In the MTF survey, the “stunning” rates of past-month e-cigarette use that worry Matthew Myers coincided with the lowest past-month smoking rates seen in the history of the study: 4 percent among eighth-graders, 7.2 percent among 10th-graders, and 13.6 percent among 12th-graders. Daily smoking also was less common than ever before. It was reported by 6.7 percent of high school seniors, down from 26.9 percent in 1975, when the study started, and 12.3 percent in 2007, when e-cigarettes were first marketed in the United States. The NYTS and the CDC’s National Youth Risk Behavior Survey show similar downward trends in smoking.
Although activists like Glantz and public health officials like CDC Director Tom Frieden worry that e-cigarettes “could become a gateway for young people to take up real cigarettes,” notes New York Times science reporter Sabrina Tavernise, “that does not seem to be happening.” Far from showing that e-cigarettes are training teenagers for the real thing, the fact that vaping and smoking rates are moving in opposite directions suggests that e-cigarettes may be replacing combustible cigarettes among people who otherwise would be smoking.
The MTF data provide some additional support for that hypothesis. Among the 12th-graders who said they had ever smoked a cigarette, for example, 17.5 percent said they had used only cigarettes in the previous month, 16.7 percent said they had used only e-cigarettes, 21.5 percent said they had used both, and 44.3 percent had used neither. This pattern suggests that e-cigarettes may be helping some adolescent cigarette smokers cut back or quit. Even when teenagers try e-cigarettes first, some of them might otherwise have smoked the conventional kind. The upshot in both cases would be the same: less smoking and less tobacco-related disease, something anti-smoking activists like Glantz ought to welcome.
As Tavernise notes, “most experts agree that e-cigarettes are far less harmful than traditional cigarettes.” That is why the crucial question, when it comes to assessing the public health impact of e-cigarettes, is whether they compete with tobacco cigarettes or somehow expand the market for them. The evidence so far indicates that more vaping means less smoking, not the other way around.