Health News Digest


July 8, 2019

E-Cigarettes Are Not a Gateway to Smoking–They Replace Smoking

By Michael D. Shaw

The recent rise in teen vaping has sparked a national conversation about the risk of e-cigarettes. Some, including former FDA commissioner Scott Gottlieb, view the problem as an “epidemic.” Meanwhile, states and municipalities across the country have moved quickly to introduce excise taxes, flavor bans, and even outright prohibitions of the product. The fear is, while vaping is safer than smoking, it’s not perfect—and it serves as a “path to nicotine addiction,” sparking concerns that e-cigarettes will act as a “gateway drug” to smoking.

The cynics among us are reminded of Bruce Yandle’s “Bootleggers and Baptists” article from 1983.

But is this hysteria warranted? Perhaps a better understanding of what actually drives people to smoke would help dampen the panic around e-cigarettes, and reset the conversation. So far, research does not point to any uptick in smoking as a result of vaping. In fact, a study out of the University of Michigan strongly suggests just the opposite. The increase in the use of e-cigarettes has driven down the use of other, sometimes more harmful activities, including binge drinking. And despite the increase in vaping, these researchers found a precipitous decline in teen smoking.

Similarly, researchers at the Georgetown University Lombardi Comprehensive Cancer Center have also acknowledged that when e-cigarettes came onto the market, “smoking rates dropped between 25 and 40 percent,” and among young adults smoking rates have “dropped by almost 50 percent.”

Still, Gottlieb and others frequently claim that adolescents who use e-cigarettes are more than three times as likely to start smoking according to data from the National Institute on Drug Abuse. On the face of it, these numbers would be alarming; but the question is what happens if we control for any of the indicators that we know actually drive more teens to smoke.

Perhaps the strongest predictor of whether an adolescent will take up smoking is whether their parents are smokers. According to a study published in Pediatrics in 2014, “exposure to parental nicotine dependence is a critical factor influencing intergenerational transmission of smoking.” In this research, teens who had a parent who were addicted to smoking, were more likely to be both “early regular smokers” and “early experimenters,” while there was no teen smoking path associated with kids who came from a smoke-free home. Overall, teens exposed to parents who smoke were nearly twice as likely to become dependent on nicotine.

A second indicator of whether a teen will smoke is their socio-economic status. The Centers for Disease Control has long-reported that Americans living below the poverty line—and those with lower levels of education—have much higher rates of smoking than the rest of the population, suggesting that more anti-smoking education needs to be directed at this population.

Finally, an important predictor of teen smoking is the company they keep. A peer group has a tremendous impact on whether an adolescent will pick up a cigarette. Research from 2017 out of the journal Psychological Bulletin found that “having friends who smoke doubles the risk that children ages 10 to 19 will start smoking and continue smoking.”

It’s true, there has been an increase in teen vaping—something we should all be aware of as we encourage our children to live healthy, balanced lifestyles. But the CDC also tells us that smoking is at an all-time low with adult smokers dropping from 20.9 percent in 2005 to 15.5 percent a decade later in 2016. With numbers like these, it is difficult to argue that vaping is a “gateway” to smoking. Instead, it’s becoming clear that vaping replaces smoking.

And that’s exactly the goal. Smoking continues to kill shy of 500,000 Americans each year—and millions more live with smoking-related diseases. E-cigarettes have proved to be a far less harmful—and far more effective—way to help adult smokers quit. Let’s not let our fears get in the way.