Does Teen Vaping Lead to Teen Smoking?

The biggest fear of anti-tobacco advocates as well as public health regulators, is that vaping is a gateway to the smoking of tobacco cigarettes among teenagers. This has become a divisive topic among public health experts, with some having the belief that it leads to the smoking of tobacco cigarettes and others believing that it leads to the decline of smoking tobacco cigarettes.
A recently released study, published in the International Journal of Environmental Research and Public Health, and conducted by international experts from the United Kingdom Centre for Tobacco & Alcohol Studies (UKCTAS), Public Health England, Action on Smoking and Health (ASH), Kings College London and the University of Sterling with partial funding from the Cancer Research UK is by far the largest study with regards to this topic.
In this study, the use of e-cigarettes and tobacco was examined among 60,000 young people between the ages of 11 and 16 years, across the UK. From the year 2015 and 2017, data was collected from 5 large scale surveys. The findings of the survey showed that e-cigarette experimentation does not lead to regular e-cigarette use. It also found that the levels of regular e-cigarette use in young people that have never smoked remained quite low, from 0.1% to 0.5%.
The study measured the frequency of use of e-cigarettes and tobacco cigarettes among the youth. The frequency was categorized into ‘ever’ and ‘regular’ use. This was important because the study of regular use which is defined as using an e-cigarette at least weekly, often accurately captures how often teens use e-cigarettes and sheds more light on whether there is or isn’t a link between vaping and smoking.
By contrast, studies coming from Canada and the US use more broadly defined measures such as ‘intent to use’ and ‘past 30 day use’, conflating e-cigarette experimentation and generating flawed assumptions establishing a causal inference between vaping and smoking. Examples of such studies include a 2016 study from the Institute for Social Research at the University of Michigan with a conclusion stating that there is a growing body of evidence supporting vaping as a one-way bridge to cigarette smoking among youth. Another example is a 2017 study from the University of Waterloo with an introductory statement reading, “Vaping doubles risk of smoking cigarettes for teens.”
These assertive statements should be suspect as they are at odds with facts on the ground that show that while experimentation of e-cigarettes among youth has risen, tobacco smoking has plummeted showing a record low not only in the UK, but also Canada and the US.
Linda Bauld, lead author of the UK study, professor of health policy at the University of Stirling, deputy director at the UK Centre for Tobacco and Alcohol Studies and co-author of the Royal College of Physicians report (Nicotine without smoke), said that findings of the study showed that from 2016 to 2017, the rates of regular use of e-cigarettes among the kids who had never smoked is still tiny at less than 1%.
She explained that this came as no surprise to them because they had been looking at this data for a few years now, and they had not discovered any changes with the trend. She added that despite the fact there was no change, it was important for them to collect this information to make it clear that when you carefully measure e-cigarette use amongst teenagers, those that have never smoked do not find these devices particularly attractive or appealing in terms of regularly using them.
“I think we know that in the group we are talking about which is eleven to sixteen year olds in the UK, and this is an age group that’s also being looked at in Canada and the US as well, these are teenagers and they tend to try things. And we are certainly seeing in this study and also other research that I am involved in that teenagers are experimenting with electronic cigarettes. They are trying them at a party, or being offered one by their friend, they do find them interesting and they give them a go and that is not really uncommon,” Linda explained.
She added that, “In fact, in our study we found that really anywhere between 11 and 20 percent of teenagers said they had ever tried e-cigarettes at least once, very similar to Canada and the US. But that’s fine and maybe we don’t want kids ever trying these products at all – some people say that, but they are. What is more important is what’s happening then after they try them, and then of course the big question is if they continue to use them, do they go on to smoking? So I guess by looking at whether they are using them regularly, is a really important marker for us in terms of risk. And we are just not seeing in the kids that don’t already smoke, that regular use and at the same time, our smoking rates in teenagers continue to decline.”
Linda concluded that according to her, if there has been a significant decline in cigarette smoking, and at the same time an increase in experimental use of e-cigarettes, then those two things are a mismatch and it does not suggest that there is causal inference between vaping and smoking cigarettes.