Two studies from January 2017 indicate that e-cigarettes are contributing to overall steady levels of tobacco use among Americans. One recent study looked at teen tobacco use, and another evaluated adult use. Researchers from both studies found evidence that e-cigarette use was in part responsible for the current rate of tobacco use in the group being observed.
Teen Tobacco Trends
The first study, conducted by the University of California San Francisco and published in Pediatrics, evaluated teen tobacco use from 2004 to 2014. Researchers noted that the frequency of teen cigarette smoking decreased during that time period. They initially hypothesized that teens were choosing e-cigarettes over traditional cigarettes and that that switch would be responsible for the downward trend. To their surprise, they found that e-cigarettes have not been replacing cigarettes. The downward trend in teen smoking levels is independent of e-cigarette use. The number of teens who reported smoking cigarettes would have gone down even without the introduction of e-cigarettes to the market.
Instead, e-cigarettes are encouraging a whole different group of teenagers to start using tobacco. Many of the youth surveyed who reported using e-cigarettes did not fall into the demographic of those likely to begin smoking cigarettes. This suggests that as e-cigarette use has risen among teens, so has the overall level of teen tobacco use even as cigarette smoking has decreased among teenagers.
Researchers noted that the numbers on teen cigarette use went up slightly between 2014 and 2015. About 9.2 percent of teenagers reported cigarette use in 2014, increasing to 9.3 percent in 2015. This slight change could mean little, and cigarette use might continue its downward trend in the coming years. Alternatively, it could indicate a new upward trend in cigarette use or usage of other drugs. Multiple studies have shown that e-cigarette use often leads to traditional cigarette use. The rising number of teens using e-cigarettes could, therefore, lead to more teens smoking cigarettes too.
One annual government-backed study called Monitoring the Future, conducted in 2017, suggests that teen smoking use is actually down – but marijuana use is on the rise. Teens are choosing vaping and marijuana over traditional cigarettes. About 10 percent of teens in the 12th grade said they had smoked cigarettes in the last month, but more than double that – 23 percent – said they had used marijuana.
Adult Tobacco Trends
Also newly released last year was the Population Assessment of Tobacco and Health (PATH). Led by Westat and the Roswell Park Cancer Institute and published in the New England Journal of Medicine, this assessment was conducted in partnership with the University of California San Francisco, the institution responsible for the study on teen tobacco use.
The PATH study looked at both teen and adult tobacco use among Americans. Like the University of California San Francisco report, this one noted a rate of tobacco use among teens that is just shy of 10 percent. PATH researchers also collected data about tobacco use among adults and found over a quarter of American adults currently use tobacco in some form. Over 27 percent of adults surveyed reported that they currently used tobacco in cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco or other forms.
This overall rate of tobacco use is not that different from the rates reported from 2002 to 2009. The American Lung Association reported that during those years, 27.3 percent of adults ages 26 and up used tobacco in some form, and over 41 percent of people between the ages of 18-25 used tobacco. According to the CDC, however, cigarette use went down among Americans during that time. From 2005 to 2015, the percentage of Americans who smoked dropped from 20.9 percent to 15.1 percent. Cigarette use, then, is far from the only culprit responsible for current tobacco use in America.
Researchers on the PATH study observed that American tobacco use is about much more than just cigarettes. In fact, they surveyed study participants regarding 12 different types of tobacco. Not only did tobacco users use a variety of products, but many of them used more than one type. Those who used multiple products were most likely to use both cigarettes and e-cigarettes.
Tobacco and Health Insurance
As these studies show, tobacco usage rates among Americans have not declined even though users face higher health insurance premiums than nonsmokers do. Under the Affordable Care Act, health insurance companies can add a surcharge to subscribers who use tobacco products, and in many states, health insurance applications ask potential customers if they use tobacco. This question most certainly applies to the use of traditional cigarettes, pipe tobacco, smokeless tobacco and other products.
What is less clear is whether the increased premium charges currently apply to e-cigarette use as well. Many health insurance companies already charge extra to customers whom they know use e-cigarettes. If, for example, applicants ask about whether vaping counts as tobacco use, an insurer might assume that that person uses e-cigarettes and counts it toward the tobacco surcharge.
However, since many health insurance applicants fill out their applications online rather than with an agent, they are left to their own devices to evaluate themselves as tobacco users or not. Application questions may not specify various types of tobacco products, and there’s a good chance that while some people who vape consider themselves tobacco users, others don’t think of it that way. This rather subjective method of evaluation most likely means that some e-cigarette users are currently paying a pretty penny extra because of their habit while others are not.
Considering that e-cigarettes, although often touted as a safer alternative to their traditional counterparts, deliver a mix of chemicals to users’ lungs, their use could be directly responsible for increased health care costs. They provide a dose of nanoparticles, solvents and carbonyls with each puff, and these substances may be at least partly responsible for cancer, asthma, diabetes, heart disease or other conditions. The science on the health impact of vaping is still fairly new, but so far it doesn’t look like it will be absolved of negative side effects.
Nonetheless, as of right now the fate of e-cigarettes’ effect on health insurance premiums is unclear. Without government regulation, the question of tobacco or non-tobacco remains in the hands of the insurance companies and the people they insure. In 2016, the U.S. Food and Drug Administration began regulating e-cigarettes like they do other tobacco products. It’s possible that regulation may eventually lead to an official position on whether e-cigarettes count as tobacco use for health insurance purposes.
What is currently clear is that, even as cigarette use declines among Americans, overall rates of tobacco use have not changed significantly. This is attributable to the wide variety of tobacco products currently on the market, and e-cigarettes – whether a less damaging alternative or not – play no small part in the frequency of tobacco use today.
