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Study Finds E-Cigarettes Act as Gateway to Smoking. No, Not Really…

A new e-cigarette study sponsored by the National Cancer Institute and carried out by researchers at the University of Pittsburgh and Dartmouth-Hitchcock Norris Cotton Cancer Center concluded that teenagers and young adults who use electronic cigarettes are more likely to move on to smoking tobacco than those who never try the devices. Unfortunately, the reasoning behind this conclusion is questionable, at best.

e-cigarette-vaporThe one-year longitudinal study followed a national sample of 694 adolescents and young adults (aged 16 to 26) who were all classified as never-smokers at baseline, meaning they had never puffed on a tobacco cigarette, and were deemed not susceptible to smoking – they expressed no interest in smoking and did not think they would start smoking within the next year. Of the 694 participants, 16 reported having used electronic cigarettes at least once during their lifetime.

At the one-year follow-up, 5 of the 16 so-called e-cigarette users (37.5%) had “started smoking” compared to 65 (9.6%) of those who had reported never having used e-cigarettes at baseline. Furthermore, another 5 “e-cigarette users” (31.3%) were no longer certain they would not start smoking, compared to 63 (9.3%) of those who had not tried electronic cigarettes at the beginning of the study. They had become susceptible to smoking, which, the authors seem to think is the same as having already started smoking.

The conclusion of this study reads as follows: “In this national sample of US adolescents and young adults, use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking. These findings support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults.

In an editorial accompanying the study published on JAMA Pediatrics, Dr. Jonathan Klein, Associate Executive Director of the American Academy of Pediatrics, said that the research conducted  by Primack et al “is one more piece of evidence that the effect of e-cigarettes on youth is happening now in real time and that these products harm nonsmokers and result in a net harm to society and public health. At a time when many claim to be uncertain about the harms and benefits of e-cigarettes and argue for more studies, these data provide strong longitudinal evidence that e-cigarette use leads to smoking, most likely owing to nicotine addiction. We do not need more research on this question; we have the evidence base, and we have strategies that work to protect nonsmokers from e-cigarettes and other forms of tobacco. What we still need is the political will to act on the evidence and protect our youth.”

So not only is Klein referring to electronic cigarettes as tobacco products even though there is absolutely no tobacco in e-liquid, but claims we need no more research on the topic of e-cigarettes as a gateway to smoking. Yes, we should all ignore all the previous studies that found e-cigs do NOT lead to smoking and put our trust in this flawed study instead. Thank you for the objective opinion on this subject, doctor…

The problem with the study conducted by Dr. Brian A. Primack and his team is that it didn’t really find what it claims to have found, but merely that youths who experiment with electronic cigarettes are likely to experiment with tobacco cigarettes as well. Of the 16 participants who had ever used an e-cigarette at baseline, only 5 went on to have at least one puff off a cigarette in the next year. It could have been only one puff, or just a few, maybe one cigarette, just to see what it tastes like, and yet they were all classified as having progressed to traditional cigarette smoking, as if any kind of regularity had been proven by the study.

That’s because the researchers defined smoking as any use of a cigarette, even a single puff. As Dr. Michael Siegel of Tobacco Analysis notes “they may simply have tried a puff on a cigarette and decided it was not for them. In fact, it is entirely possible that they tried a puff on a cigarette, decided that the e-cigarette was much better tasting, and that they chose to vape instead of smoke. In this way, e-cigarettes could have actually served as a deterrent to smoking among this population.”

In fact, the study failed to document whether the 16 “e-cigarette users” were vaping regularly, mentioning only that they had tried electronic cigarette at least once at baseline. To the researchers that makes them e-cigarette users, while in reality they could be just kids who tried e-cigs once out of curiosity and decided vaping was not for them. Instead of proving the gateway effect is real, this research only shows youths who experiment with e-cigs are more likely to experiment with analogs as well, which is a natural finding that has already been documented.

Worse still, is that out of the 16 “e-cigarette users”, five were classified as having progressed to smoking, when in fact they had only become susceptible to smoking – were no longer certain that they would not smoke cigarettes. How can someone who has never taken a single puff from a tobacco cigarette, but merely thought about it, be referred to as having progressed to “traditional smoking?”

If someone had misinterpreted the findings of the study, I would be inclined to give the authors the benefit of the doubt, but they themselves draw the misleading conclusion that e-cigarette use is associated with progression to smoking, which isn’t supported by any sound evidence. Unfortunately, as is always the case with such negative e-cigarette studies, it has been picked up by the largest online news outlets, none of which have so far mentioned its many limitations and flawed logic.

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