Policymakers have cited a gateway from e-cigarette use to cigarette smoking as a key motivation for various regulations toward heavily restricting e-cigarette use, particularly among young people. However, recent research studying UK youth indicates that the prevalence of e-cigarette use in England among youth aged 16 to 24 is not associated with either an increase or decrease in regular smoking.

This research is contrary to several longitudinal studies that suggested a connection between e-cigarette adoption and later cigarette smoking among adolescents.

Using a time series analysis approach to avoid self-selection bias, the study measured the gateway effect of vaping among young people by examining the association between the prevalence of e-cigarette use among and uptake of smoking among young adults generally, including among non-smokers. The researched proposed that if such a gateway effect existed, it should be reflected in a population-wide change in the prevalence of smoking uptake when the prevalence of vaping changed. Conversely, in the absence of a gateway effect, changes in e-cigarette prevalence should not be associated with changes in smoking uptake among young adults.

The current study found no statistically significant association between vaping and ever having smoked regularly among those aged 16 to 24. According to lead author Dr. Emma Beard, “These findings suggest that the large gateway effects reported in previous studies can be ruled out, particularly among those aged 18 to 24. However, we cannot rule out a smaller gateway effect and we did not study younger age groups. If the upper estimates are true, we would estimate that of the 74 thousand e-cigarette users aged 16 to 17 in England, around 7 thousand would become ever regular smokers as a consequence of e-cigarette use. At the same time, approximately 50 thousand smokers are estimated to quit per year as a consequence of e-cigarette use.”

This study is important given the conflicting information available according to senior author, Professor Lion Shahab, “These findings are important given the contrasting advice given by health bodies and governments in different countries. Research to date supports the argument that e-cigarettes are less harmful than tobacco and help smokers to stop smoking. Although some harm from vaping relative to never vaping cannot be ruled out, this study suggests there is little evidence of a substantial gateway effect into smoking.”

This study appeared in the journal Addiction

Beard E, Brown J, Shahab L (2022) Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time series analysis between 2007 and 2018. Addiction.

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