US surgeon general warns of teen risks from e-cigarettes
By MATTHEW PERRONE
AP Health Writer
Tuesday, December 18
WASHINGTON (AP) — The government’s top doctor is taking aim at the best-selling electronic cigarette brand in the U.S., urging swift action to prevent Juul and similar vaping brands from addicting millions of teenagers.
In an advisory Tuesday, Surgeon General Jerome Adams said parents, teachers, health professionals and government officials must take “aggressive steps” to keep children from using e-cigarettes. Federal law bars the sale of e-cigarettes to those under 18.
For young people, “nicotine is dangerous and it can have negative health effects,” Adams said in an interview. “It can impact learning, attention and memory, and it can prime the youth brain for addiction.”
Federal officials are scrambling to reverse a recent explosion in teen vaping that public health officials fear could undermine decades of declines in tobacco use. An estimated 3.6 million U.S. teens are now using e-cigarettes, representing 1 in 5 high school students and 1 in 20 middle schoolers, according to the latest federal figures.
Separate survey results released Monday showed twice as many high school students used e-cigarettes this year compared to last year.
E-cigarettes and other vaping devices have been sold in the U.S. since 2007, growing into a $6.6 billion business. Most devices heat a flavored nicotine solution into an inhalable vapor. They have been pitched to adult smokers as a less-harmful alternative to cigarettes, though there’s been little research on the long-term health effects or on whether they help people quit. Even more worrisome, a growing body of research suggests that teens who vape are more likely to try regular cigarettes.
Adams singled out Silicon Valley startup Juul. The company leapfrogged over its larger competitors with online promotions portraying their small device as the latest high-tech gadget for hip, attractive young people. Analysts now estimate the company controls more than 75 percent of the U.S. e-cigarette market.
The surgeon general’s advisory notes that each Juul cartridge, or pod, contains as much nicotine as a pack of cigarettes. Additionally, Adams states that Juul’s liquid nicotine mixture is specially formulated to give a smoother, more potent nicotine buzz. That effect poses special risks for young people, Adams says.
“We do know that these newer products, such as Juul, can promote dependence in just a few uses,” Adams said.
Juul said in a statement that it shares the surgeon general’s goal: “We are committed to preventing youth access of Juul products.”
Last month, San Francisco-based Juul shut down its Facebook and Instagram accounts and halted in-store sales of its flavored pods. The flavors remain available via age-restricted online sales. That voluntary action came days before the Food and Drug Administration proposed industrywide restrictions on online and convenience store sales of e-cigarettes to deter use by kids.
Adams recommends parents, teachers and health professionals learn about e-cigarettes, talk to children about the risks and set an example by not using tobacco products.
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Flavored e-cigarettes are fueling a dangerous increase in tobacco use
December 21, 2018
Author: Leah Ranney, Director of Tobacco Prevention and Evaluation, University of North Carolina at Chapel Hill
Disclosure statement: Leah Ranney receives funding from NIH/FDA. I was part of the UNC Tobacco Centers of Regulatory Science award.
Partners: University of North Carolina – Chapel Hill provides funding as a member of The Conversation US.
An upsurge in e-cigarette use among middle and high school students occurred nationally between 2011 and 2018, with nearly 21 of every 100 high school students surveyed reporting e-cigarette use in the past 30 days, according to data from experts at the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention.
This trend is not by chance. Tobacco companies have spent billions of dollars annually on tobacco product advertisement, according to a Federal Trade Commission report, and have used appealing packaging, culturally tailored brand names and advertisements that appear to target specific minorities and youth. The colorful packaging and other strategies employed by the industry contribute to lower harm perceptions of these products and higher susceptibility to use among young people, according to researchers at the Center for Global Tobacco Control, Harvard School of Public Health and recent research on cigarillo packaging I conducted with my research team.
The FDA has announced efforts to impose restrictions on flavored e-cigarettes and tobacco products. FDA recognizes the high rates of e-cigarette use among young people as a public health concern, and sees the urgent need for stricter product access.
Part of the agency’s plans call for restricting young people under the age of 18 from accessing flavored e-cigarettes via retail establishments and online websites. The FDA is seeking to have retailers move flavored e-cigarette products – excluding mint- and menthol-flavored products – to age-restricted areas in stores, and the FDA is proposing to heighten practices for age verification online. Agency officials have also called for removing e-cigarette products that are marketed to kids, among other measures.
