Wesley J. Foster
David F. Gerhardt
Rosalie Pehousek Lambert
Jane Gracine Leach
Vernon William Roehl
James W. Shuga
Judith “Judy” Trudeau
Robert W. Zastoupil
Dorothy M. Zimmerlee
In almost any other year it would be hailed as a public health victory: The smoking rate among U.S. high schoolers took its biggest hit ever this year, federal figures show, falling to a new low.
Instead the milestone was relegated to a lone figure at the bottom of a government press release and went unremarked by anti-tobacco groups that have spent decades working to stamp out youth smoking.
It’s a new era in the tobacco wars—one in which the alarming rise of underage vaping has almost completely overshadowed a parallel drop in traditional smoking. And the pivotal question of whether electronic cigarettes are inadvertently helping to wipe out smoking among young people has become a polarizing topic: embraced by some experts, dismissed by others.
“Smoking is disappearing among young people and it’s a great public health triumph that we are failing to celebrate, much less even note,” says Kenneth Warner, professor emeritus at the University of Michigan’s school of public health.
E-cigarettes typically heat a solution that contains nicotine, the drug that makes tobacco addictive. They are generally considered less harmful than cancer-causing traditional cigarettes. But there is little long-term research on the health effects of vaping.
With one in four teenagers now using e-cigarettes, underage vaping is universally condemned, and the federal government considers it an epidemic.
But Warner and some other researchers believe recent trends continue to show vaping’s promise as a tool to steer millions of adults away from cigarette smoking, the nation’s leading cause of death.
That potential makes the case for keeping e-cigarettes readily accessible for adults—even if a certain level of teen use persists.
But that approach is a nonstarter for many tobacco opponents.
“When adults make policy gains on the backs of children, that’s bad, and that’s what the argument boils down to here,” says Dave Dobbins, an attorney with the anti-tobacco nonprofit, Truth Initiative.
Even if e-cigarettes were responsible for the smoking decline among teenagers—which Dobbins says is unlikely—allowing young people to get hooked on vaping nicotine is not a solution.
“I don’t buy the argument that these things showed up and magically changed the world,” says Dobbins. Instead, he thinks the vaping industry has increasingly pursued young people as smoking has fallen out of fashion.
But no one disputes the decline.
The percentage of high schoolers who reported smoking fell to 5.8% in 2019 from the prior year, a 28% drop and the largest since the U.S. government began surveying teens, according to preliminary numbers released in September. The trend isn’t limited to one year or one survey.
A similar study conducted by the University of Michigan shows smoking among 12th graders has plummeted 50% since 2015, the largest drop of its kind in the survey’s 40-year history.
The smoking rate for adults is roughly 14% and has been falling slowly for decades.
The decline among teens has been seized upon by vaping proponents, who argue it undercuts the gravest argument against the nicotine-emitting devices: that they act as a “gateway” to traditional smoking.
That’s the conclusion of a number of short-term studies that followed young people and surveyed their use of tobacco and nicotine. The prestigious National Academies found “substantial evidence” for the gateway effect in a 2018 consensus paper. And the Food and Drug Administration even uses the concept as the tagline in its anti-vaping video ads: “Teens who vape are more likely to start smoking cigarettes.”
For now, experts on both sides acknowledge there is no definitive evidence linking e-cigarettes to the decline in youth smoking. The question is clouded by too many long-term trends and complicating variables. Teen smoking has been decreasing since the late 1990s and is influenced by government policies, public opinion, changing products and tobacco industry marketing.
But for researchers who believe vaping is benefiting public health, the falling numbers make one thing clear: E-cigarettes are not driving large numbers of young people to smoke. The numbers suggest the exact opposite.
“The key point here is that it seems we have seen a drastic reduction in smoking,” says Dr. David Levy, a tobacco researcher at Georgetown University. “That’s clearly a good thing and it’s not something that we want to mess with.”
The question of how to best regulate e-cigarettes remains unresolved in Washington. The Trump administration has recently backed away from an earlier plan to ban virtually all vaping flavors due to their appeal to teens. No deadline has been set for a new proposal or announcement.
Levy and others favor targeted approaches to curb youth use, such as raising the minimum purchase age to 21 nationwide. They oppose sweeping bans and restrictions, which could affect use by adult smokers.
In a paper last year, Levy, Warner and several colleagues estimated that smoking among 12th graders has fallen three times faster since an uptick of e-cigarette use around 2014, compared with the earlier long-term trend.
However, the authors did not conclude that e-cigarettes caused the decline and noted that it could have been influenced by other factors, such as anti-tobacco campaigns.
Brian King of the Centers for Disease Control and Prevention also emphasized that survey data cannot prove a cause and effect between vaping and smoking rates. Therefore, it’s impossible to know which teens avoided or quit smoking due to vaping, versus those who would never have picked up cigarettes anyway.
