Are vaping products a gateway to smoking for teens and young adults? Though this has long been a key concern for vaping opponents, the evidence does not provide a clear-cut answer. Researchers Lynn Kozlowski from the University at Buffalo and Kenneth Warner from the University of Michigan conducted a review of data from several leading studies regarding youth vaping product use and published their findings in a March 2017 paper in the journal Drug and Alcohol Dependence.
While many studies have reported evidence consistent with a gateway effect, Kozlowski and Warner raise concerns that “These prospective studies suffer from limited measures of smoking.” In particular, the paper notes that for many surveys “Smoking has been defined as having puffed on a cigarette at least once, with no indication of current use, frequency, or intensity. One puff on a cigarette, or even more experimentation, provides little evidence of progression to significant smoking.”
Most current studies also do not address use of other psychoactive substances or account for demographic variables such as membership in a high-risk group. In studies that did involve other risk factors such as alcohol use, the same gradation problem was present. Kozlowski and Warner cite a study by Adam Leventhal where habitual drinking was treated the same as a single drink weeks earlier, and as a result the data would portray experimentation the same as alcoholism. When analyzing one study where additional variables such as marijuana use and a subject’s perception of smokers were accounted for, Kozlowski and Warner found those factors to be a better indicator of future smoking habits than vaping device use was.
Crucially, the writers explain, uptake of vaping product use among teens has not been accompanied by increase in smoking. Multiple studies show that the rate of teen smoking has actually fallen as vaping product use rises. They discovered an even bigger blow to the idea of vaping products leading to addiction in a 2015 research paper by Richard Miech: two-thirds of students polled said they had been using flavor-only e-liquids. With no nicotine content in the vaping products, the majority of teens were not receiving any of tobacco’s primary addictive compound at all.
Updated graphics on very positive recent US youth smoking trend based on 2017 Monitoring the Future data >
Simple chart: https://t.co/x4gSQM3CVA
Detailed chart: https://t.co/p1M7ByiW4R
(nb. association ≠ causation) pic.twitter.com/8LDf6EGCr4
— Clive Bates (@Clive_Bates) April 1, 2018
Kozlowski and Warner also note that the growth of vaping started to slow and even fall during 2015 and 2016, prompting some discussion of whether teen use may reflect a passing fad rather than ongoing addiction. Finally, the authors put forth a theory that the unprecedented drops in teen smoking during the rise of vaping products could even indicate that vaping is replacing smoking for users in high-risk groups that have shown little response to other smoking cessation methods.
Having established that the gateway effect of vaping products is far from proven and that a strong possibility exists for vaping to actually combat smoking in teens, Kozlowski and Warner make some regulatory recommendations. They support prohibiting sale and use of vaping devices by minors, but suggest that keeping an equal or even lower age for less harmful forms of nicotine such as vaping devices could help to discourage minors from taking up smoking. More importantly, they stress that the government needs to play a large role in guiding both youth and adult smokers to less harmful alternatives. This would require a comprehensive strategy including newly-devised differential tax systems that seek to discourage the use of combustible tobacco products and clear communication from health and safety authorities about relative risk.
Do e-cigarettes lead to a teen smoking epidemic? According to Kozlowski and Warner, “Prospective studies – the only evidence that e-cigarette use might lead to smoking – do not yet persuade that e-cigarettes are a substantial causal gateway to cigarettes.” The youth population continues to trend away from smoking even as vaping products have become the most-used tobacco product among teens.
Within a larger context, the authors posit that public health benefits may far outweigh the risks. They explain that adults are already seeing strong cessation results with vaping products, and with prevailing public opinion clearly against smoking, teens who pick up smoking now are less likely to become lifelong smokers. While no use use of vaping or tobacco products is the best result for youth, those who try vaping today and continue with vaping products instead of combustibles will also have a better chance to live healthier, longer lives.
More research with larger scale and more detailed data will be needed to address the issues highlighted in previous studies and gain a better view of the situation, but so far, the effect of vaping devices is promising.
Original article: Adolescents and e-cigarettes: Objects of concern may appear larger than they are by Lynn T. Kozlowski and Kenneth E. Warner
Article: A Policy Experiment is Worth a Million Lives by Lynn T. Kozlowski
Study: Association of Electronic Cigarette Use With Initiation of Combustible Tobacco Product Smoking in Early Adolescence
Study: How is the effect of adolescent e-cigarette use on smoking onset mediated: A longitudinal analysis.
Study: What are kids vaping? Results from a national survey of US adolescents.