Vaping: A Stop Sign

Vaping: A Stop Sign, Not a Gateway to Smoking

Anti-vaping activists often try to ban (or simply blame) vaping based on the idea that vaping is a gateway to smoking cigarettes, or even to “harder” drugs. They cite studies that supposedly support this claim in order to limit access to e-cigarettes, but the evidence we’ve seen points to the contrary.

This “anti-vape” line of thinking is not only frustrating for those that enjoy vaping, but also factually incorrect. Studies that “support” the gateway theory are often flawed or funded by those with outside interests, and smoking rates have dropped significantly since vaping has gained popularity.

In fact, many smokers have switched to vaping to improve their health, and gradually wean off nicotine. Vaping serves as a stop sign, not a gateway, to smoking. But don’t just take our word for it, let’s explore further below.

What is the Gateway Theory?

The gateway theory is the idea that using one product or substance will lead to using other, often more dangerous products or substances. This idea originated in the 1950s when marijuana use was often cited as a “gateway” to harder drugs, which is an idea that has been solidly debunked. Researchers are now grasping at straws, trying to use the same line of thinking to link e-cigarette use to tobacco use, especially as it relates to teens and young adults.

Problems with the Gateway Theory

One underlying (yet, glaring) problem with the gateway theory is that a certain percentage of people will experiment with using combustible cigarettes regardless of whether e-cigarettes are available, and these gateway studies don’t account for that fact. Additionally, many studies don’t differentiate between users who simply tried combustible cigarettes (i.e. had a few puffs or smoked a few cigarettes here or there) versus those that became habitual smokers. Taking a few puffs of a cigarette doesn’t automatically lead to a full-blown smoking habit.

Additionally, there are other personal factors that often aren’t accounted for in studies. Prior use of cigarettes, e-cigarettes, or smoking tobacco by the individuals in the studies isn’t always taken into consideration. Further, both environmental and genetic factors can play a huge role when it comes to the probability of becoming a smoker. For example, an individual living with family members that also smoke or that have close friends who smoke are more susceptible to becoming a smoker themselves. Genetically speaking, an individual’s predisposition to becoming addicted will also be a factor as to whether or not they continue or quit.

Studies that “Support” the Gateway Theory

Despite these factors, research is published frequently that cites e-cigarette use as a gateway to smoking. Looking closely at these studies can reveal the underlying problems and whether they truly show that vaping is a gateway to using combustible cigarettes.

Virginia Commonwealth University

For example, a study at Virginia Commonwealth University found that vapers were three times more likely to be smoking cigarettes than those who don’t vape. Researchers followed almost 4,000 students to see if vaping lead to smoking combustible cigarettes. However, once you dig into the study, it actually doesn’t show a gateway effect at all. It only shows that they tried a cigarette, but the majority hadn’t smoked within the past 30 days. Six students did, in fact, switch from vaping to smoking, but 20 students switched from smoking to vaping, and 45 students who used both were exclusively vaping by the end of the study. The study, at best, shows a level of experimentation, but no actual evidence that vaping leads to habitual smoking.

JAMA Pediatrics Studies

Two studies published in JAMA Pediatrics had similar problems. The first study, published in August 2015, followed 2,500 14-year-old students for one year. Less than 10 percent of them had tried e-cigarettes. After one year, a quarter of those who had tried e-cigarettes had also taken at least one puff of a combustible cigarette. Nine percent of non-e-cigarette users had also tried a cigarette.

The second study, published in September 2015, followed almost 700 teens and young adults for a year. Sixteen of them had tried e-cigarettes in the past. After one year, they found that 38 percent of e-cigarette users had tried cigarettes, while 10 percent of non-e-cigarette users had tried cigarettes.

Both of these studies used the “at least one puff” standard of measurement. This is not indicative of a full-blown smoking habit. It is indicative of experimentation, but the numbers aren’t significant enough to show a true link between e-cigarette use. And we all know that “experimentation” with cigarettes among young adults takes place (and has for decades) absent of vaping.

Another study, also published in JAMA Pediatrics, is what’s called a meta-analysis. A meta-analysis is a review of other research. It looks at numerous studies that have been completed and then draws conclusions from that research. This meta-analysis looked at studies that showed a link between cigarette smoking and having tried an e-cigarette in the past, as well as studies that looked at e-cigarette and combustible cigarette use in the past 30 days.