Additionally, the data suggest many of the estimated 5.3 million underage students who vape were never at risk to become smokers.
“So that reflects an on-ramp to nicotine use that we otherwise would not have had without e-cigarettes,” says King, a deputy director in CDC’s Office of Smoking and Health.
The CDC and other health experts warn that nicotine can harm parts of the developing brain that control learning, memory and mood in young people.
The vaping debate underscores a growing rift in the tobacco control field. For decades, advocates, regulators and researchers were united in a common fight against cigarettes, which cause cancer, heart disease, stroke and many other deadly diseases.
But views have diverged since the introduction of e-cigarettes and other alternative products. Some experts believe the most realistic approach is to shift smokers away from burning tobacco toward less risky products.
On the other side are those who say there is no safe way to use tobacco or nicotine and that quitting should be the goal.
With local, state and other authorities cracking down on e-cigarettes—particularly kid-friendly flavors—public sentiment has increasingly been turning against vaping. On Tuesday the influential American Medical Association called for a “total ban” on all e-cigarettes and vaping products.
Some longtime industry observers warn that vaping proponents might have missed their opportunity to benefit public health.
“The industry blew it,” said Dr. David Kessler, speaking at a recent conference for vaping and tobacco executives. Kessler served as FDA commissioner during the 1990s, when he tried unsuccessfully to assert authority over tobacco products. Congress did not grant the FDA that power until 2009.
Starting in May, all e-cigarettes will need to undergo FDA review. Only those that can demonstrate a benefit for U.S. public health will be permitted to stay on the market.
Some vaping companies expect to win the FDA’s endorsement, but Kessler noted: “I don’t see it.”
“You lost the trust of the American public when it comes to vaping and you’ve set back the issue decades,” he said.
A hot ham and “holey” (Swiss) cheese sandwich on wheat and a half order of fries.
It’s an order Major Grimes, manager at Sneakers Sports Bar & Grill, knows well.
“He would change it up every once in a while, but for him to have his last sandwich here today, I’m not surprised one bit that it’s a hot ham and holey cheese sandwich,” Grimes said.
Grimes was talking about Pat “Hoppy” Cassidy, an 87-year-old patient at Mercyhealth Hospice whose final wish was to go dancing at Sneakers one more time.
While he wasn’t up for dancing, he celebrated turning 87 last week with a surprise party at the bar Friday night, complete with plenty of Irish music, friends and family.
He entered Sneakers on Friday in his usual manner—with a smile and a thumbs-up. His blue eyes twinkled behind his round glasses as he laughed with Grimes from his wheelchair.
“He is a genuine, simple man. He’s easy to please, but he has a lot to offer. He simply can just light up a room,” Grimes said.
About two weeks ago, Andrea Kussmaul, a registered nurse supervisor with Mercyhealth, heard Cassidy’s wish was to visit Sneakers and dance one more time. Staffers wanted to make it happen.
“When we heard that, we kind of went with it and wanted to make sure we were able to achieve his goal,” she said.
The bar donated food and drinks, and Festival Foods gave him a free birthday cake. The Mercyhealth Development Foundation helped fund Friday’s party through donations.
Kussmaul said the party was important to Mercyhealth.
“It warms my heart. This is exactly why we do hospice,” Kussmaul said.
Before he had to get hospice care, Cassidy had been a regular at Sneakers since the bar opened in 2010. His family met him for lunch there at 11:45 a.m. every Saturday.
When someone at the hospice reached out to Grimes about hosting a party, she was a little confused about why the bar was the patient’s choice. When she heard it was Cassidy, it all made sense.
Sarah Hiatt, a certified nursing assistant, has worked with Cassidy a lot over the last few months. Watching him in his “old stomping grounds” Friday almost brought her to tears.
“He’s very much a happy guy. It’s great to see him smiling right now,” Hiatt said.
“It makes me happy to see him so happy. It’s bringing back memories for him because this was his hangout spot, and it’s such a blessing that he was able to get out here,” she said.
Cassidy’s daughter Cindy McIntosh said her dad’s quiet personality is a bit at odds with his Irish ancestry. Still, he clearly was enjoying his party Friday.
McIntosh said it was an emotional evening for the family.
“There’s a lot of feelings,” McIntosh said. “He loves coming here; he loves the staff here and the hospice people, too. For them to work together to put this together, it’s special.”
Grimes said she’s going to miss serving one of her favorite orders.
“Since day one he’s been coming here. I think it’s wonderful that he considers us family, and I’m not surprised because he is to us, as well.”
Katharine Buker has been prosecuting crimes in Rock County for 38 years. For most of that time, she said, an armed robbery conviction meant prison—no ifs, ands or buts.
But in court Friday, the assistant district attorney asked a judge to give a young armed robber a chance to avoid prison and expunge some of his convictions.
