Latest Report

Credit: JHVE Photo
Monthly e-cigarette sales skyrocketed during the first two years of the COVID-19 pandemic, according to a new study published Thursday by the U.S. Centers for Disease Control and Prevention.
“In the United States, the prevalence of e-cigarette use is markedly higher among youths and young adults than it is among adults overall. In 2021, 4.5% of all adults aged ≥18 years (an estimated 11.1 million) and 11.0% of young adults aged 18–24 years (an estimated 3.1 million) currently (≥1 day during the previous 30 days) used e-cigarettes; during 2022, 14.1% of high school students (an estimated 2.14 million) currently used e-cigarettes,” the CDC’s weekly Morbidity and Mortality Weekly Report (MMWR).
However, in 2020, the U.S. Census Bureau counted 331.4 million people living in the United States; more than three-quarters (77.9 percent) or 258.3 million were adults aged 18 years or older and 30 million (of the 258.3 million) were aged 18-24. The Annie E. Casey Foundation confirms the CDC data. In 2019, 15.3 million students enrolled in high school (9th to 12th grade). Many U.S. high school students turn 18 before graduating high school, as well.
Major media outlets such as ABC News are now reporting that “the CDC noted in its report that e-cigarette use is more common among young people than adults overall” even though the statement is misleading at best.
The agency also states that e-cigarette sales boomed in 2020. Between January 2020 and December 2022, monthly unit sales increased by 46.6 percent, from 15.5 million units to 22.7 million units, the study found. Studies have also shown that combustible cigarette sales plummeted during the same time period.
Researchers found the surge in vape sales was mostly driven by disposable e-cigarettes in flavors, including fruit and candy, which are popular among youth and young adult users, and several studies have found they are also preferred by adults who have quit combustible cigarettes..
Additionally, while the share of pre-filled e-cigarette cartridges decreased from 75.2 percent to 48 percent of total sales, the share of disposable e-cigarette units increased from 24.7 percent to 51.8 percent of total sales.
The study found this may be due to an announcement the U.S. Food and Drug Administration made in January 2020 that prioritized enforcement against prefilled cartridges in flavors other than tobacco and menthol.
Disposable vaping products were the first e-cigarettes to be distributed broadly across the U.S. After winning a landmark lawsuit against the FDA in 2010, the Njoy King became the bestselling e-cigarette on the market after just a few years.
By 2017, pod systems became more popular as battery technology improved. It was easy to switch between flavors, and the rechargeable battery lowered the cost of products for consumers compared to disposable devices.
Open systems were popular too, but pods were easier and cleaner without the chance of spilling e-liquid everywhere. The versatility of pod systems helped vaping become more mainstream.
Then in January of 2020, the FDA created an unnecessary problem. The regulatory agency stepped in under the guise of a youth vaping “epidemic” and banned the sale of all flavored (except tobacco and menthol) pod-style vaping products.
Today, disposable vapes are the best-selling e-cigarettes, and millions are disposed of improperly every year, according to industry data.
June 26, 2023
FDA, NIH Fund Center for Rapid Surveillance of Tobacco
Credit: Onticello
The U.S. Food and Drug Administration and the National Institutes of Health (NIH) have awarded funding for a new Center for Rapid Surveillance of Tobacco (CRST). Through rapid surveillance and reporting of information, CRST will enhance the Center for Tobacco Products (CTP) and the research community’s ability to understand, document and quantify changes in the tobacco product marketplace and tobacco use patterns.
“Nothing like this has ever been attempted before now,” said Cristine Delnevo, director of the Rutgers Center for Tobacco Studies and principal investigator of the rapid surveillance center. “No one has collected such comprehensive information, let alone organized and disseminated it rapidly. We think it will provide the FDA with meaningful and timely data to inform their congressionally authorized regulation of the tobacco market.”
Research results from the CRST are expected to generate findings and data that are directly relevant in informing the FDA’s regulation of the manufacture, distribution and marketing of tobacco products to protect public health. In particular, the CRST will support more time-sensitive data collection, analysis and reporting—making potentially actionable information available before more traditional data collection methods.
“Given the rapidly evolving tobacco landscape, it’s critical that we have nimble surveillance tools that can keep pace to best protect public health,” said Brian King, director of the FDA’s CTP. “This new center is another important addition to our surveillance toolbox to help identify emerging issues and to inform timely action.”
The CRST is supported through the Tobacco Regulatory Science Program, an interagency partnership between the NIH and CTP to foster tobacco regulatory research.
The work is led by Rutgers Center of Excellence in Rapid Surveillance of Tobacco with substantial involvement from a large collaborative network that triangulates multiple data sources, federal scientific staff at CDC, NIH and CTP as well as external advisors with relevant expertise.
“The signals about JUUL’s popularity with youth were there as early as 2017, but without identifying early, meaningful signals and subsequently implementing nationally representative large surveys with appropriate measures, it took much longer to evaluate the problem,” Delnevo said. “Successful rapid surveillance will facilitate a comprehensive understanding of the problem in a timely manner.”
The grant money will fund the Rutgers Center of Excellence in Rapid Surveillance in Tobacco, which officially began operations on June 1, pulling information from numerous data sources. Researchers will:

Collect information from marketing company databases, tobacco maker websites, social media and merchant outlets to spot new marketing strategies;
Analyze retail scanner data to track tobacco-product sales and spot trends involving new product characteristics such as innovative flavors or delivery mechanisms;
Triangulate responses from surveys of youth, young adults, and adults who use tobacco and nicotine products to understand preferences and behaviors;
Synthesize the data to identify meaningful trends early and provide the FDA with actionable information to improve its regulation of tobacco products.
Another seven faculty members from the Center for Tobacco Studies will join Delnevo on the rapid surveillance project, as will 13 co-investigators from Roswell Park Cancer Institute, East Carolina University, Stanford University, the University of Kentucky, The Ohio State University, Columbia University, and Westat, Inc.
June 2, 2023