Update 30 April 2018 – JUUL: hold the moral panic
Introducing a modern moral panic
Over the weekend in an aside in my long blog about the sophistry of anti-vaping activists, I mentioned the unfolding moral panic about vaping and, especially, Juul e-cigarettes among teens (see the quote from the blog below for background). I want to add to this with some views on appropriate journalistic inquiry and suggest a line of sceptical questioning a credible journalist could use.
Moral panic case study: “Juuling”. The New York Times ‘I can’t stop’: schools struggling with vaping explosion, and CNN, Vaping now an epidemic among US high-schoolers and dozens of other American news outlets have been feeding a moral panic about Juul e-cigarettes. This effort is obviously prompted by the Campaign for Tobacco-Free Kids, which has its fingerprints all over it (e.g. here, here, here, here, here, here, here) as part of its campaign to wipe out the vaping industry by forcing FDA to bring forward extremely burdensome and restrictive regulation that will leave only a few products from tobacco companies on the market, if that.
Rapid rises in ‘Juuling’ (the use of Juul e-cigarettes) are being cultivated into a full-scale moral panic, as far as I can see based only on anecdote and the outstanding success of Juul as a product. But let’s suppose there has been a rapid rise in Juuling in American schools – it really is a teenage craze. But how can anti-vaping activists be sure it isn’t a reason for celebration rather than panic? No-one currently pimping up the moral panic can be sure the rise of Juul is not simply the best news in years.
For all these anti-Juul activists know (which is almost nothing), the Juul craze (to the extent it is real) may be driving out smoking from schools, finally breaking the myth that smoking is cool, diverting kids from other risk behaviours like illicit drugs, and giving adults an easily accessible simple alternative to cigarettes that they can buy easily and learn to use without needing an engineering degree. That would be great news! The more popular, the better – smokers may be finally overcoming the barrage of deceitful nonsense from ‘tobacco control’ and getting on with the business of quitting smoking. So, before anti-vaping activists blunder around in the dark making policy demands or clumsy interventions, just remember that it was only a few months ago that the activists’ primary explanation for adolescent vaping was ‘kiddie-appealing’ flavours with demands that most or even all flavours should be banned. But there is nothing kiddie-like about the Juul flavours. They should admit this: they just don’t know what they are doing. Or rather they do know what they are doing, but it just isn’t what it appears.
How should a responsible journalist interrogate this story?
Please dig deeper… I suggest the following questions are asked or at least considered before writing more stories on this:
- How do we know about the rise of vaping in schools – what is the data and where is the source? How much is anecdotal, what is the source of those anecdotes and how usefully quantified are they?
- Has the success of Juul been at the expense of other e-cigarettes – is it adding to the total use or displacing existing use? (You can find data on this for total sales, but not disaggregated by age)
- What is happening to teenage smoking in those places where vaping or Juul is rising (and how do we know?) – is vaping/Juul suppressing cigarette smoking? Judgements on vaping or incomplete and misleading without information on what’s happing on smoking?
- What has been the pattern of teenage smoking since vaping increased from 2011? (Clue: teen smoking has fallen sharply)
- Are the teen users just messing about with these products and using them occasionally or is it really an entrenched ‘substance use’ issue – these are very different behaviors? What is the frequency distribution of use? How much is daily and how much weekly or monthly? Not all vapers are the same.
- How much safer is vaping/Juul compared to smoking? (Clue: much less harmful). This matters a great deal because if the former is displacing the latter, you may be witnessing (and misreporting) a major public health win.
- What are the actual risks vaping/Juul compared to non-use? (Clue: not much more – nearly all the health risk of smoking arises from smoke and products of combustion. Smoke is not created in vaping)
- If your sources are saying that kids will be addicted to Juul, what is their basis for saying this? Not all nicotine products are ‘addictive’ and it depends how they are used.
- What do kids think of vaping compared to smoking? Is vaping making smoking uncool?
- Who is promoting these stories and what are they trying to achieve? Would doing what they propose to do address the perceived problem here, or would it cause much wider impacts? (Clue: yes, they are campaigning for regulation that would close down most of the vaping industry, while leaving the cigarette trade untouched)
- Have you got to the bottom of where this story is coming from and why? Are you being played by ‘abstinence-only’ activists who essentially want 99% of vaping products de facto banned through burdens of regulation, even if all that would do is to protect the cigarette trade and gift the surviving vaping market to Big Tobacco?