And with the announcement that tobacco giant Altria paid US$13 billion for a 35 percent stake in Juul, the vaping company that uses flavors to market its e-cigarettes, the need to impose youth restrictions on flavored tobacco products takes on even more urgency.
Flavors change perception of risk
Using a survey of young adults aged 18 to 26 recruited through an online crowd-sourcing tool, our group of researchers at the University of North Carolina School of Medicine found in a study published in PLOS ONE that cigarillo pack flavor descriptors, such as grape and sweet, and colors such as pink and purple resulted in more favorable product perceptions among young adults. These pack attributes had a greater impact on how people who had never used cigarillos perceived product flavor and taste, compared to current cigarillo users, and people who have previously used them.
Further, we conducted a systematic review of all the scientific literature through April 2016 examining the impact of flavors on tobacco product perceptions and use behaviors. Important findings from this study, published in Tobacco Control, suggested that flavored tobacco products have a strong appeal to youth and young adults because of the variety and availability of flavors; that flavors are a reason for use; and that flavors play a primary role in the use of e-cigarettes, little cigars and cigarillos, and hookah among younger people.
Two studies within our systematic review found that packs containing flavor descriptions were more likely to be rated as having a lower health risk. Another study of smokeless tobacco packs in the United States found that young adults were more likely than older adults to report that packs without flavor descriptions would contain more dangerous chemicals. Research is clear that flavored tobacco products have the potential to undermine progress gained to reduce youth tobacco use in the United States.
Importance of flavors in product use
Research and survey data have shown that tobacco habits in this age group are changing. Youth cigarette smoking rates have declined substantially in recent years, with the National Youth Tobacco Survey showing current use of cigarettes declining from 15.8 percent in 2011 to 7.6 percent in 2017 among high school students, according to data from experts at the CDC and FDA. Meanwhile, e-cigarettes were the most commonly used product in that population in both middle and high school students in the survey data.
While traditional cigarette smoking has declined, patterns of dual (that is, use of two or more tobacco products in 30 days) and poly tobacco use (or the use of three or more tobacco products in 30 days) have emerged. In 2013, in a survey of North Carolina high school students, almost 30 percent reported use of any tobacco product, according to a study from our team published in 2015 in the International Journal of Environmental Research and Public Health.
Within this sample, 19.1 percent used multiple tobacco products, compared with just 10.6 percent of the sample who were single product tobacco users. Youth predominately used cigarettes in combination with little cigars and cigarillos, or cigarettes with e-cigarettes. While there is substantial racial variation in multiple tobacco use patterns over time, in 2015, e-cigarettes were the most commonly used tobacco product among single product users across all racial groups, according to one of our studies published in Nicotine Tobacco Research.
Using data from the 2015 North Carolina Youth Tobacco Survey, we found in a study published earlier this year in Preventing Chronic Disease that among survey respondents who were not susceptible to smoking cigarettes, 26 percent were at “high risk” for future e-cigarette use; 11.3 percent were classified as “susceptible” to using e-cigarettes; 10.4 percent had already tried an e-cigarette; and 4.5 percent were current e-cigarette users.
Using school enrollment figures, we estimated that 55,725 high school students in our home state of North Carolina were at low-risk of smoking cigarettes, but at high risk for e-cigarette use – which meant that they were susceptible to using e-cigarettes, had experimented with e-cigarettes, or currently used e-cigarettes. On a national scale, these findings are a considerable public health problem.
Specifically, high school students who believed that e-cigarettes and secondhand e-cigarette vapor were not harmful, or only somewhat harmful, were more likely to be susceptible to using e-cigarettes than students who thought e-cigarettes and secondhand e-cigarette vapor were harmful, our study found.
Moreover, exposure to e-cigarette vapor in indoor or outdoor public places was associated with greater odds of being susceptible to using e-cigarettes. This could mean that restricting secondhand exposure to vapor of e-cigarettes in public places, such as in school buildings, stores, restaurants, school grounds and parks, and mass media efforts to educate youth about the harms of e-cigarette use could be just as necessary as restricting access to these products.
We know that adolescents and teenagers are very vulnerable to the influence of tobacco marketing. The use of appealing packages and flavors has a significant impact on young people, causing them to perceive these tobacco products as less harmful and, in turn, making them more likely to experiment and continue using tobacco products. As research on the impact of flavored tobacco products builds, I look forward to increased action to help prevent youth tobacco use.
