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.
Further reading
- 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.
Update 30 April… JUUL: hold the moral panic
A Truth Initiative survey has just been published in Tobacco Control – with some data:
Recognition, use and perceptions of JUUL among youth and young adults
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?
Perhaps another question Clive? What benefit would the complete annihilation of tobacco be to the anti vape brigade? the answer is obvious…none. By protecting tobacco from hiniouse vaping they are protecting THEIR industry.
Somewhere I’ve read that Tobacco Control is a $57BN/year industry in the U.S.
Can we find figures for that?
No, it is nothing like that much.
That may be the sum of all taxes, master settlement payments and user fees paid by tobacco companies. But it definitely isn’t all spent on ‘tobacco control’.
The figure I’ve used, gleaned from a variety of sources over the years, including American Medical Association Annual Reports, is $500 Million to $900 Million per year from the MSA “smokers’ tax” payments alone pumped into “Tobacco Control”. I believe there are still some “targeted” state/city taxes out there on top of that as well.
Plus you’ve got all the fundraising appeals from Big Charity that pluck our heartstrings and purse strings with images of happy, innocent, vulnerable little children surrounded by clouds of Evil Deadly Secondhand Smoke. And that’s not even mentioning similar advertising from the NicoGummyPatchyProductPeople. As a *pure* guess I’d peg Big Pharma and Big Charity antismoking ad input up in the several hundred million per year range as well.
Overall? I’d say we’re likely looking at between a thousand million and 1.5 billion per year. And then there are the PSAs aired by all the networks… how does THAT money get accounted for, and what would be a fair valuation?
Antismokers like to compare that to the much greater marketing expenditures by Big Tobacco, but how much of those expenditures have you ever seen being spent for the same kind of marketing: e.g. happy children playing in the playground while smoking parents laugh and take pictures of them, smiling couples romantically sharing a cigarette while watching the sun rise over the ocean, etc? Big T did that kind of stuff in the 1950s, but that was the better part of a century ago. Today the great bulk of their spending seems to be either purely on brand-name advertising or on their attempts to move into the vaping market.
– MJM, who wonders what ever happened to “Equal Time Act” or whatever it was called…
Analysis of 2015 NYTS data on 6-12th graders reveals teen smokers were exponentially more likely to vape daily and frequently than were never smokers, exposes many false claims by CDC, FDA, US SG, and the National Academies about teen vaping and smoking.
https://www.sciencedirect.com/science/article/pii/S074937971831626X
Key Findings (note that frequent use = 20+ of past 30 days, and infrequent use = <20 of past 30 days)
– frequent smokers were 84 times more likely than never smokers to vape daily (16.9% v 0.2%)
– infrequent smokers were 36 times more likely than never smokers to vape daily (7.3% v 0.2%)
– frequent smokers were 73 times more likely than never smokers to vape frequently (21.8% v 0.3%)
– infrequent smokers were 41 times more likely than never smokers to vape frequently (12.2% vs 0.3%)
– frequent smokers were 12 times more likely than never smokers to vape in past 30 days (64.7% v 5.5%)
– infrequent smokers were 9 times more likely than never smokers to vape in past 30 days (50.4% v 5.5%)
In 2016, Villanti et al revealed the 2014 NYTS found 100 days in their life in 2015-2016
– teens who vaped 10+ days (in past 30 days) declined from 2.8% in 2015 to 2.2% 2016
– lifetime teen vaping declined from 25.7% in 2015 to 22.9% in 2016
– in 2016, nearly as many teens (8.6%) reported vaping THC as vaping nicotine (10.6%)
https://www.cdc.gov/tobacco/data_statistics/surveys/nyts/data/index.html
During the past 30 days, on how many days did you use electronic cigarettes or e-cigarettes?
Days 2014 2015 2016
0 89.3 87.4 90.0
1-2 4.3 5.0 3.5
3-5 1.5 2.0 1.8
6-9 1.0 1.4 0.9
10-19 0.9 1.1 0.8
20-29 0.5 0.6 0.3
All 30 0.9 1.1 1.1
In total, on how many days have you used an electronic cigarette or e-cigarette in your entire life?
Days 2015 2016
0 74.3 77.1
1 7.3 6.5
2-10 7.5 6.8
11-20 2.9 2.6
21-50 2.6 2.1
51-100 1.7 1.5
>100 2.1 2.1
2016 NYTS
Have you ever used an e-cigarette device with a substance besides nicotine? (Select one or more)
8.6% A. Yes, I have used an e-cigarette device with marijuana, THC or hash oil, or THC wax
1.9% B. Yes, I have used an e-cigarette device with another substance that is not marijuana, THC or hash oil, or THC wax
10.6% C. No, I have only used an e-cigarette device with nicotine
71% D. No, I have never used an e-cigarette device
7.4% E. Don’t know/not sure
Food for thought for sociologists and researchers in social sciences: how come the opposition to vaping in the USA (and practically only in the USA) is so strongly focused on moral panic about “the kids”? This focusing on “the kids” does not arise with comparable intensity in the anti-vaping discourse in other countries, not even in culturally similar countries like prohibitionist Australia or Canada. This issue cannot be reduced to MSA money or the interests of the FDA/CDC regulating bureaucracy. It must have some handles and explanations on cultural patterns within educated liberal middle classes in the USA that respond and resonate with the main figureheads that propagate this obsession: the anti-smoking charities like CTFK and/or Glantz and Glantz-like minions in academic circles.
It would be interesting to shed some light on all this.
That being said, have you looked at the Department of Environmental Medicine, University of Rochester Medical Center, Rochester, NY, medical research results showing that the various flavoring chemicals used in e-liquid/e-juice have an adverse effect when heated at different temperatures on the health of the lung immuno-system?
I quote from the research paper, ‘Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids without Nicotine’:
“In conclusion, cinnamaldehyde, vanillin, and pentanedione were the most toxic flavoring chemicals on monocytes. Majority of the tested flavoring chemicals and the e-liquids caused the secretion of significantly elevated pro-inflammatory cytokine levels by monocytes. Mixing multiple flavors of e-liquids caused the greatest cytotoxicity implying the health risk of acute exposure to a variety of e-liquids as opposed to a single flavor. Some flavors and their key flavoring chemicals which impart flavors were more toxic than others. Based on flavoring chemical toxicity of the individual flavoring chemicals in e-liquids, flavors can be regulated. Further, our data indicate that tighter regulations are necessary to reduce the risk of inhalation toxicity due to exposure to e-liquids without nicotine and flavoring chemicals.”
Here is the source: https://www.frontiersin.org/articles/10.3389/fphys.2017.01130/full?utm_source=G-BLO&utm_medium=WEXT&utm_campaign=ECO_FPHYS_20180207_e-cigarette-health#B44
This is the best advertising Juul could ever wish for.
No kidding… I hadn’t even heard of Juul until I started hearing people freaking out about it. And I think it’s safe to say I’m not the only one.
It is nothing short of amazing how the media is now reporting an “epidemic” (if you’ve been paying attention, that ‘e’ word has been used far too often to describe things that aren’t epidemics) among teens concerning vaping. I have now noticed PSA’s on the radio, warning listeners of the dangers of Juul products. These warnings are not based on facts; they are not based on peer reviewed data. And how in the world did these “lung problems” all of the sudden pop up out of nowhere? This is a smear campaign of epidemic (yes, I used the ‘e’ word) proportions, and the sad thing is that vaping is indeed helping smokers quit. And that is a fact. This effort to destroy Juul and other vaping companies is analogous to reefer madness, and it is shameful.