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To Know If Vaping Is a 'Gateway to Smoking,' We Need More Than Stats

A study last week made headlines, but there's still a lot of questions about teens and vaping.
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When it comes to vaping, even the most hard-core proponents are concerned about kids picking up the habit. Though the research we have so far shows vaping to be much less harmful than smoking, it's most likely not completely harmless—and nobody wants kids who never would have smoked to start vaping. Public health officials worry that e-cigarettes could serve as a gateway to smoking, and a new study recently gave more credit to that view. But is vaping really to blame?

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Last week, a study published in the journal Pediatrics made headlines because it showed that teens who never smoked and then tried e-cigarettes were more likely to try smoking in the future. The study interviewed 298 non-smoker teens in southern California and tracked their habits a year later. While only 11 percent of those who never tried e-cigarettes at the initial survey later tried smoking, 40 percent of those who had already tried e-cigarettes went on to try a cigarette. The researchers controlled for smoking risk-factors (like having parents or friends who smoke), and teens who tried e-cigarettes were still more likely to smoke than their peers who hadn't, regardless of external factors.

Unfortunately, overall there's a lack of scientific data on this topic and in that vacuum a single study—even a solid, peer-reviewed study like the Pediatrics one—can get overemphasized. There have been a handful of studies with similar findings, but it's still not clear if kids who vape would have smoked anyway, or if it was vaping that led them down the rabbit hole. And there's some conflicting data out there, too.

Just a few days after the study in Pediatrics was published, a group of researchers from the UK Centre for Substance Use Research presented early findings at the Global Forum on Nicotine suggesting that, rather than a gateway to smoking, vaping might be a roadblock. The researchers presented qualitative results from a survey of 120 people aged 16 to 28, many of whom actually said vaping made them less likely to smoke.

Neil McKeganey, one of the researchers on this survey, told me the majority of respondents considered smoking to be much more harmful, and had a much more negative view of it compared to vaping.

"The issue of a gateway effect needs long-term, longitudinal information to determine what proportion of young people are vaping and then going on to smoke," McKeganey said. "But even with that quantitative data over time, you still don't know whether it's the vaping or something else that's led them to start smoking. You can't infer a gateway effect without understanding public perception."

These aren't necessarily contradictory findings—one study looked at behavior, another at attitudes and beliefs—and it's important to consider that the Center for Substance Use Research's survey has not yet been published in a peer-reviewed journal (though McKeganey said it will be later this year). But his group is also not the first to question the gateway theory. In its report earlier this year touting vaping as a harm reduction tool, the Royal College of Physicians in the UK stated that "there is no evidence thus far that e-cigarette use has resulted, to any appreciable extent, in the initiation of smoking in either adults or children," and that "even if such gateway progression does occur, it is likely to be inconsequential in population terms."

Even McKeganey was quick to not discredit studies like the one published in Pediatrics, and said we need much more data—both qualitative and quantitative—to determine what the risks are for youth vaping.