NYTS 2023: reaction with trend graphics

Clive Bates, Counterfactual Consulting, UK
3 November, 2023
See this note at: https://bit.ly/2023NYTS

Some fascinating developments in the United States youth vaping and smoking data.

Birdsey, J. et al. (2023). Tobacco Product Use Among U.S. Middle and High School Students — National Youth Tobacco Survey, 2023. MMWR. Morbidity and Mortality Weekly Report, 72(44), 1173–1182. https://www.cdc.gov/mmwr/volumes/72/wr/mm7244a1.htm

A few reactions and highlights - all data is high school past 30-day use unless specified.

1. High school past 30-day vaping 2023 is down quite sharply, from 14.1 to 10.0 per cent compared to 2022.
2. Frequent vaping (≥ 20 days per month) as a share of total vaping is down from 46.0% to 39.7%. In absolute numbers, frequent vaping is down from 980,000 to 620,000 (a 37% decline). Daily vaping is down from 620,000 to 460,000 (-26%)
3. Disposable as a share of "device type most often used" has increased from 57.2 to 65.2 per cent.
4. A lot of churn in "any brand" and "usual brand". Juul has declined to 3.4% of high school and middle school vapers (70,000, or 0.26% of students < 3 in 1,000)
5. Cigarette smoking is slightly down from 2.0 to 1.9 per cent compared to 2022
6. "Any combustible" use (the best public health metric, in my opinion) is down from 5.2 to 3.9 per cent compared to 2022. It is important to focus on "any combustible" to account for little cigars - and any other possible substitutions between different smoking products.

My reaction: 3 November 2023:

The numbers are quite a surprise to me, to be honest - in a good way. And the cut in high school past-30 day vaping is large - from 14.1% to 10%. Smoking is now increasingly rare in teens, and it’s likely that the vast majority of this cohort will never become smokers. So I think we will be seeing the end of cigarettes as today's young people age into adulthood. One generation at a time, the cigarette is becoming obsolete.

The new data probably confirms that we were dealing with little more than a teenage vaping fad in 2018-21, yet it triggered a major moral panic and furious regulatory backlash that will set back the progress on dealing with today's burden of adult smoking. It’s quite likely that many of those adolescents still vaping would otherwise be smoking and that their vaping is net beneficial. But the published data doesn’t allow us to calculate that.

I hope this will allow the political space for a rethink and refocus of policy and what matters - cutting smoking as deeply and rapidly as possible and taking advantage of vapes to bring on the end of smoking without delay.

I have some updated graphics to share:

The youth vaping trend

The vaping and frequent vaping trend

The vaping and smoking trend

The accelerating trend in the decline in smoking

This one shows an increase in the linear combustible trend decline since the onset of the "youth vaping epidemic" in 2018. The gradient doubles. (Note that the expected trend would be more likely to have geometric characteristics, so this is impressive)