A spike in U.S. youth vaping rates back in 2018 sparked a worldwide moral panic over teen vaping. But the so-called “epidemic” was short-lived. In just 4-years, U.S. teen vaping fell over 60% to a historic low in 2023. It’s good news for everyone except those campaigners who profit from panic.
Featuring:
Michelle Minton
Senior Analyst, Reason Foundation
reason.org
@michelleminton
Transcription:
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Brent Stafford: Hi, I'm Brent Stafford and welcome to another edition of Reg Watch on GFN.TV. No matter where in the world you're from, every tobacco harm reduction advocate knows the United States is ground zero in the war on vaping. In 2018, when then US FDA Commissioner Scott Gottlieb pronounced there is an epidemic of teen vaping, that poses a clear and present danger to youth, he provoked a moral panic over e-cigarettes that continues to ripple across the globe even today, despite the fact that teen vaping in the US has fallen over 61% since Commissioner Gottlieb made his statement. Joining us today to discuss the made-in-the-USA war on vaping is Michelle Minton, Senior Analyst at the Reason Foundation. Michelle, it's great to see you again. Thanks for coming back on RegWatch.
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Michelle Minton: Thanks for inviting me back.
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Brent Stafford: Michelle, earlier this month, the US Centers for Disease Control and Prevention released the results of its 2023 National Youth Tobacco Survey. And the results confirmed the trend we've seen for some years now, and that is US teen vaping continues to fall. This year, the CDC reports only 10% of US middle and high school students used e-cigarettes and that's a 4% drop over 2022 and miles away from the 27.5% high that sparked the moral panic over teen vaping. What do you make of these numbers, Michelle?
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Michelle Minton: I mean, what the numbers show us during the pandemic, it was sort of difficult to see because people distrusted the results because, instead of giving the survey to kids in school, they were taking them home. So it's kind of hard to compare. But generally what this shows is that the trend remains fairly consistent over the last 10 to 20 years when it comes to youth and tobacco use is that their interest is declining in basically every single category. And the e-cigarette phenomenon is really interesting because it's one of the few that have gone up and down over the last 15 years. But what this shows is that, starting in 2019, youth interest in e-cigarettes began to decline and has continued that decline very impressively. Back in 2019 at its peak, upwards of 28 percent of high schoolers reported any past month vaping. Now that number is down into 12 percent range, 10 percent for both middle schoolers and high school. So really, this should be fantastic news.
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Brent Stafford: So why is it not?
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Michelle Minton: Well, it's not, I mean, I should also mention that the best news here is that, youth smoking rates are now well below 2%, which is functionally extinguished, exterminated. We've been talking about a smoke-free generation for many decades now and it, congratulations, America, we've reached it. We're there. It doesn't mean you have to rest on your laurels or anything, but, but we've done it. The reason I say it's not exactly great news. I mean, it's good news for people who care about public health, who want to see, a new product category kind of settle into itself with the regulations and the society and all of that, but for the people who are anti-nicotine zealots, the ants, so to speak, the people who do not want to see any tobacco or nicotine use among any age group, It's not the greatest news because really all it does is make the case, which I'm making now, is that the panic surrounding youth vaping that prompted all of this attention on tobacco again and all of this flush of money into the anti-tobacco space is this new data threatens to make that go away, to make the interest and the money and all the other things that the people who are fighting for specific policies want to, they still want. So they don't want the attention and the urgency to dissipate, which is, not just this survey results, but previous surveys have indicated that the urgency around youth vaping should have never been as urgent as it was. And now it's definitely time to ratchet that down.
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Brent Stafford: But it feels like a crisis that public health is reluctant to let go of.
