Evidence from UK Casts Doubt on Assertion that Electronic Cigarettes are a Gateway to Youth Smoking Addiction

The Centers for Disease Control has asserted that electronic cigarette use among youth is a gateway to a lifetime of addiction to smoking. This assertion, which has been picked up by politicians and health groups throughout the country, is being used to justify extreme proposals, such as those to ban e-cigarette advertising and to ban all e-cigarette flavorings.

But is there any truth to the assertion that electronic cigarettes are a gateway to youth smoking? New evidence from the UK suggests not. Despite the widespread proliferation of electronic cigarettes throughout England during the past few years, and a concomitant increase in youth experimentation with these products, smoking rates among 11 to 15-year olds has declined to an historic low of just 3%.

Commenting on these results, Deborah Arnott - the chief executive of ASH - stated:

"Some people have been worried that electronic cigarettes could be a gateway into smoking for young people. These figures show that has not happened so far. But we need to keep monitoring use in young people, and make sure advertising and promotion of electronic cigarettes doesn’t glamourise their use."

The Rest of the Story

These data add to the increasing evidence that the dramatic increases in youth experimentation with electronic cigarettes are not leading to increased smoking. The gateway hypothesis - that e-cigarette use leads to smoking - does not appear to be supported by any evidence at the current time.

Why is it that youths who experiment with electronic cigarettes do not seem to be progressing on to cigarette smoking?

There is a good theoretical explanation: the flavors.

It is difficult enough for youth to initiate cigarette smoking because of the harsh taste of the smoke. This is precisely why menthol cigarettes are so popular among youth. Menthol acts as an anaesthetic which makes it easier for a new smoker to tolerate the harsh taste. For smokeless tobacco products, adding flavorings appears to make these products more appealing to youth, probably for this very reason.

The problem with e-cigarette experimentation, for the prospects of cigarette smoking initiation, is that youth are getting used to sweet and flavored products. It is going to be extremely difficult to go from the sweet and flavored taste of the electronic cigarette to the harsh taste of a tobacco cigarette. That transition is not favored, at least not on a theoretical basis. Why would a youth switch from a cherry e-cigarette to a Marlboro?

It may actually be the case that electronic cigarettes serve as an inhibitor of smoking initiation by getting a youth used to a flavorful experience, thus making it less likely - not more likely - that the youth will move on to the harsh taste of tobacco. It is difficult enough to enjoy the initial experiences with tobacco cigarettes, but it would be expected to become that much less enjoyable if one has become accustomed to a flavored nicotine product like electronic cigarettes.

Ironically, banning the flavors in electronic cigarettes could have the perverse effect of decreasing e-cigarette use but increasing use of real tobacco cigarettes. Hopefully, the FDA will examine this issue closely before taking the advice of anti-smoking groups and advocates, who are already calling for a ban on e-cigarette flavorings.