This study did not look at whether people who had never smoked then tried e-cigarettes, and that e-cigarettes led them to use combustible cigarettes. In other words, it didn’t actually look into whether e-cigarettes really caused people to become regular, habitual smokers. At best, it showed people may experiment with both. That doesn’t mean there is a link between the two habits. Correlation does NOT equal causation.

Public Health Department of England – Surprising results?

A study in the United Kingdom showed different results. This study, conducted by Public Health England, compiled results from five different surveys. It showed no link between vaping and eventual use of combustible cigarettes. They studied 60,000 teens, and between 11 and 20 percent of them had smoked at some point in the past. Only 1 to 4 percent of them were regular smokers, and between 1 and 3 percent were regular e-cigarette users. The study showed an increase in e-cigarette use and a decrease in combustible cigarette use, as well as large numbers of teens who had never smoked. If e-cigarettes are truly a gateway, wouldn’t regular cigarette use increase rather than decrease?

27% Decrease in Smoking in the USA

In the United States, the numbers are similar. E-cigarette use tripled between 2013 and 2014, but smoking decreased by 27 percent between 2013 and 2015. Teen smoking is at an all-time low, and e-cigarette use by teens has fallen as well.

Clearly, e-cigarette use does not lead to smoking. If it did, smoking use would increase as vaping has increased, but it hasn’t. If anything, vaping provides smokers with an alternative that can help them end harmful tobacco use.

Safety of Vaping vs. Tobacco Use

Most people are aware of the dangers of smoking and tobacco use. Tobacco use is considered to be the largest preventable cause of death, with over 400,000 Americans dying from causes related to tobacco use each year. Smoking increases the risk of heart disease, lung cancer, and strokes. And it has been shown that smoking can contribute to the increased risk of most cancers throughout the body.

Cancer Risk

Cancer is caused by combustion, or the process of burning the tobacco. Smoking creates a layer of tar in the lungs, which is incredibly damaging and causes emphysema and bronchitis. Nicotine, which is found in both cigarettes and e-liquids used for vaping, does not have any links to cancer or cardiovascular disease. E-liquids allow those addicted to nicotine from smoking to switch without going through a harsh withdrawal process. You can also find many flavorful e-liquids without nicotine.

A study in Scotland showed that the cancer risk from vaping is similar to the cancer risk involved in using nicotine replacements like patches or gum, which is less than 1 percent. In other words, vaping is far safer than tobacco use when it comes to cancer.

Heart Disease

Smoking tobacco is linked to about a third of all heart disease deaths in the United States. Nicotine isn’t the primary cause of these events. As with cancer, the smoke itself seems to be the culprit. Smoking also raises your levels of unhealthy cholesterol and increases the buildup of plaque in your blood vessels. Carbon monoxide is a particularly dangerous chemical in cigarettes, and it isn’t present in e-liquids at all, making them a safe alternative.

Lung Disease

Lung disease is caused by combustion. COPD, for example, is caused by the gases and particulates in smoke. Like with other health issues, no link has been shown between vaping and lung disease. In fact, switching to vaping has improved asthma in former smokers.

Fire Risk

Since cigarettes are burned, there is a risk of fire. Fires from cigarettes have declined significantly, but there are still tens of thousands of fires caused by smoking materials each year. Vaping, which does not involve burning, is far safer. There are concerns regarding the lithium-ion batteries often found in vaporizers exploding, but these events are very rare and typically caused by user error. As long as batteries are stored and handled properly, they don’t pose a significant safety risk.

Overall Safety of Vaping is Well Established

A report from the United Kingdom’s Department of Health found vaping to be 95 percent safer than using combustible cigarettes. Other studies in England have shown that vaping exposes you to far fewer toxins than regular cigarettes.

The American Heart Association has also stated that e-cigarettes are safer than tobacco cigarettes, and a good alternative for smokers looking to quit. In fact, former smokers who vape are twice as likely to succeed at quitting than smokers who quit without vaping.

Vaping is clearly superior to smoking when it comes to health and safety. Rather than being a gateway to using harmful tobacco products, vaping provides an alternative to help people quit using products that cause significant harm to their health and well-being. E-liquids with nicotine allow smokers to quit without harsh withdrawal symptoms and gradually lower their nicotine use until they eliminate it altogether.