Renée Bagslint, logged in via Google: So what are the risks of tobacco use in the form of e-cigarettes? Strangely they are not mentioned in this article.
The Institute for New Economic Thinking
The Top Journals Club in Economics
By Jakob Kapeller
Nov 20, 2018
Prejudice and collusion, not simply research quality, drive journal citations
Economists typically make use of citations to measure the alleged quality of researchers, institutions, journals, or disciplines. Such a perspective aligns well with some standing presumptions on the nature of the scientific process prevalent in economics—for instance the idea that the best research is done in the top departments or that economic research is superior to research in neighboring fields like sociology or political science. However, it systematically neglects the fact that citation patterns are driven by institutional constraints, reputational concerns and disciplinary identity as recent research funded by INET indicates.
In the theoretical part of our project, we show that scarcity of journal space in combination with a competitive, ranking-oriented research culture is not sufficient to ensure that high-quality contributions find their way to the top of the discipline. Quite the contrary, the scarcity of journal space in a competitive environment may quickly lead to perverse crowding-out effects for high-quality contributions even in the absence of factors generally recognized as distorting—like the role of social ties and networks or the importance of the topic under study.
In our model we show that assuming ambitious authors, who only have imperfect knowledge on the relative merit of their contributions, is sufficient for producing such distorting bottlenecks (Kapeller & Steinerberger 2016, see Figure 1). This latter finding resembles a general property of the current academic publishing process and implies that citation-based quality measures and other criterions of visibility should be taken with caution as they might lead us to miss some great ideas.
Combining these findings with insights on the social structure of the economics discipline supports the indication that the selection of high-quality papers that eventually remain unpublished or ignored in economics is not random: indeed, the strong impact of established hierarchies in the economics discipline (e.g. Hodgson & Rothman 1991, Medoff 2006, Fourcade et al. 2015), social networks (Colussi 2018), political orientation (D’Ippoliti 2017) and theoretical affiliation (Aistleitner et al. 2017) is to be expected. Such an interpretation is therefore completely in line with the results achieved by James Heckman and Sidharth Moktan on the gatekeeping-power of top journals in the discipline of economics (Heckman & Moktan 2018)
In addition, we find that the importance of journal rankings within an academic discipline further strengthens established hierarchies by establishing an additional positive feedback-loop in the process of academic reproduction. We document this by pointing to the immediate rise in submission to journals as a consequence of being included in an important ranking (Aistleitner et al. 2018) as well as by showing how the prestige of journals—relative to individual authors and articles—plays a greater role after the introduction of such rankings (Aistleitner et al. 2017)
To provide a novel perspective on the allegedly strong internal stratification within economics, we inspect the share of reciprocal citations among top journals economics relative to other disciplines. In doing so, we ask to what extent an average paper in a top journal draws on other contributions from established top journals. Our archetypical finding is that the research discourse at the “top” of economics is much more concentrated than in the neighboring social science disciplines, with the average share of reciprocal citations within top journals standing at about one quarter of all citations—far beyond the ratio measured for the other disciplines in our sample (Figure 2).
While such a high degree of reliance on contributions from top journals could theoretically be solely due to their superior quality, reputational concerns—top journals are cited, because those who cite them want to signal that they also belong to the “top”—provide an alternative explanation for the observed patterns. The latter interpretation is not only much more easily aligned with related findings on the sociology of the economics profession, but it is supported by recent studies on the “gatekeeping” function of top journals: in this account, generalist top journals effectively decide which topics and approaches from more specialized fields of the discipline should gain broader reception.
The disciplinary culture in economics does not put much emphasis on diversity. While a lack of diversity in terms of demography is well documented in economics (e.g. Bayer & Rouse 2016), Fourcade et al. (2015) recently studied the role of intellectual diversity in economics from a disciplinary angle. By analyzing both attitudes towards interdisciplinary research as well as interdisciplinary citation patterns in economics, sociology, and political science, Fourcade et al. show that economists are comparatively less inclined to import findings from other disciplines and also have less trust towards interdisciplinary approaches and research strategies. These findings are highly consistent with past results from data-driven research on citation patterns (e.g. Figure 3), which document the solitary character of economics in terms of disciplinary location.
