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March 10, 2022

2021 CDC Survey Shows Teenage Smoking Is Almost Extinct

More than five months after releasing preliminary 2021 vaping numbers from the National Youth Tobacco Survey, the Centers for Disease Control and Prevention (CDC) has finally followed up with the rest of the survey results. The NYTS is an annual survey of middle- and high school students designed to assess current patterns of nicotine and tobacco use.

The CDC’s report shows that past-30 day middle- and high school cigarette smoking has fallen to just 1.5 percent—less than half the already record-low 3.3 percent reported in 2020. Just 1.9 percent of high schoolers reported smoking in the past 30 days, and less than 0.4 percent smoked on 20 or more of the past 30 days. That means only about one in 250 high school students smokes cigarettes daily or almost daily. Middle school past-30 day smoking fell to just 1.0 percent.

As the early results issued last fall indicated, school-age vaping has also fallen dramatically. High school past-30 day use has declined more than 60 percent since its 27.5 percent high in 2019—first falling to 19.6 percent in 2020, and then to just 11.3 percent last year. The middle school past-30 day vaping rate was just 3.8 percent in 2021.

Past-30 day vaping among all school-age users has fallen from 20.0 percent in 2019 to just 7.6 percent in 2021. And use of any tobacco product (including vapes) has dropped from 23.0 percent in 2019 to just 9.3 percent last year.

The only tobacco or nicotine product use that CDC claims increased last year seems to be a mistake. The agency reports that 170,000 middle- and high school kids used heated tobacco products (HTPs) in 2021. But the only HTP sold in the United States last year (or in 2020) was IQOS, and it was only available in a few test markets. Clearly this group of survey participants confused HTPs with something else (probably cannabis vaporizers).

The story is a good one for youth tobacco and nicotine use, but CDC managed to pull gloom from the sunshine, questioning its own survey’s validity in the summary. Because of COVID, the survey was administered online, rather than in classrooms as it normally is. Ergo, CDC says, the results “cannot be compared with previous NYTS survey results that were primarily conducted on school campuses.”

Does anyone really believe students are more truthful about tobacco use when a teacher is supervising their answers? A more important COVID-related issue is probably school closures’ reduction of time spent away from home. Because students were less able to meet friends during and after school, there were probably fewer opportunities for socializing and sharing nicotine and tobacco products. It is especially difficult to hide cigarette smoking for a kid stuck inside their home. But even if half of the smoking decline was caused by school closures, the drop would still have been significant. The same is true for the drop in vaping.

The most common reason given for vaping by past-30 day users was “I [was/am] feeling anxious, stressed, or depressed,” with 43.4 percent listing that among their answers (survey participants could give multiple reasons). That’s an understandable response, especially given the social isolation and health concerns rampant during the coronavirus pandemic. But the CDC authors use it to suggest that mental health issues may be caused by vaping—a much different thing than people vaping to combat stress or depression.

CDC even references the anti-vaping Truth Initiative’s widely panned report on vaping and mental health, and refers to a hypothetical “bidirectional association between nicotine use and mental health disorders such as depression and anxiety.” (Probably not coincidentally, Truth Initiative is launching a campaign to convince the White House to acknowledge that vaping is a mental health risk.)

The top five reasons for vaping cited by past-30 day users are:

  • I am feeling anxious, stressed, or depressed – 43.4%
  • To get a high or buzz from nicotine – 42.8%
  • A friend uses them – 28.3%
  • I can use them to do tricks – 20.0%
  • Some other reason – 19.5%

Way down at number seven is “They [were/are] available in flavor [sic], such as menthol, mint, candy, fruit, or chocolate.” Just 13.2 percent of users cited flavors as a reason they vaped in the past 30 days. That’s not a surprise. After all, even at the height of the “vaping epidemic” in 2019, just 22.3 percent of school-age vapers named flavors as a reason for using e-cigarettes.

Some anti-tobacco/anti-vaping groups, like the American Cancer Society’s lobbying arm the Cancer Action Network (ACSCAN), simply ignored the news about the historic drop in teen smoking, and used the occasion to call for immediate government action on synthetic nicotine and flavored vape products. “The results from this survey are a clear sign we are headed in the wrong direction when it comes to youth tobacco use,” said ACSCAN President Lisa Lacasse.

If by wrong direction she means the 2021 results represent the lowest youth vaping prevalence since before the ”vaping epidemic” era—and the lowest youth smoking rates ever—she’s right.

Smokers created vaping without any help from the tobacco industry or anti-smoking crusaders, and vapers have the right to keep innovating to help themselves. My goal is to provide clear, honest information about the challenges vaping faces from lawmakers, regulators, and brokers of disinformation. I recently joined the CASAA board, but my opinions aren’t necessarily CASAA’s, and vice versa. You can find me on Twitter @whycherrywhy
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