Clearing the myths about youth vaping

Posted by DrMendelsohn on 21 May, 2018

The following letter was published in the Medical Journal of Australia today, responding to misleading claims about vaping by young people

Download a pdf copy of the letter here.

Dear Editor,

I write to comment on the Perspective by Wolfenden et al. on e-cigarette use by young people. 1

The authors make regulatory recommendations for e-cigarettes based on the assertion that vaping causes young people to take up smoking, the so called ‘gateway theory’. However, while many studies have found that adolescents who try vaping are more likely to try smoking, there is no evidence of cause and effect. The longitudinal studies described show only an association and are unable to demonstrate causality.2  An alternative explanation is ‘common liability’ i.e. that young people who are more attracted to experimentation are more likely to try both products.

In fact, international reviews suggest that vaping is diverting adolescents away from smoking and reducing smoking rates. 3 As vaping rates have been increasing in young people, smoking rates are rapidly declining, a finding inconsistent with a gateway effect.

Real world studies show that most vaping by young people is experimental and short lived and only a small minority use nicotine. Regular vaping among teens is almost exclusively confined to those who already smoke. A recent analysis of five national surveys in the United Kingdom of 60,000 adolescents found that regular vaping by never-smoking 11-16 year olds was 0.1-0.5%. 4

Perhaps most important of all, Wolfenden et al. dismiss the substantial public health benefit that could result from vaping. Population studies have indicated that millions of smokers have quit using e-cigarettes and modelling studies have found a substantial net public health benefit, even using pessimistic scenarios.5

Banning wider access to e-cigarettes on the basis of an unproven, potential risk to adolescents would prevent access to a life-saving quitting aid for millions of smokers. A better solution is to employ strategies to minimise youth access and make vaping available for adult smokers who are otherwise unable to quit smoking with conventional therapies.



1. Wolfenden L, Stockings E, and Yoong SL. Regulating e-cigarettes in Australia: implications for tobacco use among young people. Med J Aust 2018; 208: 89

2. Kozlowski LT, and Warner KE. Adolescents and e-cigarettes: Objects of concern may appear larger than they are. Drug & Alcohol Dependence 174 209-214

3. O'Leary R, MacDonald M, Stockwell T, et al. Clearing the Air: A systematic review on the harms and benefits of e-cigarettes and vapour devices. University of Victoria, BC: Centre for Addictions Research of BC. 2017. Access date 1 July 2017

4. Bauld L, MacKintosh AM, Eastwood B, et al. Young People's Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015-2017. Int J Environ Res Public Health 2017; 14 (9):

5. Levy DT, Borland R, Lindblom EN, et al. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tobacco Control 2017 DOI: 10.1136/tobaccocontrol-2017-053759;


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