Results of New Study Refute E-Cigarette Gateway Hypothesis as Well as Claim that Youth Vaping is Re-Normalizing Smoking

The results of a new study published late last week in the journal Tobacco Control strongly refute the hypothesis that e-cigarettes are a gateway to smoking and that vaping is re-normalizing smoking among youth.

(See: Miech R, Patrick ME, O'Malley PM, Johnston LD. What are kids vaping? Results of a national survey of US adolescents. Tob Control. Published online ahead of print on August 25, 2016. doi: 10.1136/tobaccocontrol-2016-053014.)

The study reports results from the 2015 Monitoring the Future survey, as study of a nationally representative sample of U.S. youth in grades 8, 10, and 12. The sample size was approximately 15,000.

The key result of the study was that the vast majority of youth who had used electronic cigarettes reporting having used e-liquids that only contained flavoring, but not nicotine. A much smaller proportion of youth reported using e-liquids containing nicotine. For example, among 12th graders who had ever vaped, 65% reported using e-liquids with just flavoring, while just 22% reported using e-liquids containing nicotine. Overall, fewer than one-fourth of adolescents who had experimented with e-cigarettes reported using nicotine-containing vaping products.

The study summarizes its main finding as follows: "Among students who had ever used a vaporiser in their life, the portion who used ‘just flavouring’ the last time they vaped was greater than all other substances combined. This response was markedly consistent across grades and was reported by 65–66% of students in 12th, in 10th and in 8th grades. ... The percentage who vaped ‘just flavouring’ at last use was also high among students who used a vaporiser in the past 30 days, at a prevalence of 59% or higher in all three grades."

The study concludes that: "the majority of US youth who use vaporisers and e-cigarettes do not vape nicotine."

The Rest of the Story

The results of this study have three major implications.

First, the findings bring into question the language that anti-tobacco groups and health agencies are using in talking about youth e-cigarette use. These groups and agencies, including the CDC, are calling e-cigarette use a new form of "tobacco use." This is inaccurate in the first place because e-cigarettes do not contain any nicotine. But even if one allows for the use of the term tobacco product because the nicotine in e-cigarettes is derived from tobacco, calling e-cigarettes that youth use a tobacco product is still inaccurate. Most youth are apparently using e-liquids devoid of nicotine. Moreover, to include e-cigarette use under the category of "tobacco use," as the CDC has been doing, is a practice that needs to end.

The authors of the study go further and suggest that even the term "electronic nicotine delivery system" is inaccurate. They write: "these results suggest the need to reconsider the term ‘ENDS’ to denote vaporisers and e-cigarettes, at least among US adolescents. The term stands for ‘electronic nicotine delivery system’, which seems inaccurate for the description of a device that the majority of youth do not use to vape nicotine."

The second major implication of these findings is that they add to the evidence that e-cigarettes are not a gateway to tobacco use and that youth don't even look at these products as being a form of smoking. It appears that the major factor related to youth e-cigarette experimentation is the vaping experience itself (including the flavoring), rather than the nicotine. 

This leads us to the third implication of these findings, which is that the study adds to the already strong evidence that vaping is not re-normalizing smoking, but quite the opposite: it is helping to further de-normalize smoking. While anti-tobacco groups and health agencies like the FDA and CDC have been spewing propaganda whose effect is to make kids think of e-cigarettes like they think of smoking, if left to their own "devices," youth do not tie vaping to smoking and therefore, vaping plays no role in re-normalizing smoking.

Ironically, it is the CDC and other health and anti-tobacco organizations that are putting it into kids' heads that vaping is essentially the same as smoking, or at least should be viewed in a similar way. This is the opposite of what we should be doing. Again, and ironically, it is those who are promoting vaping who are clearly presenting these products as being different from traditional cigarettes and therefore creating a climate in which vaping can further de-normalize smoking.

By repeatedly hammering home the perception that vaping is just another hazardous form of tobacco use, anti-tobacco groups and health agencies like the CDC and FDA are doing more damage than good.