Thread by @MyHarmReduction

The 2019 National Youth Tobacco Survey (NYTS) results are out. And there are some major issues with how they present their findings.

Shall we begin? (1/?)

cdc.gov/mmwr/volumes/6…

1) E-cigarettes are NOT tobacco products. They are nicotine delivery products. Tobacco is plant-based.

Seriously, all they had to do was to name this report, "Nicotine product use and associated factors..." and it would have been factually correct.

It is deliberately misleading for this national governmental public health body to conflate different products with one another. We know that tobacco use - combustible or otherwise - is associated with cancer risk. The risks associated with nicotine itself are far fewer.

2) It is also disingenuous for us to lump together the use of these different substances/products because then we miss key issues - namely, that the use of combustible cigarettes has gone down dramatically and is at remarkably low rates in this generation of young people.

3) The study proclaims that 23% of middle school and high schoolers were "current" users of these products. They actually mean that 23% used a product in the past 30 days. This metric lumps together someone who used it once in past 30 days with daily users. Messy data.

4) In addition, we need to tease apart age groups here for a second. They found that 1 in 8 middle schoolers (12.5% ) used a product in the past 30 days.

That means 7 in 8 middle schoolers (87.5%) DID NOT use even once last month.

5) They found that 31% of high schoolers used a product in the past 30 days.

But unless you tell me the breakdown by grade/age - you risk lumping together 12th graders (many of whom are 18 and legal adults) with 9th graders who might be 13.

Those of us who watch the substance use numbers know that older teens are more likely to have tried substances than younger ones, and are most likely to use recently.

The trouble with lumping together teens of diverse ages in these reports is that it washes out differences.

Note- I am not minimizing the fact that young people are using e-cigarettes. However, I do believe they are using a far less risky nicotine product than the alternatives.

I'm actually very interested in WHY they are using but the survey asked bad questions about motivations.

Again, as a harm reductionist, I want to understand the WHY. I want to hear about motivations. Perceived benefits of use. How pleasure fits in. Whether people use substances to cope, enhance performance, feel better.

This survey didn't ask about any of this.

Instead, the types of questions about motivations reveal a fundamental IGNORANCE about substance use and why people really use drugs. See them here:

As a teacher, parent, community member, therapist, or policy maker - what do I even do with this information? It's clear these questions have a political purpose. These questions are meant to inform prohibition and bans. Not real prevention.

If I could design a study to understand teen vaping and to develop prevention programming, or even to help moderate use or quit, I would ask completely different questions. Base them on the known pharmacological properties of nicotine and why ppl like it.

Nicotine produces euphoria, it boosts mood, it helps with focus, it can make you more alert, it suppresses appetite, it helps w constipation.

#1 principle of harm reduction - "Don't take away what you can't replace."

Before talking about cessation, learn what you are giving up

After identifying what benefits that young people seek from nicotine, you can actually develop real programming and propose solutions that work.

Are your kids vaping bc they are stressed out/overwhelmed? Have untreated mental health symptoms? Have trouble focusing?

- Are they lonely and find community with vapers/smokers?
- Are they vaping bc they haven't gotten enough rest/sleep?
- Are they vaping bc they feel pressure to stay slim?

Rather than making VAPING the problem, why aren't we looking at our young people's environments, unmet needs, stress, pressures, and fears that might be driving use?

That's the crisis.

FIN.