Another day, another alarmist and misleading gateway study
Posted on September 13, 2024 By Colin
ONCE AGAIN, AUSTRALIAN RESEARCHERS have jumped on the bandwagon, making alarmist claims that vaping causes young people to start smoking. But let’s be clear: this study proves no such thing.
The researchers behind the Generation Vape study followed up 14-17-year-olds who had tried vaping and found they were five times more likely to also try smoking (even just "a few puffs") at a later date.
This association is unsurprising, but it does not prove that vaping caused subsequent smoking as claimed
It’s long been recognised that some young people are simply predisposed to experiment with nicotine, whether through cigarettes, vaping, or other means. Surely the authors know this.
Causality requires more than surface-level associations. In this case, it would take more robust, sophisticated longitudinal studies to even begin establishing a causal relationship. Nonetheless, the authors claim their findings "indicate that vaping markedly increases the risk of subsequent smoking initiation.” They went a step further in their media release, declaring that vaping poses a real threat to increasing youth smoking rates, calling for tighter regulations.
Typically, these flawed conclusions had widespread media coverage in Australia and internationally
A far more likely explanation: common liability
A far more plausible explanation for the observed association is “common liability.” (Vanyukov 2012) In short, young people who try both vaping and smoking are simply different from their peers. They are predisposed to experiment with nicotine, driven by many underlying smoking predictors like peer pressure, parental smoking, and socio-economic status.
While this study adjusted for four smoking predictors (risk factors), it ignored a host of others. Crucial influences that increase the risk of smoking like school performance, genetic predisposition, personality type and mental health factors such as anxiety and depression were left out.
Studies that adjust for a broader range of risk factors (confounders) tell a very different story
Two such studies, which accounted for 14 and 22 risk factors, found that the link between vaping and later smoking vanished entirely. (Sun 2023; Kim 2019) A further study accounted for 34 risk factors which eliminated almost all (87%) of the association between vaping and smoking. (Lee 2019)
Where are all the smokers?
If vaping truly acted as a gateway to smoking, we’d expect to see a dramatic rise in youth smoking since the introduction of vaping in Australia.
Yet, the opposite is true - youth smoking has almost disappeared
In the most recent 2022-2023 ASSAD survey, just 0.3% of Australian students aged 12-17 reported daily smoking. Only 2.1% had smoked within the last week. Similarly, the NDSHS 2022-23 survey showed that only 3.5% of 14-17-year-olds had smoked in the past 30 days.
In fact, youth smoking rates have been falling faster than anticipated since vaping entered the scene. (Delnevo and Villanti 2021; Pesola 2021 Levy 2019; Meza 2021; NHS Digital UK 2022; ASH NZ 2022),) Studies suggest that youth vaping may actually be displacing smoking rather than encouraging it. (Foxon 2020, Selya 2021, Sokol 2021)
Experimentation vs. sustained smoking
One particularly misleading aspect of this study is its definition of “smokers.” A young person who takes "a few puffs" of a cigarette is classified as a smoker, but this is hardly equivalent to habitual smoking. Much adolescent cigarette use is fleeting, a brief experiment rather than the start of a smoking habit.
A recent analysis found that very few young people who tried smoking developed a regular smoking habit two years later, regardless of whether they had vaped beforehand. (Sun 2023) Another analysis showed that roughly two-thirds of youth who had tried smoking never progressed to regular use. (Friedman 2019)
Conclusion
This paper has sparked unnecessary alarm with its misleading claim of causality, feeding into the growing moral panic about youth vaping. By confusing correlation with causation, the authors have made a fundamental error. It's hard to believe this wasn’t a deliberate decision.
Unfortunately, the recommendations from this paper—calling for stricter regulations on vaping—could ultimately do more harm than good. If these restrictions affect adult smokers, the public health consequences could be severe. We must prioritise evidence-based policy decisions, not reactions driven by alarmist studies that overstate the risks.
References
Is vaping a gateway to smoking?. Blog
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