Another week, another gateway study. This time the journal Pediatrics got into the act, publishing a cross-sectional study that purports to show teenagers who vape are more likely to move to smoking cigarettes than their non-vaping peers. But the study has problems, and the conclusions of the researchers -- some of whom have been involved in similar studies before -- are a real stretch.
"People who try things try things"
To begin with, most serious researchers think that kids who engage in any kind of “risky behavior” are also more likely to engage in other such behaviors. So a teen who would try vaping might also be more prone to experiment with cigarette smoking.
“What the study does show, quite convincingly, is that kids who have a personality type that lends itself to experimenting with e-cigarettes are also more likely to experiment with regular cigarettes,” wrote Dr. Michael Siegel. “There is no surprise here and had the researchers found anything different, one would have to question the validity of the study findings. Frankly, the study doesn’t really add any knowledge that we didn’t have already. It simply confirms what we already knew: kids who are more likely to experiment with e-cigarettes are more likely to experiment with tobacco cigarettes.”
“The authors misinterpret their findings,” said Prof. Peter Hajek, Director of the Tobacco Dependence Research Unit at Queen Mary University of London. “Like several previous studies of this type, this one just shows that people who try things, try things.”
How do you define a user?
Another issue is the authors’ measure of what constitutes a user. “Baseline e-cigarette use was defined as ever having taken even one puff of an e-cigarette,” wrote Dr. Siegel. “And smoking initiation was similarly defined as ever having taken even one puff of a cigarette.
"So the study did not document that even one subject in the study was ever a regular vaper.
"It is entirely possible (and in fact likely) that the majority of these kids had experimented with e-cigarettes, failed to become vapers, and then turned to regular cigarettes. In fact, it’s entirely possible that had these kids been able to stick with vaping, they would never have become smokers.”
We simply don’t know how much or how often these teenagers were vaping -- or how much or how often they smoked! We don’t know if they smoked regularly, or continued to smoke at all. Serious researchers would care about those questions. As Clive Bates wrote, “How much of a problem is someone who tried vaping, tried smoking and then went on to do neither?”
There really is a gateway!
Never addressed in these gateway studies is the fact that as vaping has increased among teenagers (and adults), smoking rates have plummeted. According to 2015 Youth Risk Behavior Survey data released last week by the CDC, smoking among high school students has dropped to 10.8 percent -- more than a 40 percent decline in the last four years! Gateway?
“However, population-based data on trends in youth vaping and smoking released last week do provide evidence that relates to the gateway hypothesis,” writes Dr. Siegel. “But those data suggest that e-cigarettes are a gateway away from smoking. In other words, as vaping has become more popular among youth, it has displaced cigarette smoking and contributed towards the de-normalization of cigarette smoking.”
“The authors seem to argue that trying one puff of an e-cigarette caused some young people to try tobacco smoking within the next 16 months,” said Prof. Ann McNeill, Professor of Tobacco Addiction at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London. “If so, we would be seeing large increases in tobacco smoking, but instead we are seeing marked declines in youth tobacco smoking since e-cigarettes came on the market. This suggests e-cigarettes are actually helping young people not to smoke tobacco cigarettes (something this study did not even consider).”
What can we learn from studies like this?
Bates: “There are just too many desperately biassed academic papers making ridiculous claims based on data and methods that could never describe a gateway effect. We should be looking at what is happening to the main trends in youth smoking, and this shows rapid declines in smoking and at a faster rate as vaping has risen. When you look at the full picture the data far more consistent with the vaping gateway being an ‘exit’ from smoking than an entrance.”
Hajek: “E-cigarettes do not lure non-smoking adolescents even to vaping – let alone to smoking.”
McNeill: “The gateway hypothesis in the addictions field is frequently used but is highly contested as it has a poor evidence base in general. This study does nothing to strengthen that evidence base”
Siegel: “This study is virtually meaningless in terms of its evaluation of the ‘gateway’ hypothesis.”
One thing we can learn is that the intention of many in tobacco control is not to learn facts and address them, but to use intentionally limited data to smear a product they just don’t like.
Rather than seriously investigating teenage e-cigarette use, they churn out study after study like this one -- half-baked vehicles for broad conclusions on glossy press releases, “science” spread in interviews offered to reporters who don’t ask too many questions. It's garbage. But they call it science.
Smokers created vaping without any help from the tobacco industry or anti-smoking crusaders, and vapers have the right to keep innovating to help themselves. My goal is to provide clear, honest information about the challenges vaping faces from lawmakers, regulators, and brokers of disinformation. I recently joined the CASAA board, but my opinions aren’t necessarily CASAA’s, and vice versa. You can find me on Twitter @whycherrywhy