- It wasn’t that long ago we were being told that vaping was rising because of ‘kiddie flavors’ (supposedly like Gummy Bear and Cotton Candy) and that most flavors should be banned… was that explanatory theory of teenage vaping wrong? Was it the flavors theme just an expedient campaign message in favor of yet more damaging regulation?
I loathe fake news and, even more, the false accusations of fake news hurled at news organisation like the New York Times (I am a subscriber) and CNN when they publish truthful stories that are uncomfortable for the powerful and corrupt. But the extraordinary uncritical hype generated around this vaping story leaves me wondering if anything goes in health and science journalism (or should we recognise it as activism), and we should simply disbelieve everything they report.
- JUUL knows it has a popularity problem – Bloomberg New, Joe Nocera
- The promise of vaping and the rise of JUUL – New Yorker, Jia Tolentino
- Finding a balance between protecting our youth and saving 40 million smokers’ lives, Professor David Abrams, NYU College of Global Public Health, writing in The Hill
- Attorney General Miller announces initiative with JUUL Labs to fight underage use, AG Tom Miller, Attorney General, Iowa
- Miller: JUUL offers opportunity to reduce smoking rates, AG Tom Miller, Attorney General, Iowa
- Hysteria over vaping goes to new levels as media calls Juuling the new youth epidemic Daily Vaper, Steve Birr.
- The crusade against JUUL and other vaping products is childish, even for tobacco control, Washington Examiner, Paul Blair.
- Why The Panic Over JUUL And Teen Vaping May Have Deadly Results, Forbes, Sally Satel.
A Truth Initiative survey has just been published in Tobacco Control – with some data:
Key section from the results…
One quarter (25%) of respondents reported recognition of the device, 10% reported both recognising and having ever used a JUUL, and 8% reported recognition and past 30-day use of JUUL. Compared with those aged 15–17 years, those aged 18–24 were more likely to recognise JUUL (29% vs 21%) and report ever using a JUUL (12% vs 7%) (p<0.01). Compared with females, males were more likely to recognise JUUL (30% vs 21%), and report ever (13% vs 7%) and past 30-day use (10% vs 6%) (p<0.05). A significantly higher proportion of those who reported living comfortably with respect to their financial situation reported recognition (34%) and past 30-day use of JUUL (11%) compared with those reporting other financial situations (p<0.01). (emphasis added in red_
It shows ‘ever use’ of JUUL among 15-17-year-old kids at 7%.
It’s not properly reported, so some assumptions are needed. If the ratio of ever use to current (past 30 days) use is the same in this ‘youth’ group (age 15-17) as in the full sample age 15-24 (10% to 8%), then we might cautiously assume current 30-day use is about 6% in the 15-17 segment, compared to ever use of 7%.
In 2016, the current (past 30 days) use of any e-cigarette was 11.3% in high school students (aged 14-18).
We know that Juul has taken about 55% of the convenience store market.
So if this overall market shift had merely been replicated in youth e-cigarette use at 2016 levels, then it would account for about 6% (11.3% x 55% = 6.2%) of 15-17 years old using JUUL. So, on this admittedly incomplete analysis, JUUL appears to be doing about what you would expect if the ‘adolescent market’ was mirroring the adult market.
But suppose there was a significant increase and lots of additional vaping was occurring? We would still not know whether to respond by wailing or cheering. It depends on at least three other things:
- What sort of use is occurring? Is it young people just messing about blowing clouds and experimenting with new tech, or is it something that looks like substance use?
- Is the use displacing other vaping?
- Is the use displacing smoking or other risk behaviors? In which case it could be immensely beneficial.
- What is going on with adults? The product is popular for a reason, is that because it works as a breakthrough in providing an alternative for smokers? Id so, we should be applauding the genius of American innovation, not treating them like criminals, as FDA has chosen to do.
Note: why do I say the quick-and-dirty analysis above ‘admittedly incomplete’?
Of course, the journal Tobacco Control did not insist on publishing key data that would be needed to make this calculation…
- What was overall current (i.e. use in last 30 days) vaping prevalence, if possible by the frequency of use within 30 days, in under 18s?
- What was current JUUL vaping prevalence (if possible by the frequency of use) in under 18s?
- What was smoking prevalence in under 18s?
One can only speculate on why space was unavailable for such findings. Perhaps because the authors did not like the results. Given a major national panic is underway, shouldn’t we have all the data, and not have to resort to the approximations as shown above?