In contrast, the typical approach to citations in economics—to interpret them as a measure of performance—implies a competitive setting, where different disciplines are to be evaluated with regard to their “export performance,” or in the words of a practitioner:
“What is interesting to think about are the terms of trade between economics and all these other disciplines. We are clearly a net exporter to political science and sociology.” (Wolfers 2010, 30)
Such a stance on the subject seems represents a lop-sided approach to the data as it is equally possible that the alleged excellence of economics (measured in terms of net citations exports to other disciplines) is mostly based on its ignorance of other disciplines (as citation-imports from neighboring fields are exceptionally low).
In our paper, we show that the same argument also holds for different paradigms in economics: we find that alternative, heterodox approaches do consider mainstream economic research, while mainstream economics largely neglects contributions from heterodox sources. Here, again mainstream appears to be superior since it is cited by competing approaches, but does itself not rely on external input.
A more interdisciplinary perspective, that is also incorporating interdisciplinary citation-flows, would lend additional support to the interpretation that the neglect of heterodox ideas is often due to either prejudice or ignorance as heterodox contributions seem to reference an over-proportional share of citations from other disciplines.
What Do Citations Tell Us?
Our research shows how the standard interpretation of citations in economics—as a signifier of the quality of the cited contribution—is fragile. Instead, citation patterns are determined by more than one factor. And, indeed, many of these factors—like social networks, existing hierarchies, paradigmatic identities or reputational concerns—relate to concerns of belonging that can actively distort and dominant the impact of the intrinsic quality of a manuscript. It is at this point that our findings go beyond the narrow realm of economics, but, rather, carry some general implications for established institutional routines in science.
Aistleitner, M., Kapeller, J. & S. Steinerberger (2017): Citation Patterns in Economics and Beyond. Forthcoming in: Science in Context.
Aistleitner, M., Kapeller, J. & S. Steinerberger (2018): The Power of Scientometrics and the Development of Economics. Journal of Economic Issues, 52(3): 816-834.
Bayer, A. & C. E. Rouse (2016): Diversity in the Economics Profession: A New Attack on an Old Problem. Journal of Economic Perspectives, 30(4): 221- 242.
Colussi, T. (2018): Social Ties in Academia: a Friend is a Treasure. The Review of Economics and Statistics, 100(1), REST_a_00666–50. http://doi.org/10.1162/rest_a_00666
D’Ippoliti, C. (2018): “Many-Citedness”: Citations Measure More Than Just Scientific Impact. INET Working Paper #57 https://www.ineteconomics.org/uploads/papers/WP_57-DIppoliti-revised.pdf
Fourcade, M., Ollion, E., & Y. Algan. (2015): The superiority of economists. Journal of Economic Perspectives, 29(1): 89-114.
Heckman, J. & Moktan, S. (2018): Publishing and Promotion in Economics: The Tyranny of the Top Five. Institute for New Economic Thinking, Working Paper 82 https://www.ineteconomics.org/research/research-papers/publishing-and-promotion-in-economics-the-tyranny-of-the-top-five ; NBER Working Paper 25093.
Hodgson, G. M. & H. Rothman. (1999): The editors and authors of economics journals: a case of institutional oligopoly? Economic Journal, 109(453): F165-F186.
Kapeller, J. & S. Steinerberger (2016): Emergent Phenomena in Scientific Publishing: A Simulation Exercise. Research Policy, 45(10): 1945-1952.
Medoff, M. H. (2006): Evidence of a Harvard and Chicago Matthew Effect. Journal of Economic Methodology, 13(4): 485–506.
Wolfers, J. (2010): Interview in Region Focus, Second Quarter 2010, Federal Reserve Bank of Richmond, online available at https://www.richmondfed.org/~/media/richmondfedorg/publications/research/re gion_focus/2010/q2/pdf/interview.pdf (accessed 13.03.2017).
US fertility is dropping. Here’s why some experts saw it coming
May 30, 2018
Caroline Sten Hartnett
Assistant Professor of Sociology, University of South Carolina
Caroline Sten Hartnett does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Partners: University of South Carolina provides funding as a member of The Conversation US.
The Centers for Disease Control reported this month that the number of births in the U.S. is down 2 percent – “the lowest number in 30 years.”
