The CDC survey on youth tobacco use (see: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6235a6.htm) kicked up a veritable storm in the media, with sensationalistic journalists repeating the results giddily at every single suggestion e-cigs will be used by teens or even children and could serve as a “gateway” to tobacco smoking. According to their press release, use of e-cigarettes in high school students doubled from 2011 to 2012, up to around 10 percent of students having ever tried them. In addition, it found that the proportion of high school and middle school students who used an e-cigarette in the last 30 days (incorrectly classing them as a “current user”) increased from 1.1 percent to 2.1 percent, another figure which effectively doubled over a year. Of these past-month users, over three-quarters had also smoked a tobacco cigarette over the same period.
Ever since, the findings have been used by anti-vaping advocates to argue that children are being targeted and that these kids will go on to smoke cigarettes, despite the fact that the CDC actually found that only 0.5 percent of respondents were non-smokers who’d tried an e-cig at any point in the last month. At the time, CDC Director Tom Frieden commented, “Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.” Now, a piece of research has given the first hard evidence that this is not the case.
The Study
The new piece of research (see: http://consumer.healthday.com/cancer-information-5/tobacco-and-kids-health-news-662/e-cigarettes-may-not-be-gateway-to-smoking-study-681597.html) was presented at a conference, meaning that there isn’t a published version of the full methodology or findings yet, but it will hopefully see print soon. The aim of the research was to determine whether e-cigarettes do serve as a gateway to further tobacco use (see: http://ecigarettereviewed.com/e-cigarettes-are-not-gateways-to-tobacco-smoking), so they surveyed 1,300 college students (average age of 19), asking them what the first tobacco product they ever tried was and some questions about their current use.
Out of the entire sample, only 43 students reported that their first use of a nicotine product was an e-cigarette. This equates to around 3.3 percent of the entire sample, showing the rarity of anybody using e-cigarettes before smoking tobacco. The “gateway” hypothesis would have it that a significant proportion of these students then went on to smoke regular cigarettes, or at least continued to use an e-cigarette. This survey suggests that the “gateway” argument is just plain wrong, since only one of the respondents went on to use tobacco cigarettes afterwards. Out of those whose first encounter with nicotine was through an electronic cigarette, a mere 2.3 percent went on to smoke cigarettes. The vast majority of them didn’t even consume nicotine or tobacco in any form by the time the survey was conducted.
It’s worth noting that this phenomenon is so rare that this percentage value should be taken with a pinch of salt – this single individual identified out of 1,300 is obviously unusual in his or her nicotine-consuming timeline, it’s just not clear quite how unusual from this data alone. If you consider the number of confirmed “gateway” cases in proportion to the whole sample, it accounts for a mere 0.077 percent. Researcher Theodore Wagener commented, “It didn’t seem as though it really proved to be a gateway to anything.”
Clearly with an acute awareness of how these findings may be interpreted, Wagener did point out that kids who use e-cigarettes “are still putting something that has carcinogens and toxins into their system.” Yeah, about as many carcinogens as if they used a nicotine patch (see: http://tobaccoanalysis.blogspot.com/2009/07/comparison.html).
The Issues
As with any piece of research, there are potential issues with this finding. Firstly – and as mentioned earlier – we don’t really have full details of the method or findings yet, realistically more information would be available from a paragraph-long “abstract” of the study. However, the core data and basic methodology do hold some weight, unless the researchers managed to screw up their survey about as much as the CDC did with theirs earlier this year.
Additionally, the time-scale is a little tight. With participants at an average age of 19, the fact that most people will try their first cigarette between the ages of 13 and 16 (see: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5903a1.htm), it could be argued that this could put some of the first encounters with tobacco back to before 2008, when e-cigs really started to take off in the US. More data (which would be available in a full printed version) may have shined a little light on the overall number of respondents who’d tried cigarettes first and the average age of the first encounter with tobacco among this sample.
Conclusion
The study may not have been perfect, but it was still able to identify some college students who’d first consumed nicotine through an electronic cigarette, and the finding for them does speak volumes. It clearly shows that e-cigarettes don’t act as a “gateway” to tobacco use, and thereby calls the CDC’s statements in their press release into question. The data was presented to suggest the gateway hypothesis, but common sense and now other research indicates that this isn’t the case. As we all know, e-cigarettes are designed to reduce the harm for people who already smoke, and neither survey has shown that teens are using them in significant numbers for any reason other than that.
Lindsay is a vaper and blogger for EcigaretteReviewed. Follow her on Twitter @ecigreviewed.