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Michelle Minton: It is. And like I said, back in the early 2000s, a lot of the tobacco funding, the funding that went towards anti-tobacco projects, whether that was private, like the campaign for tobacco for kids, or if you look at public health departments, even the CDC and the FDA, their tobacco budgets were really dwindling because smoking had been plummeting for so many years. It just, there wasn't a lot of interest in pursuing quite the same effort when it came to tobacco. And youth vaping, when the numbers started to creep up, and then the news started to pick up on it, and the FDA started to pick up on it, it really renewed interest in funding. So I think, and I do think there's a lot of people in tobacco control in that space who are genuinely concerned about mitigating and reducing all of the threats surrounding nicotine and tobacco as much as possible. So, if the panic goes away, so does the interest, the eyeballs, the attention.
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Brent Stafford: Let's take a quick look here at a CNN article. Now this came out on the very same day that the survey results came out. Youth tobacco use rates declined slightly in the US but work is far from over, health officials say. A couple of questions I've got with that is that is it really only slightly? Because if you look at the last couple of years together, it's been a crash. And what does it mean that the work is far from over?
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Michelle Minton: I mean, that could go one of two ways. That could be the same thing of if panic goes away, so does the opportunity to pass legislation and get people's attention. But if you actually look at the numbers, in 2019, that was the peak and 2020, 2021, 2022, 2024, I mean, there was a slight uptick in there, basically statistically insignificant uptick, but for the most part, Youth e-cigarette use from 2019 till now has been decreased by 60 to 65%, depending on how you look at how you splice it, high school, middle school, or both. That's phenomenal and indicates a lasting and consistent decreased interest among youth in this particular product. And in fact, youth interest in all tobacco products went down in this latest study. And again, that's fairly consistent.
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Brent Stafford: Michelle, FDA Center for Tobacco Products Director Brian King says the agency: "cannot and will not let our guard down on this issue." Yet he's also said the agency is no longer referring to youth vaping as an epidemic. How do you square that?
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Michelle Minton: I mean, look, if well, first of all, Brian King needs to tell everybody else that the epidemic is over. It's nice for them to have a really big, splashy announcement about it and then just very quietly retire the terminology. They're going to actually have to go out and say, like, it's over now. I can square this by saying that, I mean, they shouldn't let their guard down, right? As we've seen over the last 20 years. The market is creative, it's innovative, it shifts, it brings new products. And with every new type of product or new type of innovation, there's going to be an adjustment in society. And that is a thing that public health experts and agencies are going to have to watch. Youth tobacco interest or other types of risky youth behavior and adult behavior can change at any second. So you don't want to ignore the issue entirely. The thing is, you just don't want to spend 100% of your effort on this one particular issue of youth and vaping, because you're missing the forest for the trees and functionally creating really dangerous public health policy by only looking at one group.
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Brent Stafford: So is it fair to say that the US war on vaping, the whole epidemic narrative, and then of course, we've got that vaping related lung illness from 2019, but we can almost leave that aside just the epidemic and focus on teens narrative. How much of an impact has that had on tobacco harm reduction in the rest of the world?
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Michelle Minton: I mean, it destroyed it almost really, the American panic over youth vaping, because harm reduction is a thing that people in the drugs reform movement have been talking about for a very long time. And it's something that started to pick up with tobacco even before vaping existed. It was a thing people were talking about, the idea of harm reduction. That's what the nicotine patch is. It's a non combustible replacement for nicotine for people who smoke so they can reduce their risks. But when the focus shifted on to teen use and the panic arose in America and it led to just a massive wave of frankly ill thought out legislation passing across the states. As in the US, when a bunch of states start to do something, the federal government gets interested. Other countries around the world, when they see the US federal government doing something, particularly our FDA, which is kind of, at least it was 10 years ago, a world standard in public health, when they see them doing something, lawmakers in other countries kind of want to get ahead of whatever problems might be coming, and they start to enact similar legislation. Like we saw, for example, in India, where the last time I looked, I think in 2021, or I'm sorry, in 2019, the youth ever vaping rate was under 3%. Yet that's the year that India decided to entirely prohibit e-cigarettes for all age categories, despite the fact that India has, the greatest number of smokers in the world with over a million people in that country dying every year from smoking related disease. The conversation about harm reduction was almost completely sidelined, especially in America, in the American legislative process. It was completely sidelined by this urgent need to address this youth vaping crisis.