Jaden C. Fair, 18, of 1423 Harvey St., Beloit, is accused of picking up an acquaintance in Janesville with a third man and then robbing the acquaintance at gunpoint. They got $90 in the May 21 incident.
Buker said her recommendation reflected changes going on nationwide in the criminal justice system, including the Rock County Evidence-Based Decision Making Committee.
Buker’s boss, District Attorney David O’Leary, has pushed for reforms on that committee and at the state level, where he has taken a leadership role.
Some of the “evidence” in the effort is data showing that people who are sent to prison, especially those with no criminal records, such as Fair, tend to learn how to be criminals.
But what if people like Fair got a second chance? Society could be spared the costs of a life of crime and imprisonment, and the criminal could have a chance to turn his or her life around and contribute to society.
As part of a plea agreement, Fair pleaded guilty to armed robbery, possession with intent to deliver 200 or fewer grams of marijuana, felony theft and five misdemeanors: possession of drug paraphernalia, disorderly conduct while armed, armed theft, pointing a gun at someone and possession of marijuana.
Buker and defense attorney Barbara Gerber recommended three years of probation, to include six months in jail.
They recommended that the armed robbery charge be held open until Fair completes probation. If he does so without violating the rules, the charge would be dismissed.
Also, the marijuana trafficking and felony theft charges would be expunged—wiped off his record.
The misdemeanor charges would remain on his record and “give fair warning that there has been a very serious incident here,” Buker said.
“He made a terrible choice. I know he feels remorse,” Gerber said.
Gerber said Fair is the father of an infant and is highly motivated to be there for his son.
Fair is enrolled in Community Action’s Fresh Start program, an effort to turn around the lives of young people. His mentor in the program, James Turner, spoke on his behalf, saying he believes Fair will graduate from high school in June.
Fair apologized and asked Judge Karl Hanson to give him the second chance.
Hanson told Fair he is not fully mature but has potential to succeed. He told him other people his age might bend or break the rules as they mature, but he doesn’t have that choice, because if he does, prison awaits him. The armed robbery charge alone carries a maximum of 40 years in prison.
Hanson went along with the recommended sentence with one exception. He imposed four years of probation instead of three.
He also allowed Fair work-release from jail.
“I think this period of probation should be sufficient for you to show the community … that Jaden Fair is something much more than an armed robber,” Hanson said.
Gerber asked that Fair be allowed to delay his jail sentence so he can spend Christmas with his child. Buker opposed that idea, saying it’s important for Fair to see that his actions have consequences.
Hanson agreed, saying Fair must understand how serious it was for him to point a gun at someone. He ordered Fair to report to jail no later than Dec. 6.
Democratic Sen. Tammy Baldwin asked the head of the Air Force on Friday to halt discharge proceedings against a Wisconsin Air National Guard whistleblower until investigators determine whether his commanders are retaliating against him for complaining about sexual assaults in his unit.
Master Sgt. Jay Ellis complained to Baldwin last year about sexual assaults and harassment within his 115th Fighter Wing squadron, spurring two federal investigations that are still ongoing.
Ellis filed a separate complaint in May alleging that his superiors are trying to discharge him on medical grounds and deny him retirement benefits in retaliation. The Wisconsin National Guard’s inspector general is investigating those allegations, but the discharge process is still moving forward.
Baldwin sent a letter to Air Force Secretary Barbara Barrett asking her to put a hold on the discharge process until the reprisal investigation is complete. She said it is “unacceptable” that the discharge process is proceeding despite the ongoing investigation into Ellis’ accusations and that it could discourage potential witnesses from coming forward in the sexual assault probes.
“The timing and nature of this (discharge) process has the alarming appearance of retribution and retaliation against ... Ellis,” Baldwin wrote.
Barrett’s office didn’t immediately respond to an email seeking comment on the Wisconsin senator’s request.
Baldwin has been working to protect Ellis since a medical evaluation board at Scott Air Force Base recommended Nov. 6 that he be discharged. She wrote a letter to Maj. Gen. Donald Dunbar, the Wisconsin National Guard’s top commander, and Gen. Joseph Lengyel, chief of the National Guard Bureau in Washington, D.C., on Nov. 8 asking them to halt the process.
Dunbar wrote back this week saying he lacked the authority to stop the process but that he wouldn’t finalize Ellis’ discharge until the reprisal investigation was complete. He added that Ellis wouldn’t lose any benefits.
Ellis said he wouldn’t lose any benefits linked to the Guard but that he would lose his federal benefits from the Air Force worth hundreds of thousands of dollars.
Baldwin said in her letter to Barrett on Friday that Lengyel’s staff has indicated that Barrett has the authority to halt the process.
Ellis is appealing the discharge decision from the Scott Air Force Base evaluation board. He is scheduled to appear before another evaluation board at Randolph Air Force Base in Texas on Dec. 3.