E-cigarettes a gateway to smoking? Not likely, according to new published research

March 13, 2017
Lynn Kozlowski, professor of community health and health behavior, University at Buffalo Credit: University at Buffalo

Are e-cigarettes a gateway product that lead more people, especially teens, to smoke regular cigarettes? No, according to public health researchers from the University at Buffalo and the University of Michigan writing in the journal Drug and Alcohol Dependence.

"The national trends in vaping and cigarette smoking do not support the argument that vaping is leading to smoking," said Lynn Kozlowski, the paper's lead author and a professor of community health and health behavior in UB's School of Public Health and Health Professions.

Kozlowski, PhD, added that research in the U.S. shows that as use of e-cigarettes—the act of which is known as vaping—has increased, overall have decreased.

Kozlowski's co-author is Kenneth Warner, the Avedis Donabedian Distinguished University Professor of Public Health in Michigan's School of Public Health. Both Kozlowski and Warner are also former deans of their respective schools.

"Our analysis focused on the risks for moving from e-cigarettes to cigarettes. There is little evidence that those who have never smoked cigarettes or never used other tobacco products and first try e-cigarettes will later move on to cigarette usage with great frequency or daily, regular smoking," said Kozlowski.

Their paper highlights several shortcomings in studies that appear to show a link between e-cigarette use and subsequent smoking.

For example, many studies use misleading measures for what is actually considered smoking. "Measures of 'at least one puff in the past six months' can mean little more than the experimenting vaper was curious how cigarettes compared," Kozlowski said.

Warner added that in one study, only four e-cigarette users who previously hadn't smoked reported when measured again at a later time. "All of them said they'd smoked only one or two cigarettes in the past 12 months," Warner said. "None of the studies was designed to be able to follow up smoking intensity at a later date."

E-cigarette flavorings are another important consideration, because many young people report vaping with only flavorings—no nicotine. Kozlowski and Warner pointed to a 2015 national survey of eighth- through 12th-grade students conducted by the University of Michigan's Monitoring the Future, an ongoing study of the behaviors, attitudes and values of American students and young adults and funded by the National Institute on Drug Abuse. The results showed that only 20 percent of the students surveyed who had used an e-cigarette reported that it contained nicotine.

Major national studies also have failed to control for most other tobacco use, including smokeless tobacco, and few have paid sufficient attention to confounding issues such as other alcohol and drug use and , the researchers say. Youth who are experimenting with other substances are more likely to also try e-cigarettes or combustible cigarettes, according to the researchers.

"The evidence from the prospective studies is weak at best," Warner said. "All that it demonstrates is that there is a connection between kids who vape and future experimentation with smoking. But we know that these kids are different from those who do not vape. Even if there is a small gateway effect, it is totally swamped by the overall trend toward less and less smoking," Warner adds.

For next steps, Kozlowski and Warner say that regulations are needed to minimize product risks. "The public deserves accurate information on the health risks of e-cigarettes versus cigarettes," Kozlowski said. "From the best evidence to date, e-cigarettes are much less dangerous than cigarettes. The public has become confused about this."

Adds Warner: "The persistent focus on the potential risks to kids has caused adults' understanding of the risks of e-cigarettes to worsen over time. This is likely discouraging adult smokers from using e- as a cessation tool."

Explore further: Young people do not associate e-cigarettes with increased likelihood of smoking

More information: Lynn T. Kozlowski et al, Adolescents and e-cigarettes: Objects of concern may appear larger than they are, Drug and Alcohol Dependence (2017). DOI: 10.1016/j.drugalcdep.2017.01.001

Related Stories

Young people do not associate e-cigarettes with increased likelihood of smoking

March 8, 2017
New peer-reviewed research published today in Drugs Education Prevention and Policy shows that e-cigarettes are not increasing the likelihood of tobacco consumption and may in fact be contributing to negative perceptions ...

Increase in e-cigarette use, decrease in smoking, is encouraging, expert says

April 20, 2015
The increase in electronic cigarette use, coupled with a decrease in smoking, could be a positive sign for the prevention of cigarette use, said Lynn Kozlowski, University at Buffalo professor of community health and health ...

Teens who vape at increased risk for future cigarette smoking

February 7, 2017
Among high school seniors who have never smoked a cigarette, those who vape are more than four times more likely to smoke a cigarette in the following year than their peers who do not vape.

1 in 4 U.S. adults, 1 in 10 teens use tobacco

January 26, 2017
(HealthDay)—Despite the dangers, many American adults and teens still use tobacco products, a new study finds.

Depression linked to e-cigarette use among college students

February 13, 2017
The emergence of e-cigarettes as a nicotine product has left scientists with many questions about their impact on health, including how the product interacts with depression. A new study by researchers at The University of ...

Research discredits theory that e-cigarettes make tobacco use socially acceptable

December 20, 2016
A study conducted by the Glasgow-based Centre for Substance Use Research (CSUR) has cast doubt on the link suggested by some between the increased visibility of e-cigarette use and the renormalisation of smoking.

Recommended for you

Exercising immediately after study may help you remember

August 24, 2017
Exercise may be the secret to retaining information, according to new research from UNSW that may encourage more physical activity in classrooms and nursing homes.

Americans misinformed about smoking

August 22, 2017
After voluminous research studies, numerous lawsuits and millions of deaths linked to cigarettes, it might seem likely that Americans now properly understand the risks of smoking.

Women who sexually abuse children are just as harmful to their victims as male abusers

August 21, 2017
"That she might seduce a helpless child into sexplay is unthinkable, and even if she did so, what harm can be done without a penis?"

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.