Vape debate: Are e-cigarettes wiping out teen smoking?

Washington — In almost any other year it would be hailed as a public health victory: The smoking rate among U.S. high schoolers took its biggest hit ever this year, federal figures show, falling to a new low.

Instead the milestone was relegated to a lone figure at the bottom of a government press release and went unremarked by anti-tobacco groups that have spent decades working to stamp out youth smoking.

It’s a new era in the tobacco wars — one in which the alarming rise of underage vaping has almost completely overshadowed a parallel drop in traditional smoking. And the pivotal question of whether electronic cigarettes are inadvertently helping to wipe out smoking among young people has become a polarizing topic: embraced by some experts, dismissed by others.

“Smoking is disappearing among young people and it’s a great public health triumph that we are failing to celebrate, much less even note,” says Kenneth Warner, professor emeritus at the University of Michigan’s school of public health.

E-cigarettes typically heat a solution that contains nicotine, the drug that makes tobacco addictive. They are generally considered less harmful than cancer-causing traditional cigarettes. But there is little long-term research on the health effects of vaping.

With one in four teenagers now using e-cigarettes, underage vaping is universally condemned, and the federal government considers it an epidemic.

But Warner and some other researchers believe recent trends continue to show vaping’s promise as a tool to steer millions of adults away from cigarette smoking, the nation’s leading cause of death.

That potential makes the case for keeping e-cigarettes readily accessible for adults — even if a certain level of teen use persists.

But that approach is a non-starter for many tobacco opponents.

“When adults make policy gains on the backs of children, that’s bad, and that’s what the argument boils down to here,” says Dave Dobbins, an attorney with the anti-tobacco nonprofit, Truth Initiative.

Even if e-cigarettes were responsible for the smoking decline among teenagers — which Dobbins says is unlikely — allowing young people to get hooked on vaping nicotine is not a solution.

“I don’t buy the argument that these things showed up and magically changed the world,” says Dobbins. Instead, he thinks the vaping industry has increasingly pursued young people as smoking has fallen out of fashion.

But no one disputes the decline.

The percentage of high schoolers who reported smoking fell to 5.8% in 2019 from the prior year, a 28% drop and the largest since the U.S. government began surveying teens, according to preliminary numbers released in September. The trend isn’t limited to one year or one survey.

A similar study conducted by the University of Michigan shows smoking among 12th graders has plummeted 50% since 2015, the largest drop of its kind in the survey’s 40-year history.

The smoking rate for adults is roughly 14% and has been falling slowly for decades.

The decline among teens has been seized upon by vaping proponents, who argue it undercuts the gravest argument against the nicotine-emitting devices: that they act as a “gateway” to traditional smoking.

That’s the conclusion of a number of short-term studies that followed young people and surveyed their use of tobacco and nicotine. The prestigious National Academies found “substantial evidence” for the gateway effect in a 2018 consensus paper. And the Food and Drug Administration even uses the concept as the tagline in its anti-vaping video ads: “Teens who vape are more likely to start smoking cigarettes.”

For now, experts on both sides acknowledge there is no definitive evidence linking e-cigarettes to the decline in youth smoking.