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Brent Stafford: Is FDA and Center for Tobacco Products perpetuating the moral panic if they don't loudly and proudly change course and make these announcements so even like foreign governments can hear that the epidemic is now over?
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Michelle Minton: I mean, it's regulatory malfeasance to not say something in this place. It gets back to the lung injuries you mentioned when the CDC was telling everybody and they named it EVALI, e-cigarette or vaping lung injury, associated lung injury. And then when it very quickly became clear that e-cigarettes had nothing to do with that outbreak of lung injuries, they just let it continue, just let the ripples of the stone they threw into the water carry forward to this day where adult cannabis users and youth cannabis users have no idea that outbreak of lung injuries was actually related to illicit market THC or cannabis products, right? So that's dangerous for a health body that is disseminating important health information to consumers, and then again to the rest of the world, to not correct misinformation. I think it's absolutely imperative that Brian King and the FDA tell people, first of all, what qualifies as an epidemic in this context, because they've never said, and then two, that it is no longer an epidemic requiring all hands on deck, ignoring everything else.
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Brent Stafford: So by ignoring the data, by ignoring the fact that teen vaping has fallen to such degree, are the agencies being unscientific?
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Michelle Minton: Absolutely. Yeah. I mean, if if science based policy is going to be based on research data and what things that are proven to be effective strategies in public health, and then also on the other side of it, examining the effects of those policies you put into place. Nearly all of the evidence that isn't produced by people paid by one of the agencies or one of the anti-tobacco people indicates that the route that we have been going is not actually helping consumers have better knowledge and make better choices. The FDA has been saying for years, internally and sometimes publicly, that they need to correct the record on nicotine, that too many people still misunderstand the role that nicotine plays in the health risks of tobacco products as a whole, in that nicotine itself doesn't isn't related to cancer or most of the other smoking related illnesses that we worry about. Yet the FDA has still not done very much to correct that misperception.
00:11:55 --> 00:12:13
Brent Stafford: So if the agencies are reluctant, if not downright refusing to embrace the science about vaping and tobacco harm reduction and correcting the record, if an historic low of 10% means the work is not done, when will it ever be over?
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Michelle Minton: I mean, the work will never be over. That's the thing about dragon slayers or agencies or nonprofits that have a specific mission, if they want to continue to exist, that mission has to stick around. Now, what a lot of the anti-tobacco groups have done over the years is kind of, pivot to whatever new product comes out. But for some reason, the FDA, the CDC, they seem extremely reluctant to just take it down from DEFCON one, actually, I'm not sure which one's the worst one or Three or five?
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Brent Stafford: One is the worst.
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Michelle Minton: They seem reluctant to just let the world kind of relax a little bit, and that's what I think they mean by don't let our guard down is because if they're not constantly talking about how bad tobacco is, then we're not doing anything about it, which isn't the case.
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Brent Stafford: Well, and that brings up a point. Nnow so many these young people that tried vaping in big numbers in the fad days of 2018 and 2019, they're all now like 22, 23 years old. Aren't we able to, with some science, be able to go back and see how well they have done. We know that smoking has crashed and crater. How come two and two aren't being added together to make four?