These reports were met with surprise and alarm. ScienceAlert, for example, led with the headline “U.S. Fertility Rates Have Plummeted Into Uncharted Territory, and Nobody Knows Why.”
However, this recent decline fits with global trends and isn’t unprecedented in U.S. history. As a demographer who studies fertility trends, what strikes me as anomalous is not the recent drop, but the previous high fertility “bubble.”
Unusually high rates
The U.S. maintained surprisingly high fertility rates for a long time.
After the baby boom of the 1950s and 1960s, fertility in the U.S. and other wealthy countries fell during the 1970s. However, the U.S. steadily rebounded, even as rates in most other wealthy countries stayed low or fell even lower.
By 1990, there were 2.1 children per woman in the U.S., compared to 1.4 in Spain and 1.5 in Germany, for example.
This gap between the U.S. and other developed countries baffled demographers through the 1990s and early 2000s. Public policy choices couldn’t explain it. The U.S. maintained its high fertility rate even while being comparatively weak on “pro-fertility” policies like family leave and financial support for parents.
Several factors propped up the fertility rate. The U.S. had a steady flow of immigrants from higher-fertility countries. It also had a persistently high unintended pregnancy rate; a flexible labor market that allowed parents to exit and re-enter the workforce; and a strong, stable economy.
Catching up with others
The recent drop in fertility brings the U.S. more in line with peer countries.
In 2017, the U.S. dropped to 1.76 children per woman. This number is well within the range of similar countries, and even remains toward the top of the pack. Only a few wealthy countries – including France, Australia and Sweden – have higher fertility rates than the U.S., and differences are small.
But depending on how you measure it, fertility in the U.S. is not at a historic low. By one measure, called the “general fertility rate,” U.S. fertility is indeed the lowest it’s ever been. This is the measure widely cited in media reports.
But, in my view, this measure is flawed, because variations in the age structure of women can artificially inflate or depress it. For example, having a high proportion of women in their late 20s will inflate the rate.
A better measure, without this issue, is total fertility rate. Using this superior measure, the U.S. rate in 2017 was higher than in 1976 and equal to fertility rate in 1978. So, the country has been here before.
Fluctuation is normal
It’s normal for fertility rates in wealthy countries to go up and down. People tend to adjust the timing of births to take advantage of a “good” year – such as one when high state benefits are offered – or avoid a “bad” year – such as one with high economic uncertainty.
Spain’s fertility declined from the 1970s to the early 1990s, as women increasingly joined the labor market but husbands didn’t share the load at home. (Perhaps working and taking care of three kids was more than most women wanted to handle.)
In Russia, fertility fell steadily following the economic and political shock of the collapse of the Soviet Union. It later climbed back.
And, between the 1990s and early 2000s, Sweden’s fertility fell and then rose, in part due to changes in the timing of births, the economy, and the state’s generous supports for parents.
There are a number of possible explanations for the recent dip in U.S. The Great Recession is certainly important, and its effects linger even as the economy has recovered. A Gallup poll indicates that, for the past several years, Americans’ “satisfaction with the way things are going in the U.S.” has remained substantially below levels in the late 1990s and early 2000s.
In addition, declines in fertility rates have been particularly steep among younger people, who are disproportionately affected by high student loan debt and may find it harder than previous generations to get on their feet economically. However, if economic conditions improve for these young people, research suggests they are likely to “make up” many of these births later in their lives.
Finally, part of the drop in overall fertility is due to declines in unintended and adolescent birth rates. Such declines have been a public policy goal for decades — so the dip in fertility should be seen as a good thing, not a cause for gloom.
Keep it steady
The fertility rate in the U.S. isn’t alarming, yet. But a continued drop could cause problems.
There are at least two scenarios to worry about. The first is a persistently low fertility rate that leads, over time, to a shrinking population. A population with a sustained fertility rate of 1.3 children per woman, for example, will quickly contract.
The second is a large, rapid fall in fertility. That eventually creates a lopsided population with more old than young people – making it hard, for example, to sustain policies like social security.
Both of these scenarios could happen, but it’s important to emphasize that the U.S. is not currently experiencing either one. However, it might be wise for the government to consider implementing stronger pro-family public policies such as paid family leave and subsidized child care. The U.S. is unlikely to return to the exceptionally high fertility rates enjoyed before the last recession, but the current rate is one that many countries would be thrilled with.