More Studies Test The Hypothesis That Vaping Leads to Subsequent Smoking

Recent studies have analyzed the “Gateway Theory" once again, examining whether vaping leads to subsequent smoking among teens.

A study analysing longitudinal data from two large-scale cohorts in the U.K. and U.S., titled, “E-cigarette use among early adolescent tobacco cigarette smokers: testing the disruption and entrenchment hypotheses in two longitudinal cohorts,” reported that in the US, those who vaped as teens, were also more likely to become smokers or vapers in later years, than never users. Similarly in the UK, early adolescent vaping was associated with a higher likelihood of being a frequent smoker than an infrequent one in the future.

Lead study author Jeremy Staff, PhD, of Pennsylvania State University in University Park, and his team, specified that in youth who began smoking before age 15, the odds of later adolescent smoking were significantly higher than for those who vaped versus those who did not.

Within the US cohort 42% of early vapers continued smoking in late adolescence, in comparison to 24% of participants who never vape. While across the UK cohort, 61% of early vapers went on to smoke in late adolescence, compared to 50% of smokers who never vaped.

UK health authority rejects the Gateway Theory
On the other hand, a number of peer reviewed studies deny the link between vaping and smoking uptake in teens. Renowned UK Health authority Public Health England (PHE) has recently highlighted that no such link has been observed, “latest survey results in the UK do not support the idea that vaping (or the use of e-cigarettes) is a gateway to smoking.”

While Action on Smoking and Health (ASH)-UK, cited results of five major surveys of minors conducted between 2015 and 2017, which indicated that “most young people who experiment with e-cigarettes did not become regular users.” “Overall, there is no evidence that e-cigarettes have driven up smoking prevalence in this age group. In fact, smoking prevalence among young people has declined since e-cigarettes came onto the market,” said ASH-UK.

Moreover, a research team from the University of Michigan analyzing nationwide data on tobacco product use among 8th, 10th and 12th-graders, from 1991 to 2019, has recently concluded that the infamous Gateway Theory: the theory that vaping leads to subsequent smoking, holds no ground. The compiled data indicated that daily smoking rates among 12th-grade boys rose by 4.9% a year between 1991 and 1998, but fell by 8% a year between 1998 and 2006, and by 1.6% from 2006 to 2012.

A recent study titled, “Association of Electronic Cigarette Use by US Adolescents With Subsequent Persistent Cigarette Smoking,” questioned whether e-cigarettes are to blame in the progression from vaping to smoking in some teens. To analyse this, the research team used data from a national sample of 8671 “cigarette-naive” teens who had used e-cigarettes at baseline, and compared them to those who had not.

The analyzed data indicated that those who vaped had higher odds of continuing smoking 2 years following initiating smoking the year after baseline. However, the absolute risks of continued smoking for both baseline e-cigarette users and nonusers were very small.

In fact, another study published by the scientific journal Addiction has revealed that the increase in vaping rates in England among young adults between 2007 and 2018, did not correlate with increased smoking rates.

The UK study aimed to measure the gateway effect by looking at the association between prevalence of e-cigarette use among young adults and prevalence of uptake of smoking generally, including among people who have never smoked. If a gateway effect did exist, associated population-wide changes in the prevalence of smoking uptake should increase in parallel to vaping rates. In fact the study authors found no statistically significant association between the prevalence of e-cigarette use and regular smoking among participants aged 16 to 24.

Countries endorsing vaping are experiencing a drop, not increase, in smoking
In line with these findings, scientific data has consistently indicated that countries which have endorsed the use of e-cigs for smoking cessation, such as the UK and New Zealand, are not only reporting low smoking rates, but also not experiencing increases in teen vaping rates. Supporting reports from such countries and in line with previous studies looking into these patterns, a recent review titled, “Does the gateway theory justify a ban on nicotine vaping in Australia?,” dismissed the Gateway Theory once again.

Review authors Colin Mendelsohn and Wayne Hall had pointed out that a more plausible explanation as to why young people who vape are more likely to smoke, are personality factors. This means that those teens who are risk-takers and are therefore also more likely to smoke, drink alcohol, use cannabis and other substances, and so forth, are also more likely to vape than their peers. This argument has already been emphasized by other experts in multiple studies.

More importantly, recent data from the statewide SHARP survey has indicated a sharp drop in vaping rates among eighth, tenth, and twelfth graders, in the last two years in Utah. In 2019, 12.4% of the teens surveyed reported vaping, as opposed to 7.8% in 2021 reported the survey. “All of the trend is downward,” said Sharon Jensen, Jordan School District Consultant in Student Support Services, who works on substance abuse issues in the district and is also on the State Board of Education’s Safe and Drug-free Schools Task Force.