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Michelle Minton: Yeah, as far as I'm aware, there haven't been any studies. I mean, we have these annual surveys of youth and adults. We have the PATH data, which I can't remember exactly what PATH stands for now, but it's this giant survey of huge junk of the population that they do year on year, and they follow the same cohorts for many years. It wouldn't be, I think, too difficult for researchers to go into that data and say, OK, these were the youth who are experimenting with e-cigarettes in 2018-2019. What are they up to at this point in their life? Are they still vaping? We know just from the age, like how much vaping there is in each age category. Now, once you hit the age of 30, that tends to decline. People above the age of 30 don't vape as much as people who are younger. So there's attrition happening. People are falling out of the habit. And I think it'd be very helpful for us to know what is that number? Because that would give us an idea of a lot of the data that we collect is past month e-cigarette use. Like the National Youth Tobacco Survey, that's what is considered current use, is have you used even once an e-cigarette in the last month? And that doesn't really tell us that whether or not these youth are habitual users and whether they're going to carry on or whether they just took a hit off of a friend's vape at a party. And the data also kind of shows that here when they ask youth, what flavor do you typically use? And you get 35% saying, I don't know. Or you ask what type of device do you typically use? And you have 30% saying, I don't know. That 30 to 35% very likely don't own their own vapor device and therefore probably aren't doing it on any kind of regular basis that would lead to nicotine dependency or a habit that would carry forward for any length of their lives. That information is really important. Because those kids, they went through all of that. They went through the D.A.R.E.-style anti-vaping campaigns. They hit college. Some percentage, I'm guessing a very large percentage of them, never vaped again after that. And now they're still hearing the same messaging, which in my mind, because I went through this as a young person who went through D.A.R.E., it says to me that all of that stuff I was told in those campaigns and those like initiatives to get me not to do something were bullshit. And I wonder, on the other hand, I wonder what that does to those young people now adults and how they feel about public health messaging and public health agencies and institutions.
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Brent Stafford: Now, correct me if I'm wrong, but one of the things that FDA is doing is using the concern over flavored e-cigarettes as justification for not approving them for the marketplace. So because teens like flavors and there is an epidemic, a teen vaping, or at least whatever the concern is now that's not being called epidemic. Nevertheless, this is the justification they've got for the regulation of these products.
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Michelle Minton: Yeah. And I mean, if you actually look into the numbers, I mean, I've said this before, if you ask a kid, you can have a piece of pizza. Do you want a cheese pizza or do you want a pepperoni pizza or a pizza with something else on it? Most people, not just youth, most people are going to pick the extra topping pizza. So if you have the option as a youth to have a unflavored or tobacco flavored vape versus one that tastes better, you're going to pick the one that tastes better. Then the other factor that we have is with all of the product bans, all the letters being sent out to FDA, cease and desist orders, products voluntarily and involuntarily being pulled off the market, as predicted by literally everybody with a brain, it led to a giant illicit market. In that illicit market, there aren't restrictions on flavors. You get a lot of wacky flavors coming in from Chinese imports and disposables. Going back to the FDA not approving flavors, yes, they are very worried about youth interest in flavors. If you look at what FDA is doing on the cigarette side of things, they're currently talking about a menthol ban, banning menthol cigarettes because black people in America disproportionately use menthol cigarettes and it supposedly attracts kids and all of this other stuff. If you actually look at the numbers, menthol in the e-cigarette category for youth wasn't one of the top two or three, I think, preferred flavors. Menthol was pretty low on that list. And at the same time we're so worried about the youth in this particular flavor, we're going to ban it in cigarettes. Except for the fact that the FDA's plan to ban menthol, when they say this many lives will be saved hinges on the fact that a lot of adult smokers will switch to menthol vapes, which none have been approved yet. So they have nowhere to go. So the FDA is kind of putting itself into a regulatory catch-22 with their solutions. They're functionally banning or disallowing their supposed solutions to other problems. And this is what I mean where you cannot look at one group and that group's behavior around one product. You have to look at the entirety of the public health picture so that you don't end up with unintended consequences.
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Brent Stafford: Michelle, I went digging into my archives on youth vaping and the epidemic in prep for this episode. And I found in my Scott Gottlieb folder, an article you wrote in the Washington Examiner published August 5th, 2019. This was just over two weeks before the first reports of the so-called vaping related lung illness. And I might add a couple of months before the first reports of what became the COVID pandemic. In this article, you chastise Commissioner Scott Gottlieb for paying lip service to e-cigarettes as a tool to help smokers quit. Also, you state in the article: "a year before the CDC released the results of its survey showing that after two years of declines, teen vaping had increased. The FDA had already launched its epidemic campaign." You say this was a market-tested messaging initiative designed to scare the public about vaping. What do you mean by market-tested?
