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