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E-cigarettes a gateway to smoking? Not likely, UB researcher says

The paper by UB and University of Michigan tobacco control experts published in the journal Drug and Alcohol Dependence cites the shortcomings of major national studies that appear to link e-cigarettes to later smoking.

By DAVID J. HILL

Published March 14, 2017

“There is little evidence that those who have never smoked cigarettes or never used other tobacco products and first try e-cigarettes will later move on to cigarette usage with great frequency or daily, regular smoking.”
Lynn Kozlowski, professor
Department of Community Health and Health Behavior

Are e-cigarettes a gateway product that lead more people, especially teens, to smoke regular cigarettes?

No, according to public health researchers from UB and the University of Michigan writing in the journal Drug and Alcohol Dependence.

“The national trends in vaping and cigarette smoking do not support the argument that vaping is leading to smoking,” says Lynn Kozlowski, the paper’s lead author and a professor of community health and health behavior in UB’s School of Public Health and Health Professions.

Kozlowski adds that research in the U.S. shows that as use of e-cigarettes — the act of which is known as vaping — has increased, overall smoking rates have decreased.

Kozlowski’s co-author is Kenneth Warner, the Avedis Donabedian Distinguished University Professor of Public Health in Michigan’s School of Public Health. Both Kozlowski and Warner are former deans of their respective public health schools.

“Our analysis focused on the risks for moving from e-cigarettes to cigarettes. There is little evidence that those who have never smoked cigarettes or never used other tobacco products and first try e-cigarettes will later move on to cigarette usage with great frequency or daily, regular smoking,” Kozlowski says.

Their paper highlights several shortcomings in studies that appear to show a link between e-cigarette use and subsequent smoking.

For example, many studies use misleading measures for what is actually considered smoking. “Measures of ‘at least one puff in the past six months’ can mean little more than the experimenting vaper was curious how cigarettes compared,” Kozlowski says.

Warner adds that in one study, only four e-cigarette users who previously hadn’t smoked reported smoking cigarettes when measured again at a later time.

“All of them said they’d smoked only one or two cigarettes in the past 12 months,” Warner says. “None of the studies was designed to be able to follow up smoking intensity at a later date.”

E-cigarette flavorings are another important consideration because many young people report vaping with only flavorings — no nicotine.

Kozlowski and Warner pointed to a 2015 national survey of eighth- through 12th-grade students conducted by the University of Michigan’s Monitoring the Future, an ongoing study of the behaviors, attitudes and values of American students and young adults that is funded by the National Institute on Drug Abuse. Results showed only 20 percent of the students surveyed who had used an e-cigarette reported that it contained nicotine.

Major national studies also have failed to control for most other tobacco use, including smokeless tobacco, and few have paid sufficient attention to confounding issues such as other alcohol and drug use, and mental health issues, the researchers say. Youth who are experimenting with other substances are more likely to also try e-cigarettes or combustible cigarettes, according to the researchers.

“The evidence from the prospective studies is weak at best,” Warner says. “All that it demonstrates is that there is a connection between kids who vape and future experimentation with smoking. But we know that these kids are different from those who do not vape. Even if there is a small gateway effect, it is totally swamped by the overall trend toward less and less smoking,” he says.

For next steps, Kozlowski and Warner say regulations are needed to minimize product risks. “The public deserves accurate information on the health risks of e-cigarettes versus cigarettes,” Kozlowski says. “From the best evidence to date, e-cigarettes are much less dangerous than cigarettes. The public has become confused about this.”

Adds Warner: “The persistent focus on the potential risks to kids has caused adults’ understanding of the risks of e-cigarettes to worsen over time. This is likely discouraging adult smokers from using e-cigarettes as a smoking cessation tool.”