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Michelle Minton: I mean the FDA literally sat down 300 youth and 900 young adults and adult smokers in separate categories and tested messaging on them to see what the effect would be. And they found that using the term epidemic was very effective in discouraging youth or making youth believe that e-cigarettes are as or more dangerous than traditional combustible cigarettes. What they also found was that among the 900 adult smokers and young smokers was that it had the unintended consequence of convincing them that e-cigarettes were as or more harmful than traditional cigarettes. And even in their document, the FDA is saying, this is why we have to absolutely laser focus our advertising, our anti-vaping advertising, only where adolescents will see it. So we don't discourage adult smokers from switching to a less harmful product. If you've been living in this world, however, for the last five years, You know that laser targeting didn't exactly work. If you go on Hulu, you go on YouTube, you constantly see anti vaping messaging. So they aren't really just hitting only the adolescents. And then again, you look at what's been happening among adults when it comes to e-cigarettes. More adults now think that e-cigarettes are equally harmful to cigarettes or even more harmful to traditional cigarettes. So fewer adults are switching.
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Brent Stafford: So this was market tested by FDA before they rolled out the epidemic narrative.
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Michelle Minton: Yes, about a year before they actually released the data. Now, presumably Scott Gottlieb and other people in the FDA were getting data as it was coming in from the states, so they noticed the uptick. One of the things people don't realize is that the FDA at that point in time, I think the contract is up, they had an over $600 million contract with a New York City ad firm to do campaigning for them over five years. That epidemic campaign was part of that. The FDA had a lot of money to spend, I suppose they had to do some kind of campaign and it turned out they hit on one that was effective, but for an outcome that I don't think anybody really wanted.
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Brent Stafford: Yeah, it's very unfortunate because adults absorbed the FDA's fear mongering as well.
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Michelle Minton: Well, and the other side of it that I've written about is that the A lot of the campaign in the FDA, maybe not the FDA's epidemic campaign, but a lot of the other campaigns that were coming out and still coming out to this day had the unintended consequence of advertising vaping and e-cigarettes and specific products and specific flavors to adolescents, which is one of the reasons I think the uptick in vaping in 2019 occurred at all, is because there was so much messaging and so much media pickup on it and so many youth in commercials saying, everybody's vaping, but you shouldn't vape. It was all the wrong messaging.
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Video: I play baseball, basketball, and play football. Those are the three sports that I play big time. When I first started vaping, I just turned 15 years old, so I've been doing it for about a year now. All my teammates do it. It's just pretty normal for everybody to do it. People that I know that do it, they're, like, good students, like, straight A's. It's a normal thing to do. I was 13 the first time I vaped. People at my high school, they would vape on the bus just because it's like so easy to hide. It's just like a little like black pen. I could just vape at home like my parents don't know at all. When I'm riding my bike, like, far distances, it makes me feel like I'm riding away. And the reason I vape is to basically get away and get my mind just off of things. I was 13 years old when I vaped for the first time. I started buying $5 vaporizers, and from there, I moved on to bigger ones. Most of my friends that vape, they use nicotine. A lot of nicotine, actually. Like, because you can put as much nicotine into it as you want. Like, the concentrates can go way past the cigarettes. There are too many flavors to count. There are endless amounts that you can get. There's cotton candy, bubble gum, peppermint. Some that taste like pancakes, coffee flavor. I heard one was unicorn puke. It sounds like cartoon flavors or something. It makes them seem a little bit more kid-friendly, so people are, like, okay with doing it. Some of my friends, they're sponsored by vape companies. They just get sent stuff for free, because then they, like, make YouTube videos of all the tricks that they're doing, and they're like, oh, this is the juice I'm using, this is the... mod I'm using. A lot of people post them on their Snapchat stories or on Instagram of them vaping. They tend to be more popular. You know, I can look up vape and a whole bunch of videos will come up and I can see what kind of cool tricks they're doing, learn what the name is, and I can go look it up on YouTube about how to do it. It's a whole culture. It's kind of a big deal for a lot of people that I know. Sometimes I do feel pressured into vaping. With all the social media nowadays, it has a really big effect on what people just think about you. If you don't vape, you're looked at as an outsider. So everybody does it. I think people that you would never expect would definitely be vapers. It's becoming more and more popular. Vaping is considered cool in my group of friends. It might just be the fact that you're doing something you know you shouldn't be doing. There's no worry that our parents are going to find us vaping on social media. We've gotten really good at hiding it from our parents. I know I'm underage, but it's just something that I do. I won't let it affect my future.
