Published online in the journal Addictive Behaviors, the study titled, “Electronic cigarette use and risk of cigarette and smokeless tobacco initiation among adolescent boys: A propensity score matched analysis,” reported that teen vapers were almost three times as likely to start smoking than their non-vaping peers.
The researchers said that unlike longitudinal studies, which argue that teens who took up smoking may have done so whether they vaped or not, this study didn’t just follow participants over time. “For an ideal study, from a purely scientific perspective, we’d give everybody an e-cigarette, follow them for a few years and see if they start smoking, then rewind the clock and don’t give them an e-cigarette. Or we’d randomly assign kids to vape or not to vape,” said lead study author Brittney Keller-Hamilton. “We can’t do either of those things, obviously.”
To this effect, the researchers used an advanced statistical approach in which they compared vaping and non-vaping teens with similar known risk factors such as alcohol use, marijuana use, impulsivity, their parents’ education levels and tobacco history.
“We identified two groups of young people who were equally likely to start vaping based on a number of factors, and then we compared the outcomes over the course of the study. We found that e-cigarette users were 2.7 times as likely to try smoking,” said Keller-Hamilton, who currently works as a research scientist in the Center for Tobacco Research at Ohio State’s Comprehensive Cancer Center.
Does vaping have a causal effect?
Study co-author Bo Lu, a biostatistics professor at Ohio State, said the approach leads to more robust scientific findings, and brings researchers closer to a true estimate of the causal effect of vaping on cigarette smoking in young people.
“I hope that our findings provide policymakers and others stronger evidence of the connection between e-cigarette use and tobacco use and that this will lead to positive impacts on more thoughtful designs in health policy research,” Lu said.
This research is part of the Buckeye Teen Health Study, which followed more than 1,200 boys from urban Franklin County and nine rural Appalachian counties in Ohio for two years. They were 11 to 16 years old when they entered the study. The data was collected before certain federal restrictions such as flavour bans, were imposed.
“But for all of these policies there are loopholes that the tobacco industry quickly identifies and works around, so it is important to remain vigilant in seeking strategies and policies to prevent teens from starting habits that pose a threat to their health, particularly when they serve as a stepping-stone to more harmful tobacco products,” said Keller-Hamilton.
Vaping and personality factors
Meanwhile, a recent review of studies looking into the same relationship, titled, “Does the gateway theory justify a ban on nicotine vaping in Australia?,” concluded that a plausible explanation as to why young people who vape are more likely to smoke, are personality factors.
Review authors Colin Mendelsohn and Wayne Hall, pointed out that those teens who vape are risk-takers and are therefore also more likely to smoke, drink alcohol, use cannabis and other substances, as well have unprotected sex. This argument has already been emphasized by other experts in multiple studies.
The Key findings from the present study were as follows:
- “Smoking usually precedes vaping. At least 70-85% of teen smokers try vaping after having already started smoking.
- Most vaping by adolescents is experimental and infrequent
- Regular vaping is rare among non-smokers. Regular vaping by non-smokers is generally 1% or less in Australian and international surveys.
- Many adolescent vapers use flavourings only and do not use nicotine. Nicotine addiction is rare in vapers who don’t smoke. In the US, <4% of non-smoking youth who vape have symptoms of nicotine dependence.
- Some adolescents use vaping to quit smoking.
- Youth smoking rates have declined rapidly in the UK and US since the introduction of vaping, making it very unlikely that is increasing youth smoking. It is more likely that vaping is diverting some high-risk teens away from smoking to a safer alternative”
Supporting such arguments, is data from countries which have endorsed the use of e-cigs for smoking cessation, such as the UK, which have low smoking rates and no teen vaping issues. On the other hand, in Australia where vaping products can only be only obtained via prescription, smoking rates remain alarmingly high, and little progress is being made in decreasing them.
More Data dispel the Gateway Theory
Moreover, recent data from the US has indicated a rapid decline in teen smoking rates corresponding with the increase in vaping uptake. A research team from the University of Michigan analyzed nationwide data on tobacco product use among 8th, 10th and 12th-graders from 1991 to 2019. The compiled data indicated a sharp drop in smoking, consistent amongst all sub-groups, corresponding to an increase in vaping rates amongst the same groups.
This led study author Rafael Meza to the conclusion that the infamous “Gateway Theory” holds no ground. “So I think the good news is that the rapid increase in e-cigarette use has not yet resulted in a reversal of the decreasing trends of cigarette smoking and smokeless tobacco use, and if anything, those trends have accelerated.”
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