Does This Study Prove That Vaping Is a Gateway to Smoking?

E-cigarette critics lean heavily on post hoc, ergo propter hoc reasoning.


FIN e-cigarette ad

Judging from press reports, a study published yesterday by JAMA Pediatrics shows that vaping is a "gateway" to smoking. What it actually shows is that people who try vaping are more inclined than people who don't to try smoking, which is not quite the same thing.

A gateway effect implies that the experience of vaping makes people more inclined to smoke, presumably because they get hooked on nicotine and yearn for a smellier, more hazardous way to get their fix. To put it another way, a gateway effect means that some people would never have tried conventional cigarettes if they had not encountered e-cigarettes first.

The fact that some people vape before they smoke does not prove such an effect, and neither does the fact that people who report using e-cigarettes are more "susceptible" to smoking than people who don't. Whatever traits or circumstances lead people to try e-cigarettes might also lead them to try conventional cigarettes. The association might be entirely due to those pre-existing differences, in which case there would be no need to invoke any supposed gateway effect. 

With those points in mind, let's consider what this study actually found. The researchers tracked 694 nonsmokers between the ages of 16 and 26 who at the beginning of the study said they "definitely" would not try a cigarette offered by a friend and "definitely" would not smoke during the next year. Just 16 of the subjects (2.3 percent) said they had ever tried an e-cigarette. A year later, five of those 16 subjects were no longer "definitely" opposed to smoking, and six more had actually tried a tobacco cigarette. Or as the researchers put it, 69 percent of these subjects had "progressed toward cigarette smoking." Among the subjects who at baseline had never tried e-cigarettes, the rate was 19 percent.

Those results do not mean that "e-cigarettes serve as smoking gateway for teens and young adults," as a university press release put it. Nor do they mean that "E-Cigs Lead to Smoking Real Cigarettes," that "E-Cigarettes 'Tempt Youth Into Smoking,'" that "E-Cigarettes 'Put Youth on the Road to Traditional Smokes,'" or that "E-Cigarettes Are a Gateway to Tobacco," as various news outlets claimed.

As I mentioned, pre-existing differences may explain the gap between subjects who had tried e-cigarettes at baseline and those who hadn't. Furthermore, although the researchers concluded that "use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking," just six subjects who initially reported e-cigarette use had actually tried conventional cigarettes a year later, and it's not clear that any of them had become regular smokers. Nor is it clear that any of them were ever regular vapers, which would be necessary if nicotine addiction explained the "progression toward cigarette smoking."

As Michael Siegel notes on his tobacco policy blog, "It is entirely possible that all 6 of the youths who had a puff of a cigarette found it distasteful and decided to use e-cigarettes instead. The results described in the study are perfectly consistent with e-cigarettes being a deterrent to smoking!"

While the researchers themselves were relatively restrained in describing their findings, Jonathan Klein, associate executive director of the American Academy of Pediatrics, claimed in an accompanying editorial "we do not need more research on this question," since "these data provide strong longitudinal evidence that e-cigarette use leads to smoking, most likely owing to nicotine addiction." That explanation is plausible only if the subjects who "progressed toward smoking" were regular vapers first and later became regular smokers, two crucial points this study does not address.

The gateway hypothesis that Klein thinks has been definitively proven seems to fly in the face of reality, since smoking and vaping trends are moving in opposite directions. While it's possible that smoking rates would be declining even faster if e-cigarettes had never been invented, critics of these products have not come close to substantiating their suspicions on that score.

NEXT: I Paid the Debt I Owed Them

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  1. This just in: Studies and their interpretations can be manipulated to reach established goals.

    1. The Devil you say?! Do you not FUCKING LOVE SCIENCE CONSENSUALLY?

      OT: Paging SugarFree….SugarFree to the red courtesy phone: http://www.dailymail.co.uk/new…..-male.html

      1. Oooooooo – I sense the basis for a new Nutrasweet slashporn short story!!!!

        Wait…I should be in morbid dread of this…

      2. Quote from the victim: “‘The only thing I ever wanted and still want is a normal life.’

        Uh huh. From all of the weird shit you put up with and did it doesn’t really seem like that is what you are looking for. Either that or you have no fucking clue what a normal life is. I don’t see it happening.

    2. Confirmation bias for the win.

  2. As I mentioned, pre-existing differences may explain the gap between subjects who had tried e-cigarettes at baseline and those who hadn’t.

    There also might not even be a gap considering that one of the groups only had 16 people in it! What are the odds that those 16 kids had a 19% chance of trying cigs, just like the “control” group, but still had 6 or more try it? Answer: greater than 5%. No statistical significance, even by epidemiological standards. This stinks on all levels.

    1. Well, at least they used a two-tailed alpha. So, progress?

  3. Precautionary principle, bitches.


  4. “JAMA Pediatrics shows that vaping is a “gateway” to smoking.”

    Who gives a shit? JAMA is a gateway to unnecessary regulation which causes stress for folks which could lead to heart disease. Ban JAMA!!!

    1. It’s gateways all the way down!

      1. We have child gateways in our house to keep the grandkid from falling down the stairs or something. They’re not a bad thing.

        Wait – those are “gates” – never mind.

        1. The “way” is protected by the “gate” my elder. So you are correct about the gateway that protects the childrenZ.

  5. What about nicotine gum? Patches? If vaping is a gateway to smoking tobacco, what about other quit-smoking aids?

    Animists are gonna animate.

    1. Vaping looks like smoking, so it must be bad.

  6. For the love of God, won’t someone please the of the children!!!!

  7. there is that nicotine thing again. nicotine hasn’t been considered an issue since the 1964 Surgeon Generals report on smoking said as much. inhaling nicotine has been known not to cause any health related issues since 1996. http://www.sciencedirect.com/s…..0596001002
    we also know nicotine does not cause dependency is people that have never used tobacco.
    so ask rhetorically when did nicotine become one of the most deadly and addictive child attracting substances know to mankind?

  8. It’s very strange to me that anyone could look at not only such a weak correlation, but such a minuscule sample size (and as the article points out, completely ignore other baseline factors) and then declare that “NO FURTHER RESEARCH NEEDS TO BE DONE.”

    How can anyone do this with a straight face? How can anyone publish an editorial that makes such claims? It simply boggles the mind.

    This is purely anecdotal on my part, but I smoked (real cigarettes) for going on 20 years. I tried to quit multiple times during that 20 year period using a variety of methods including prescription drugs. I then switched to vaporizers last year, finally quit those entirely and I am now using the occasional piece of nicotine gum.

    So, it almost seems to me that in my particular case, that if I wasn’t able to procure a nicotine vaporizer, I may very well still be smoking.

    Certainly I should be able to find another dozen or so people with similar backgrounds to mine. Shouldn’t this mean that I can also publish a completely bogus editorial claiming that vaporizers are an effective treatment for quitting smoking? It seems far more plausible than people picking up a vaporizer and then wanting to move to smellier, more expensive and unhealthier alternatives like cigarettes.

    1. SCIENCE = SETTLED! Stop asking questions!
      This particular brand of academic dishonesty sounds awfully familiar.

  9. Vaping is good, therefore it must be banned. – stupid statist scumbag

  10. Hmmmm…. I wonder what JAMA would say about Vampiring?

  11. I have a friend who vapes and his sister was raped… So yeah that shit is bad.

    1. So your friend that vaped thought it was you and had you raped? I heard they video taped while you were masked and caped.

      1. Is it still rape if I enjoyed it?

        1. Hmmm. Only if you invite them again?

  12. Absolutely not! I vape premium tobacco eliquid and I will have to part of smoking a cigarette!

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