Vaping is not a gateway to smoking. An evidence review

Posted on July 21, 2023 By Colin

ONE OF THE MOST COMMON arguments against vaping is that it will increase youth smoking (the 'gateway theory'). However, there is now good evidence that this is not true. In fact, vaping is REDUCING smoking rates in young people.

Young people who try vaping are also more likely to try smoking because they share risk factors that lead to both behaviours ('common liability'). But this does not mean that vaping caused them to take up smoking. Teens who vape are also more likely to take other risks, such as smoking, drinking alcohol, drink driving, using illicit drugs and having unsafe sex. Vaping does not cause these behaviours either.

Some young non smokers who try vaping may go on to try smoking. However, far more move in the other direction, ie many young smokers or would-be smokers turn to vaping instead, a far safer alternative.

Overall vaping reduces smoking in young people and has a net beneficial effect on population health

The gateway myth is a disingenuous tactic used by Health Minister Mark Butler, the Australian Medical Association, the NHMRC, Emeritus Professor Simon Chapman, Professor Emily Banks, Cancer Council Australia and other vaping opponents to justify their dislike for vaping.

There are 5 strands of scientific evidence demonstrating that vaping is not leading to smoking.

1. Common risk factors for vaping and smoking

Studies show that young people who experiment with vaping are three times more likely to also try smoking. However, young people who experiment with vaping are different to kids who don’t vape. Kids who try vaping are more likely to use other drugs, have friends who vape or smoke, have mental illness, parents who smoke, come from lower socio-economic backgrounds, have lower education etc. These 'shared risk factors' put them at risk of experimenting with both vaping and smoking.

Studies that allow for these differences between groups have found that the increased risk of smoking in teens who vape (compared to teens who don't vape) dramatically reduces or disappears. For example, a rigorous study by Kim 2019, adjusted for 14 shared risk factors and concluded that:

The apparent relationship between e-cigarette use and current conventional smoking is fully explained by shared risk factors, thus failing to support claims that e-cigarettes have a causal effect on concurrent conventional smoking among youth

Other studies that account for a comprehensive range of shared risk factors have found the same result, for example, Sun 2021 and Cheng 2020.

2. Accelerated decline in youth smoking

The gateway theory predicts that vaping will increase smoking rates in young people. However, we are seeing the opposite of this. In countries where vaping is readily available such as the UK, US and New Zealand, the decline in youth smoking rates has accelerated.

For example, since vaping became popular in the US in 2013, smoking by high schoolers fell from 10% to 1.9%  (dark blue in the graph).

Graph credit: Brad Rodu, Tobacco Truth

Other studies have found similar results. (Levy 2019; Meza 2021; NHS Digital UK 2022; ASH NZ 2022

2023 Update

2 recent studies from the US and UK confirmed the absence of a gateway effect:

  • Delnevo and Villanti analysed youth smoking and vaping rates in the US from 3 large national surveys over a 30-year period from 1991-2022 and found that the decline in youth smoking rates accelerated after vaping became popular in 2013. They concluded:
    “Concerns about a potential rise in adolescent cigarette use following the introduction of e-cigarettes to the U.S. market in the early 2010s are not supported by the data. In fact, the emergence of e-cigarettes has coincided with the most rapid declines in cigarette use over the past thirty years”
  • Pesola et al. analysed the associations between use and sales of alternative nicotine-delivery products [such as vapes] and smoking prevalence and cigarette sales in the UK.
    Professor Jamie Hartmann-Boyce said “This is a well-conducted study that is consistent with some other studies in this area which suggest that – at a population level – e-cigarettes do not appear to increase smoking rates and may possibly decrease them”.

3. Vaping diverts young people from smoking

Many studies have found that vaping and smoking are substitutes and that vaping is diverting young people AWAY FROM smoking.

This has been demonstrated in modelling studies (Foxon 2020, Selya 2021, Sokol 2021) and in population studies (Walker 2020).

4. Restrictions on vaping increase smoking

Other research studies (natural experiments) have found that youth smoking rates increase when access to vaping is restricted. This has been demonstrated for

These findings confirm that vapes and smokes are substitutes. Reducing access to vaping increases the uptake of deadly smoking.

5. Vaping first (before smoking) reduces smoking uptake

There is growing evidence that teens who vape first (before smoking) are less likely to smoke later, compared to those who smoke first (Shahab 2021; Legleye S 2021; Mus 2023) Other studies have found no evidence that vaping first increases smoking uptake (Chyderiotis 2020; Stanton 2023)

Study design errors

An analysis of 84 longitudinal studies of  vaping by adolescent non-smokers found major methodological design errors in the study design. The analysis concluded that the flaw resulted in an overestimation of any gateway effect from vaping to smoking. The findings support diversion by vaping away from smoking in adolescents. (Dautzenberg 2023)

Why it matters

Harsh restrictions to discourage youth vaping based on the flawed gateway theory also lead to reduced access to vaping for adult smokers. Vaping should be readily available as a quitting aid and draconian restrictions reduce its uptake send a false signal to smokers that vaping is a dangerous behaviour. More smokers will die as a result.


Summary of gateway studies referenced in this article

Further reading

What does the evidence say about youth vaping. Blog 30 May 2023

Vaping is rare in young adult Australian non-smokers and is reducing smoking – study. Blog 29 March 2023

My advice to teens about vaping. Know the facts. Blog 20 Feb 2023

Study debunks fears of youth vaping. Blog 22 June 2022

Mendelsohn CP, Hall W. Does the gateway theory justify a ban on nicotine vaping in Australia? International Journal of Drug Policy 2020

Go to Top