Studies counting underage vapers use a counting method that may not be suitable, thus distorting their results.
In summary
• Studies counting the number of young people who vape use the same calculation method as for adult smokers.
• Young people are different from adults, and smoking is different from vaping, using the same calculation method would pose several reliability issues.
• Researchers recommend modifying the questions asked to young vapers in order to count them more accurately.
A product and users that differ
What if young vapers weren’t as numerous as some studies claim?
In many countries around the world, vaping regulations are tightening. One of the main arguments put forward by governments to justify, for example, a ban on flavors, is the number of young people who vape. To this argument, proponents of e-cigarettes generally counter with their own, which is to remind that it is better for minors to turn to personal vaporizers to consume nicotine, as its use is considerably less dangerous than smoking, rather than to combustible cigarettes. An argument sometimes accompanied by another that suggests that if vaping did not exist, perhaps these same young people would have smoked instead. A reasoning that can be understood, but remains impossible to prove since it seems very complicated to demonstrate how this population would have really acted if e-cigarettes did not exist.
Last week, we reported the results of the Eurobarometer 2024. Among the details provided by our editorial team was one that will be of particular interest today: the fact that the report considered a young person a vaper even if they had only vaped once in their life. We then pointed out that this counting method could distort many results.
It is regrettable that the parameters currently used to assess e-cigarette use among young people have been directly borrowed from those used to measure smoking in adults, without reassessing whether their validity is applicable to a different product and a different population. Extract from the commentary
Smoking is not vaping
Yesterday, several scientists confirmed this observation when publishing a commentary in the medical journal Frontiers in Public Health. Examining the methods used by researchers worldwide (particularly Americans) to count the number of young vapers, the authors of the commentary expressed their concerns about the weaknesses of these methods. They note that the counting methods currently used to tally the number of minors who vape are simply the same as those used to calculate the number of adult smokers. However, «these validated measures of smoking in adults have been adapted in two distinct ways without rigorously evaluating whether these adaptations alter their utility.»
Because there are two fundamental differences between counting adult smokers and young people using e-cigarettes. First, because they are different products. «Regarding the first adaptation – from cigarettes to e-cigarettes – complications can arise from the fact that e-cigarettes have a much lower risk profile than cigarettes, which suggests that a higher threshold definition is justified to measure an equivalent level of health risk. Furthermore, e-cigarettes and cigarettes involve different usage patterns, so a given definition of use may be incomparable between products.»
The definitions of use that are more revealing of the truly problematic measures of use should include criteria for ongoing use over time, cumulative use over life, and frequent use. Extract from the commentary
Second, because the method used is adapted for adults and then applied without any modification to young people. «Regarding the adaptation from adults to young people, there are additional complications arising from the fact that consumption among young people is generally not as significant or prolonged as consumption among adults, and is more often transient and experimental.» They also highlight the fact that in studies on smoking, questions are consistently asked about the intensity or duration of the practice. In studies on the use of personal vaporizers by young people, these questions are simply not asked. «The precise questions are different: current use among adults is generally assessed as ‘some days’ or ‘every day’ (as opposed to ‘not at all’), while current use among young people is assessed as ‘any use, even a puff, in the past 30 days’,» the researchers explain.
Low thresholds have a greater «capture» and can elicit emotional reactions that are not based on quantifying real risks to individual and public health. Extract from the commentary
This lack of precision in the questions asked during studies inevitably leads to inaccuracies in their results. «The downside of using lenient usage definitions is that they encompass a large portion of experimental use that does not evolve into long-term use and (otherwise) has negligible health harms,» conclude the researchers. They recommend implementing questions to assess the intensity of vaping, for example, through the number of puffs inhaled each day or the number of times puffs are inhaled daily.