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Published study questions gateway theory's application to e-cigarettes

March 14, 2017
by Gary A. Enos, Editor
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Two leading public health researchers are strongly contradicting the notion that use of electronic cigarettes is leading to significant use of regular cigarettes. Their analysis, published in Drug and Alcohol Dependence, states that studies that have lent credence to a gateway theory around e-cigarette use have been severely flawed.

“There is little evidence that those who have never smoked cigarettes or never used other tobacco products and first try e-cigarettes will later move on to cigarette usage with great frequency or daily, regular smoking,” said Lynn Kozlowski, lead author of the research paper and professor of community health and health behavior at the University at Buffalo School of Public Health and Health Professions.

Moreover, argue Kozlowski and co-author Kenneth Warner, a professor of public health at the University of Michigan, methodologically unsound research on e-cigarettes has resulted in a worsening perception of the products among adults, leading to less of a tendency to use them as a potentially successful smoking cessation tool.

“From the best evidence to date, e-cigarettes are much less dangerous than cigarettes,” Warner said in a news release about the study. “The public has become confused about this.”

Publication of this paper coincides with release of a National Center on Addiction and Substance Abuse report that sounds greater warnings about e-cigarette use and its potential link to use of tobacco and other substances.

The Drug and Alcohol Dependence study's abstract states, “The debate about electronic cigarettes ranks as perhaps the most divisive in the history of tobacco control.”

Flaws in research

Kozlowski and Warner cite these points among what they see as the shortcomings of research suggesting that e-cigs serve as a gateway to more dangerous cigarette smoking:

  • Some studies define even one puff of a regular cigarette in a six-month period as constituting smoking. That “can mean little more than the experimenting vaper was curious how cigarettes compared,” Kozlowski said.

  • Some research has failed to make the distinction between using e-cigarette products containing nicotine and using products containing flavorings but no nicotine. The authors pointed out that in the 2015 national Monitoring the Future survey, only 20% of students who had used an e-cigarette reported that it contained nicotine.

  • National studies have generally failed to control for potential confounding factors such as other tobacco use, other substance use, and mental health issues.

“The evidence from the prospective studies is weak at best,” said Warner, who added, “Even if there is a small gateway effect, it is totally swamped by the overall trend toward less and less smoking.” The authors emphasized that as use of e-cigarettes has increased, smoking tobacco cigarettes has declined.