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Brent Stafford: Amazing, that piece and Michelle, that was California Public Health. So it was actually the state agency and they released that ad in October of 2016.
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Michelle Minton: Tobacco companies have a hard time advertising. They always get caught in advertising restrictions or being called out on social media. But for my money, nobody did a better job advertising vaping to youth than the California Department of Public Health. They did a phenomenal job. Because if you look at youth psychology around marketing, I write about reactants or backfiring. When you tell a teenager, don't do X, and the teenager just immediately does whatever X is because it's a very natural thing as a human being being told you can't do something or you have to do something to go, no, I don't. Like, I'm autonomous. I'm an adult. And young people who have even less freedom are much more possessive about the little amounts of independence that they have. So when they're being told, especially by adults and especially by authority figures, don't do something, guaranteed going to backfire. California Public Health Department learned that lesson in having real teens talk to other teenagers. Unfortunately, the message that they were sending was everybody cool is doing it. If you're not doing it, you're not cool. It's super easy. Here are some reasons why we do it to escape or whatever and here all the wonderful sounding flavors that you can try and all the cool tricks. And hey, also, maybe you'll get free stuff sent to you and become famous on social media. It's it's all the wrong types of message that you got around the youth reactants. But only so they must have hired some kind of really excellent marketing firm that specifically targets youth with their marketing, but maybe not normally with don't do something messaging.
00:26:37 --> 00:26:41
Brent Stafford: Are anti vaping forces around the world using the US playbook?
00:26:41 --> 00:27:48
Michelle Minton: They're using the US playbook, they're using our data, they're using our talking points. And again, like I said, this is the most, one of the most tragic aspects of this entire conversation is that the hyper fixation on youth and particularly youth vaping is causing us to ignore or even sacrifice the pursuit of other real policy goals that we could pursue, like with adults who smoke. So you have places where there is very little vaping, if any vaping at all. And they're looking what these moms in New York are screaming about in America because their children are vaping now. And their children weren't supposed to ever use nicotine because that's not for rich little kids in New York City. But you have that impulse being implanted or imported into other countries where their problem is not youth vaping. Their problem is adults and youth smoking and then dying from that habit. If the goal of public health is as it should be to prevent disease and death, fixating on a problem from one other country that isn't maybe even really as big of a problem to the detriment of all other issues is just bad public policy.
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Brent Stafford: Final question, Michelle. What, if anything, do you think would make a tobacco controller happy?
00:27:55 --> 00:29:09
Michelle Minton: I don't know if they want to be happy. I'll be honest, I know too many people in my life who seem uncomfortable with happiness, right? Like, if some of these people ever reached their utopia, they would find something else to complain about and campaign around stopping. I think a lot of this, a lot of the impulse, while it might be utopian, is control. Like, I say never forget, the most important word in tobacco control is control. People like this impulse to set rules and say you're going outside of the rules and I'm going to punish you now because you're not living in the way that we say is the American healthy human way to live. But that's not what freedom is. That's the thing with freedom is if you give people the freedom to make their own choices, sometimes people will make choices that you disagree with. or you wouldn't make for yourself, and that's okay. The point of a public health body, public health agencies, is to give consumers the information they need so that they can make their own informed choices, not to make those choices for them. But that's what we have with tobacco control, is they haven't been able to scare or coerce or tax people out of the behaviors they don't like, so now they're going to the good old standby of prohibition, stigmatize, control and force.