E-cigarettes are not a gateway to smoking for young people
One of the popular myths about e-cigarettes is that young people who otherwise never have smoked will get hooked on vaping and progress to cigarette smoking. In fact, the opposite may be true, that e-cigarettes are actually diverting adolescents away from smoking.
The Australian Medical Association (AMA) magazine Australian Medicine recently published an article claiming that a study in the US had demonstrated this gateway effect, where in fact no such effect was found. The article claimed that this finding supported the AMA position that e-cigarettes should be strictly regulated.
I wrote the following letter in response, which was published on 17 January 2017.
The article ‘E-cigs a gateway to smoking for young: study’(Australian Medicine, 10 November 2016) misinterprets the finding of a recent study and incorrectly claims that e-cigarettes are leading young people to smoking. In fact, the evidence suggests that the opposite is likely to be true
The study, published in JAMA (Leventhal AM et al), found that young people who use e-cigarettes are also more likely to smoke. This association tells us nothing about whether the vaping caused the smoking. A more likely explanation is that young people who are more attracted to experimentation are more likely to try both products, due to a shared underlying vulnerability.
In fact, it is likely that vaping is diverting young people away from smoking tobacco. In the US, between 2013 and 2015, as e-cigarette use in young people has been rising, the rate of smoking has declined faster than at any time in the last 40 years (Monitoring the Future study). It is obviously better for young people not to use e-cigarettes, but vaping is preferable to smoking tobacco, and is at least 95 per cent safer. Many studies have found that regular use of e-cigarettes is almost entirely concentrated in young people who already smoke.
The UK Royal College of Physicians recently completed a comprehensive review of e-cigarettes. It concluded that there was no evidence that e-cigarettes are acting as a gateway to smoking in young people. In fact, the RCP recommends that “in the interests of public health it is important to promote the use of e-cigarette ... as widely as possible as a substitute for smoking”.
On the other hand, the draconian policy of the Australian Medical Association on e-cigarettes is potentially harmful to public health and should be urgently reviewed.
Conjoint Associate Professor Colin Mendelsohn
School of Public Health and Community Medicine
Letter available here (page 34)
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