No evidence that e-cigarettes are leading teens to smoke

Posted by DrMendelsohn on 29 August, 2017

An analysis of 5 studies in the UK provides the strongest evidence yet that e-cigarettes are not leading young people to smoke.

The study analysed 5 separate surveys in the UK between 2015-2017 of 60,000 young people aged 11-16 years. The study was published today in the International Journal of Environmental Research and Public Health.

The study found that although young people are experimenting with e-cigarettes, regular use (weekly or more) is rare. A tenth to a fifth of 11-16 year olds had tried e-cigarettes, but only 3% or less used them regularly and most of those were already tobacco smokers.

According to the lead author, Professor Linda Bauld, Professor of Health Policy, University of Stirling, the analysis ‘shows clearly that for those teens who don’t smoke, e-cigarette experimentation is simply not translating into regular use’.

Importantly, across the 5 surveys, regular use (at least weekly) by young people who had never smoked was very rare, <0.5% (see below in red box).

Bauld 2017. Ecig use in teens 2.jpg

Vaping does not increase teen smoking rates

Previous studies have suggested that e-cigarettes may be enticing young people who never smoked to try vaping and that this may lead to nicotine addiction and increased smoking (the gateway effect). This theory was based on the finding that young people who tried e-cigarettes were more likely to be found smoking later.

However, the association between vaping and smoking simply reflects that kids who experiment with vaping are also more likely to experiment with smoking. There is no evidence that vaping CAUSES the smoking.

In fact, the opposite pathway is more likely. In many countries where vaping is available, the rate of smoking in young people is continuing to fall, in some countries faster than ever. The evidence suggests that vaping is diverting young people from smoking.

Getting the balance right

The UK seems to have found the right balance in regulating e-cigarettes. E-cigarettes are available to adult smokers to help them quit. Currently there are 2.9 million e-cigarette users in the UK of whom 1.5 million have stopped smoking altogether.

However, appropriate regulations are protecting children. Sale to under 18 year olds is prohibited and there are restrictions on marketing which may appeal to young people. No evidence of a gateway to smoking.

The UK has showed that it is possible to get this balance right and that the net benefits of e-cigarettes are strongly positive for public health.

The study

Bauld L et al. Young People’s Use of E-Cigarettes across the United Kingdom Findings from Five Surveys 2015–2017. IJERPH 2017

Trial funding. The YTPS was supported by a grant from Cancer Research UK (A20456). The ASH Smokefree GB-Youth surveys were supported by grants from Cancer Research UK and the British Heart Foundation. The School Health Research Network is a partnership between the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer) at Cardiff University,Welsh Government, Public Health Wales and Cancer Research UK, funded by Health and Care Research Wales via the National Centre for Population Health and Well-being Research.

Other commentary on this study

Fears over e-cigarettes leading to smoking for young people unfounded. The Guardian 29 August 2017

Most young people who try e-cigarettes don't become regular users, says study. Cancer Research UK

UK’s largest ever analysis of data shows no evidence that e-cigarettes are leading young people into smoking. ASH UK


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