As E-cigarettes become more popular each day, there has been an increasing curiosity to find out whether or not these electronic devices serve as a gateway to regular smoking. With the emergence of two recent studies, however, it seems that more people are leaning towards the opinion that e-cigarettes are an absolute gateway to smoking everyday cigarettes. (1, 2). However, it’s important to take this information with a grain of salt
Taking a Closer Look
These studies allegedly found evidence for a small connection (scientifically speaking – a “limited gateway”) between electronic cigarette use by non-smoking individuals and the increased temptation to try combustible cigarettes over a period of one year.
The more recent study of the two papers was published in November 2015 in JAMA pediatrics. In it, the researching team followed 694 12 to 26 year old subjects for one year. None of the participants had ever tried traditional cigarette smoking before the start of the study, and only 16 had ever tried an e-cigarette.
One year later, 10% of those individuals who never tried an e-cigarette had reported taking at least one “traditional cigarette puff” . However, six of the sixteen (which is a whopping 38%) of the participants who had already tried an e-cigarette reported taking at least one cigarette puff. This research was mainly focused on cigarette use and hadn’t considered a prior use of cigars, hookah, alcohol, smokeless tobacco, or marijuana smoke. In light of this, if only two of the original participants had to be excluded due to their use of one of those mentioned activities, they probably would not have qualified to volunteer for this study — making these results statistically insignificant.
In the older study of the two papers (also conducted by JAMA pediatrics in August 2015), researchers followed 2,530 fourteen-year-old students for a period of one year. None of the subjects had ever tried any tobacco products (including hookah, cigars, and combustible cigarettes) — however, 222 subjects had reported trying electronic cigarettes.
After a year, the researchers went back and examined the smoking habits of these 2,530 volunteers again. They found that only 9% of the non-e-cigarette subjects had tried any of the aforementioned tobacco products, as opposed to 25% of those subjects who reported trying an e-cigarette prior to the start of the study.
Interpreting the Results
According to both of these JAMA studies, young individuals who tried e-cigarettes prior to smoking were more likely to try combustible tobacco products sometime in their near future. However, this doesn’t support the conclusion that e-cigarettes can become a powerful gateway to classical smoking. In fact, this is the classic case of mistaking correlation with causation, where a higher correlation between vaping and trying traditional smoking does not necessarily mean that potential future smoking is caused by prior vaping.
The crucial fault of both studies is further demonstrated through the studies’ use of unclear and unproven variables of current smoking. For example, the studies have used the variables “at least one puff” and “just one puff”, instead of going for the more objectively sound metrics such as “smoking cigarettes in the past 30 days”, or even “daily smoking”.
In comparison, this is very similar to a researcher thinking that “eating at least one corn-on-the-cob bead in the past three months” is an important indication of a possible frequent corn-on-the-cob eating in the near future.
Despite this faulty reasoning and to their partial credit, these studies do acknowledge that the risks of regular and frequent smoking need to be assessed with further clinical research. More precisely, further studies are needed in order to evaluate the amount of participants who had experimented with tobacco use and the amount of participants who regularly used tobacco. If the data shows that only a small subset of these experimental smokers move on to regular smoking, then a further evaluation would be needed to know how much a prior vaping experience affects the possibility of becoming a regular cigarette smoker.
Additionally, both studies heavily rely on a measure called “susceptibility” to smoking that is even more unreliable. It can even be argued that these studies could be dismissed by introducing prior experience with other drug and smoking products, including the hookah and smokeless tobacco as well.
The Problem with Gateways
The measured gateway effect in these studies concludes that a minority of these e-cigarette users could potentially be more susceptible to smoking in the long run. However, this doesn’t mean that the majority of these subjects will develop a long-lasting smoking habit just because they used e-cigarettes prior to participating in the studies. Plus, the gateway theory in regards to causal drug use is slowly being abandoned by the majority of the scientific communities as we speak.
In fact, these “gateway models” received a significant surge in popularity back in the 1950s, asking the question of whether or not marijuana use was a gateway drug towards the excessive use of heroin. The causal link between marijuana and heroin use has since been debunked.
Additionally, a recent meta-research has shown that an individual’s personality traits play a very important role in determining a later use of tobacco, liquor, and other drug products as well. This relatively new method is called “common liability models” and introduces several contextual factors from the person’s life in order to determine later drug and tobacco use.
For instance, if an individual is inclined by their religious beliefs to avoid smoking cigarettes, drinking alcohol, or smoking e-cigarettes, then it is very likely to see a clear correlation between religious beliefs and the percentage at which these individuals either use or avoid these products.
To be fair, both of these studies attempted to consider the personal factors that could potentially lead to smoking. For instance, the study from Leventhal and colleagues tries to control the prior experience with marijuana, smokeless tobacco, and alcohol use, but the main problem is that it uses the wording of of “any use” as opposed to “no use”. This approach offers little insight into the real predictors of whether or not someone would definitely reach out for cigarettes after vaping.
Products like cigarettes or e-cigarettes from sellers such as VaperEmpire are already hard to get for people under the age of 18. However, all of these products are legal for adults. The popular gateway argument should not stop us from asking the right questions about the health risks involved with everyday cigarettes and other tobacco products. Only then we can prevent the younger population from becoming regular users of very dangerous tobacco products.