The Gateway Effect?
Do E-Cigarettes Increase Or Decrease Smoking? This is a high-explosive argument. So let’s try to clear the smoke away to reveal some hard facts. Are children being hooked on to tobacco smoking through e-cigarettes? Are adults? And are e-cigarettes taking smokers away from much better ways of quitting?
Has the Pied Piper of Hamlin been reincarnated
as an e-cigarette company executive?
Tobacco company shareholders have benefitted for decades from the millions of children who each year become addicted to cigarette smoking. These shareholders have grown rich on fabulous returns on their investments while the children became chronically sick adults. Even if the shareholders never overtly tried to entice kids into smoking there is an ineradicable stench of moral complicity.
So it is more than understandable for those who have fiercely opposed such tobacco company behavior towards children to be extremely cautious about the next generation of nicotine products.
These vaping critics say that totally wicked e-cigarette salesmen are packing e-cigarettes with flavors to entice children. Impressionable kids are then seeing TV adverts full of sexy actors. To make it worse there is the celebrity endorsement: teenage icons like Jack Nicholson irresponsibly allow themselves to photographed vaping.
Leave for now the argument that adults like flavors. And sex. And that Jack Nicholson is just an adult smoker using e-cigarettes to give up. Are these evil e-cigarette executives succeeding in creating another generation of nicotine addicts?
Possibly yes. If we look at the number of children who have used e-cigarettes then the numbers have shot up alongside the growth in adult vaping. Yet if we are to be concerned about this growth of e-cigarette use we have to ask some probing questions.
Are these children staying on e-cigarettes? Not according to the experts. “If a child tries a conventional cigarette there is a 50% chance that they will become daily users. If a child tries e-cigarettes so far we have no evidence that they progress to regular use” Professor Peter Hayek BBC News 28 April 2014 If they’re not staying with e-cigarettes are they moving onto tobacco? An emphatic no is the answer from this US University Study of 1,300 students were interviewed about their first use of nicotine. Only 43 used e-cigarettes before tobacco. And only one of these went onto become a tobacco user. Even that person might have become a tobacco user in any case. There are similar findings in the UK in research for the campaign group Action on Smoking and Health, May 2013 “Among young people who have never smoked 1% ‘have tried e-cigarettes once or twice’, 0% report continued e-cigarette use.”
The 2014 CDC studies in America show that at the same time as e-cigarette use among youth was rising, tobacco use was falling sharply. The simplest explanation is that as with adults, children are using e-cigarettes to reduce and quit their tobacco habits. It takes intellectual contortions to argue the reverse.
So what’s going on? In part it maybe that e-cigarettes are not as addictive as tobacco ones. So the kids don’t stay hooked. And it maybe that given that e-cigarettes are cheaper than tobacco and don’t make their breath and clothes stink - it makes teenage sense to vote for them. The aim is to be cool and not a social pariah. For that e-cigarettes are better than tobacco.
The transient use of an essentially safe substance is the kind of rebellion than many parents would crave for their children given the alternatives. Yet knowing how sensitive the debate is, e-cigarette executives wisely impose strict bans on sales to under 18s and urge governments to put this into law.
Such bans on sales are being imposed in the USA and Europe. Yet what should be keeping regulators awake at night is that they may well be making it more difficult for the one in five children who are addicted to tobacco at the age of 15 to quit. If e-cigarettes are helping children off tobacco then anyone who really cares about tobacco free kids should venture down that Road to Damascus and ask whether they are right to be persecuting e-cigarette use. The toxic truth maybe that we should be handing out e-cigarettes to kids who are smoking.
Are e-cigarettes leading to a “new wave”
of tobacco addiction?
This was the concern of a top official at the World Health Organisation in his plan to mandate countries around the world to suppress e-cigarettes. In a thoughtful response Letter from Scientists, 29 May 2014 53 top professors and regulators around the world said e-cigarettes were critical to reducing smoking. They were very polite, but essentially suggested that he was smoking pot.
Why were these global authorities so emphatic in saying that e-cigarettes were not leading people into tobacco addiction? It’s because of massive global surveys. A survey of 19,441 e-cigarette users showed a very small minority of e-cigarette users (0.4%) were not smoking before starting to use e-cigarettes: “It should be emphasized that none of them became a smoker after initiating e-cigarette use, debunking the theory of gateway to smoking.” Farsalinos et als, JERPH, April 2014 There’s the same result in the Press Release, April 2014 survey of 12,000 UK e-cigarette users by Action on Smoking and Health: “There is no evidence from our research that e-cigarettes are acting as a gateway into smoking.”
So fears that e-cigarettes could lead to a “new wave” of tobacco addiction are fears that disappear when the lights are switched on. They next big question is how effective are they at getting smokers off tobacco In this May 2014 study of 5,000 British smokers e-cigarette came out as much more successful at getting smokers to quit than nicotine gum and patches. They “are about 60% more likely still not to be smoking that those who used either the licensed products or nothing at all” Professor Robert West’s research BBC News 28 April 2014 That was a survey which did a like-for-like comparison factoring depth of addiction and desire to give up. Smokers may be addicts, but they’re not stupid. So long before the professors research came out they had been switching from ‘approved’ but non-working gum and patches into vaping with e-cigarettes sales outstripping the old pharmaceutical products. Yet even “Nicotine Replacement Therapies” have their place. They can be very effective with support, so it’s encouraging to see e-cigarette users forming their own informal support groups.
The effectiveness of e-cigarettes is being shown up in smokers reporting a greater willingness to quit and making more quit attempts. The fall in tobacco sales which was triggered by the ban on smoking in bars and restaurants has resumed in the UK. To take one startling example, Imperial Tobacco reported that its sales last year fell by 16% FT April 2014 If, as anti e-cigarette campaigners allege, vaping is ‘normalising’ and ‘glamorising’ tobacco use then Imperial Tobacco executives would like to know how.
It would be hubris to suggest that falling tobacco sales are just down to e-cigarettes. But alongside tobacco control measures like higher taxes, e-cigarettes are giving those who are committed to reducing smoking a remarkable new weapon. Of Britain’s 2.1 million regular e-cigarette users, one third have quit smoking entirely, while two-thirds are dual using. Some of the more nicotine dependent ex smokers use quite heavy levels of nicotine and may never give up vaping. But on average their lives will be much healthier and longer than if they had persisted with tobacco.
"We have increased conviction that consumption of e-cigarettes could surpass consumption of conventional cigarettes within the next decade.” Wells Fargo, June 2013
“…the first real possibility that cigarette smoking could be phased out” Professor Ann McNeill, Kings College London Reuters, September 2013
E-cigarettes are “the most significant development in the history of the organised tobacco industry, stretching back some 200 years,” Canaccord Genuity, July 2013