The FDA calls teen vaping an “epidemic,” but the influence of e-cigarettes on teens’ overall health might be more complicated than assumed, according to a new study out Thursday in the journal Tobacco Control. It suggests that while teens and young adults in the U.S. did start flocking to e-cigarettes these past few years, they also significantly cut back on smoking traditional tobacco cigarettes during the same time period. But there’s at least one major limitation to these findings.
Vaping advocates have long claimed that e-cigarettes can and will help current smokers wean themselves away from smoking tobacco cigarettes, with the eventual goal of making it easier for them to quit nicotine altogether. But the evidence supporting this prediction has been mixed. A study earlier this year, for instance, found that adults who became dual users of e-cigarettes and tobacco cigarettes were actually less likely to quit their habit in a year’s time than people who only smoked cigarettes.
When it comes to teens, other research has found that vaping’s popularity has had no major positive effects on their smoking rates. Some studies have even suggested that vaping is creating new smokers, with teens who start vaping becoming more likely to eventually transition into tobacco than non-vaping teens. The latter scenario being true would be an especially bitter pill to swallow, since rates of smoking among teens (and adults, for that matter) have been steadily declining over time.
But the researchers behind the current research say that past studies haven’t looked at teen vaping trends alongside smoking trends long enough for us to be sure of anything. So they decided to analyze and combine data from five different nationwide surveys of teens and young adults in the U.S., all of which were prun regularly between 2013 and 2017.
Mirroring other research, they found that vaping shot up in popularity around 2014 and has stayed popular in the years since. But they also found a faster, inverse drop in traditional smoking rates during those same years.
“This finding is important because it indicates the country experienced a major reduction in youth and young adult cigarette smoking when vaping became more popular,” said senior author David Levy, a professor of oncology at Georgetown University Medical Center, in a statement.
According to one survey of teen drug use, the Monitoring the Future survey, annual rates of any smoking in the past 30 days among 12th graders have been declining by 4.5 percent over the long term. But during 2014 to 2017, Levy and his team estimated, there was an additional 9.1 percent annual reduction of any level of smoking.
The team doesn’t discount the possibility of vaping having converted some teens into new tobacco smokers who wouldn’t have been otherwise. But they argue that the overall effect of vaping on teen smoking rates has more than canceled out this boost.
There are a few caveats to the study’s findings, though. Like other population studies, it can only tell us that an indirect connection between teen smoking and vaping exists, not whether one trend is directly impacting the other or vice versa.
But more importantly is that these surveys were all mostly done before the emergence of wildly popular e-cigarette company Juul in summer 2017. The company’s products—slimmer, USB drive-shaped devices with disposable cartridges—have quickly dominated the industry and now account for the majority of all e-cigarette retail sales, according to Nielsen data. These products, which are easier to use and contain more nicotine per puff than older devices, have also almost single-handedly sparked a second wave of new teen vapers. According to recent data from the Centers for Disease Control and Prevention, there have been more than 3.6 million middle and high school students who used e-cigarettes in 2018, nearly double the amount of teens estimated to have vaped in 2017.
The surge in teen vaping led the Food and Drug Administration to force through new policies aimed at restricting access to flavored e-cigarette products in retail and online stores, while Juul decided to pull most of its flavored products off retail shelves, at least temporarily.
Levy and his team acknowledged the lack of timely data looking at Juul’s influence on teen smoking rates. Though he doesn’t necessarily think it would change the overall picture.
“The data that I have seen so far indicates that vaping has increased, but little has changed in terms of smoking rates,” Levy told Gizmodo via email. “Much of the vaping is low intensity use (less than 5 days in the last month), but some is more regular use as indicative of addiction. It is much too soon to say the combined effects, and I expect that we probably will not even have a good indication of the effects for at least another year.”
Ultimately, while Levy and his team aren’t pushing for teens to take up vaping, they do think the conversation surrounding vaping needs to be nuanced and studied more.
“The most important take away from my study is that the public health implications of vaping are complex. We should not just focus on vaping, but should consider its effect on smoking,” he said. “Smoking presents far greater health risks, so that any reduction in smoking that arise as a result of vaping needs to be given strong consideration in evaluating any additional health risks that vaping may present.”