Vaping a gateway to smoking for non-smokers, research shows

While vaping provides a pathway to help smokers wanting to quit, for non-smokers it may be the first step on a pathway to taking up smoking, a new study has shown.

Led by University of Otago post graduate student Andre Mason and Associate Professor Damian Scarf, of the University of Otago's Department of Psychology, the collaborative research, published today in the Drug and Alcohol Review, analyzed data related to smoking and vaping status of New Zealanders from the 2018-2020 New Zealand Attitudes and Values survey.

Associate Professor Scarf says broadly, the prevalence of smoking was found to be decreasing over time, while the prevalence of vaping was increasing. No differences were observed in the likelihood of transition from smoking to vaping or vice versa, indicating that either pathway was equally as likely.

Survey results were analyzed from the three years starting in in 2018. The prevalence of those in the survey who smoked decreased at each time point (7.4, 6.2 and 5.2 percent), while the prevalence of those who vaped increased (2.8, 2.9 and 3.4 percent.)

In 2018, those who vaped were more likely to start smoking than those who smoked were to start vaping, while in 2019, the opposite effect was found.

Vaping is an increasing phenomenon worldwide. Recent estimates suggest that Aotearoa New Zealand has the second highest rates of ever using (15.5 percent) or currently using (7.8 percent) nicotine vaping products in the world. It is estimated that 81 million people vaped globally in 2022, up 39 percent from 58 million in 2018 and up 103 percent from 21 million in 2012.

Mr. Mason says vaping was initially "hailed a new tool to help people quit smoking, but to date that evidence has been inconsistent".

Unlike other studies, the researchers found no consistent evidence that vaping acts as a cessation pathway from smoking.

"Instead there are frequent transitions between smoking and vaping and vice versa. While most individuals continued to engage in the behavior they reported at the previous time point, there were individuals transitioning between both smoking and vaping," Mr. Mason says.

The results offer "critical insight" into the potential adverse effects of vaping and emphasize the need for stricter policies.

"Contrary to the desired hope, vaping appears to have emerged as just another smoking-related behavior rather than a substitute for smoking that primarily helps people quit," he says.

Although the prevalence of smoking decreased over time, the lack of evidence for a cessation effect through vaping suggests the drop may be due to other factors, such as marketing campaigns focused on the negative health impacts and increased costs of buying cigarettes.

"Furthermore, and perhaps more concerningly, vaping appeared to be equally as likely to increase the uptake of cigarette smoking as it was to have a cessation effect," he says.

"This supports the arguments that policy discussions cannot simply focus on a one-directional consideration of harm reduction, in this case that if vaping is less harmful than cigarettes, then vaping can be less regulated to enable smokers to switch to healthier behaviors."