Intended for healthcare professionals

Observations Yankee Doodling

Teenagers, smoking, and vaping

BMJ 2015; 350 doi: (Published 21 April 2015) Cite this as: BMJ 2015;350:h2110
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

Does it matter what young people smoke?

Front page headlines across the United States on 17 April screamed the news that electronic cigarettes were becoming the smoke of choice among teenagers. In 2014, for the first time, more young people “vaped” e-cigarettes than smoked conventional tobacco cigarettes.1

Is this true? Is it news? If so, is it bad news or good?

The data come from a reliable source, the annual US National Youth Tobacco Survey, which is administered in schools to around 20 000 middle and high school students every year and has a very respectable response rate of 70% to 75%. Cluster sampling and weighting are used to obtain a nationally representative sample of students who attend public and private schools in grades 6-12. The only hitch is that they changed the way they asked about e-cigarettes in the 2014 survey (more about this below).

As reported by analysts from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), the data look dramatic indeed.2 The key survey question asked about use …

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