Is Vaping a Gateway to Tobacco?
Welcome to week 9 of our Knowledge is Power blog series. This week we will be looking the argument around vaping as a gateway to smoking. Medical News Today1 defines the gateway hypothesis as “the idea that less deleterious substances can lead to use and addiction of more harmful drugs.” Do we actually know if vaping leads to smoking traditional cigarettes? Join me as we look at what we do know.
The World Health Organization (WHO)2 published a Report on Regulation of E-cigarettes in which they stated “E-cigarettes have been marketing in almost 8,000 different flavors, and there is concern they will serve as a gateway to nicotine addiction and, ultimately, smoking, particularly for young people. Experimentation with e-cigarettes increased rapidly among adolescents.” The Food & Drug Administration (FDA)3 posed the same concern in the form of a question in their policy statement regarding Electronic Cigarettes “It is not known whether e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.” As agencies tasked with the public’s health and well-being, these are valid questions to be addressed. The Centers for Disease Control and Prevention (CDC)4 conducted Youth E-Cigarette Study which concluded “The data shows that youth who had never smoked conventional cigarettes but who used e-cigarettes were almost twice as likely to have intention to smoke conventional cigarettes as those who had never used e-cigarettes. Among non-smoking youth who had ever used e-cigarettes, 43.9% said they have intentions to smoke conventional cigarettes within the next year, compared with the 21.5% of those who had never used e-cigarettes.” Based on this study, it appears as though vaping does lead youth to intend to smoke traditional cigarettes, which everyone agrees would be a bad thing. However, is that the whole story?
The Wall Street Journal5 in an article titled The E-Cigarette Gateway Myth, counteracted the claims above, “There is no evidence that the few nonsmoking youths who experiment with e-cigarettes subsequently progress to cigarette smoking. Cigarette smoking among young people, whom public-health experts are rightfully focused on protecting from use of either product, continues to decline. The CDC’s national youth risk behavior survey shows that teenage smoking has dropped over the last several years, falling to 15.7% in 2013 from the 18.1% found in 2011. The smoking rate among U.S. high school students in 2013 was the lowest level since the survey began in 1991. Meanwhile, experimentation with e-cigarettes among high-school students doubled from 2011 to 2013. Meaning, the gateway hypothesis is a myth. The evidence shows that very few nonsmokers ‘vape’. The primary reason people use e-cigarettes is to quit or cut back on smoking conventional cigarettes.” In addition, Health Day6 published an article E-Cigarettes May not be a Gateway stating “In just one year, the number of kids in grades 6-12 who said they’d never tried an e-cigarette more than doubled, rising from 3.3% to 6.8% Among the those who said they were current e-cigarette users, more than ¾ said they also smoked regular cigarettes. Given the overlap, many health experts worried that e-cigarettes might be acting like a gateway drug. A new study suggests that may not be the case. Overall, 43 students said their first nicotine product was an e-cigarette. Of that group, only one person said they went on to smoke regular cigarettes. And the vast majority who started with e-cigarettes said they weren’t currently using any nicotine or tobacco.” These seem directly to contradict the study listed by the CDC above and the negate the concerns of the WHO and the FDA, but why is there such a discrepancy of information?
New Scientists Health7 addressed this discrepancy in their article E-cigarette users are young, heavy smokers trying to quit in which they found “One of the big concerns around the use of e-cigarettes, or ‘vaping’, is that they tempt people who don’t already smoke, getting them hooked on nicotine. Research published earlier this year by the CDC found that the use of e-cigarettes in US middle and high school students was associated with a higher likelihood of also smoking real cigarettes. But this study doesn’t show whether those people already smoked before they tried e-cigarettes, which makes it impossible to say whether vaping really is a gateway to smoking.” Meaning, the original study was missing a key component, whether the youth in question were already using traditional cigarettes when they started using the e-cigarette. The American Vaping Association (AVA)8 published AVA criticizes CDC report on e-cig use by teens to dispute the CDC’s published study stating “The recent study by the CDC and its accompanying press release are just plain deceptive. The reported result is flawed because teens who answered ‘probably not’ when asked if they intended to smoke in the future were counted as likely future smokers instead of unlikely future smokers. The CDC failed to disclose this in its press release, which led to hundreds of news sources identifying e-cigarettes as a gateway to cigarettes. A growing number of studies have shown that e-cigarettes help smokers safely and effectively quit the habit and are not gateways to tobacco smoking. There is no evidence e-cigarettes are gateways to smoking, and in fact, for millions of Americans they are anti-tobacco products.” Meaning that, in addition to not taking into consideration the youth who were already using traditional cigarettes, the report was also skewed.
In summary: the study references in each of these articles regarding the concerns of vaping as a gateway to traditional cigarettes, published by the CDC, was found to be flawed upon closer examination by other sources. Studies conducted since have shown that concerns of transitioning from vaping to traditional cigarettes is not founded. Aside from the scientific studies, the idea of transitioning from vaping flavors like honeydew melon, caramel coffee, or apple pie to smoking analog cigarettes with their burnt dirt flavor seems unlikely to me.
As always, I encourage everyone to educate themselves. Read the studies and information listed in the references below, and learn more about the realities and misconceptions surrounding the subject of vaping as a gateway to tobacco. Come back next week when we look at the subject of Legislation, we want some, but how much is too much? Until then, we look forward to your questions and comments. Vape on!
Written by: Michelle Harnden
- Medical News Today ‘E-cigarettes may be a gateway’
- World Health Organization (WHO) ‘Report on Regulation of E-Cigarettes’
- Food & Drug Association (FDA) ‘Electronic Cigarettes’
- Centers for Disease Control and Prevention (CDC) ‘Youth E-Cigarette Use Study’
- The Wall Street Journal ‘The E-Cigarette Gateway Myth’ http://on.wsj.com/1s6lG8i
- Health Day ‘E-Cigarettes May not be a Gateway’ http://bit.ly/1cpNAUX
- New Scientists Health ‘E-cig users are young, heavy smokers trying to quit’
- American Vaping Association (AVA) ‘AVA criticizes CDC report on e-cig use by teens’