|used by||TI, Bloomberg/WHO, CTFK et al.|
"Gateway drug" hypotheses are easily debunked. By you know, just casually glancing at any usage statistic. Smoking goes down, whenever vaping goes up. Bidirectional substitutes.
Claims to the contrary rest on misquoting studies and extrapolating individual/cohort observations into a generalized probability. On the population level (and seemingly also teenagers), vaping is observably a gateway out of smoking. (Doesn't imply non-smokers should be encouraged). The general gateway theorizing largely stem from prior claims to such effect (also long debunked), or the visual misdiagnosis. Which is also why it's often just a fallback scare for "nicotine addiction" claims. Sometimes just a linguistic fallacy, with "could" and "might" doing a lot of heavy lifting for the argument. (It's a dependent premise, as e-cig harm exaggarations rarely hold up to scrutiny.)
- Prevalence of e-cigarette use among the youth population in England does not appear to be associated with substantial increases or decreases in the prevalence of smoking uptake.
- How not to be duped by gateway effect claims
- Expert debunks vaping 'gateway' myth, ripping 'bad science in service of bad theories'
- Study: vaping is a gateway out of (not into) smoking
Statistic on US hysteria
Despite the gateway hypothesis being fairly prevalent in media and a subset of academia, not so much in reality. US teen smoking🟫 and daily smoking🟥 went down alongside the variance in infreq/freq vaping🟦:
|year||smoking||p30d||any vape use|
For exact quantifiers see Brad Rodu blog: Sharp decline in high school vaping as smoking is almost eliminated. Albeit doesn't differentiate between infrequent and daily vaping, explains the conflation of THC vaporizers into those CDC stats.
individual gateway: smoking "upgrade"
Adolescents trying adult things is kinda their thing. And attention seekers can be predisposed to try vaping. On an individual level (→ which is what most "gateway" studies observe) they might also start smoking (later or beforehand). Not because of the claimed heroin-like effects, but because nicotine e-cigarettes are comparatively boring. Any migration to smoking is more plausibly explained by the lackluster intoxication and fairly delayed effects. (Except for the US with balooney non-regulations and excessive nicotine concentrations.)
Albeit the flavour degration for any substance use "upgrade" from e-cigs to tobacco poses a marginal deterrent still. (Even from mint vapes to menthol cigarettes). -- Btw, the simpleminded conjecture flavours cause vaping, and then vaping leads to smoking is just that: simpleminded.
population gateway: out of smoking
Individual-level gateway effects are rare, else we would see an according effect at the population level. But smoking rates are declining even for teenagers. More even, an accelerated decline in teen smoking was particular during the "teen vaping epidemic" in the US. (Albeit even the frequent-vaping uptake can't explain all of it. Can't draw many conclusions from it either way.)
The "x times more likely" claim thus can also be interpreted as a prevention potential. (Undermined by portraying combustibles as no more harmful than vaping.)
population prevalence → "renormalization"
"Renormalization" is a common pessimism to insinuate rising smoking rates. Which of course, they aren't. It's largely based on the visual misdiagnosis that "vaping looks like smoking". Which is essentially a technophobic mix-up - that millenials aren't as prone to as policy makers.
As described in the paper, while there has been a considerable uptake of vaping by youth in the United States, smoking prevalence has decreased, suggesting no overall gateway effect. However, scientists warned that the recent phenomenon of the use of e-cigarettes by youth cannot dismiss the chance that if youth prevalence of e-cigarette use increases and is sustained over time, the result might be an increase in the prevalence of combustible tobacco use. https://cataniaconversation.coehar.org/2021/09/03/electronic-nicotine-delivery-systems-are-safer-than-conventional-cigarettes-a-clinical-investigation-advises-on-fda-decisions-on-ends/
Albeit there hasn't yet been the proclaimed epidemic of teen or general vaping. But if there was, the argument might hold some clout. It's not likely that 20% of the population (= all current smokers) would switch at once to vaping. But hypothetically, if, then it could drag social acceptance along. If not smoking per se. (But I guess that explains the thought process behind "renormalization".)
flavour gateway: ATFs
The most prevalent misrepresentation stems from cohort-level observations, and misrepresenting statistics into causation.
|<q>3 times more likely to start smoking</q>||Those who vape are 3 times more probable to also show up in the also-smoking subset|
- Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study
- Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018
- Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?
- Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check
- Trends in electronic cigarette use and conventional smoking: quantifying a possible 'diversion' effect among US adolescents
- Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study
- High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)
- Has increased youth e-cigarette use in the USA, between 2014 and 2020, changed conventional smoking behaviors, future intentions to smoke and perceived smoking harms?
- Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis
- Are E-Cigarettes reviving the popularity of conventional smoking among Taiwanese male adolescents? (Taiwan 2004-2017)
- Does the gateway theory justify a ban on nicotine vaping in Australia?
- “Gateway hypothesis” and early drug use: Additional findings from tracking a population-based sample of adolescents to adulthood
- Debunking the "Gateway" Myth - Drug Policy Alliance
- Is Adolescent E-Cigarette Use Associated with Subsequent Smoking? A New Look
Among adolescent never cigarette smokers, those who had ever used e-cigarettes at baseline, compared with never e-cigarette users, exhibited modest or non-significant increases in subsequent past 12-month or past 30-day smoking when adjusting for behavioral risk factors.
- Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time–series analysis between 2007 and 2018
Young people's e-cigarette use is not a substantial gateway to regular smokingContext: UK, where officials have been careful not to message/induce smoking relapse
- Is adolescent e-cigarette use associated with subsequent smoking? A new look
- Commentary on Beard et al.: Using survey data to test the hypothesis that e-cigarettes are a gateway to cigarette smoking in youth
- The “gateway” effect of e-cigarettes may be explained by a genetic liability to risk-taking
- E-cigarette use and onset of first cigarette smoking among adolescents: An empirical test of the ‘common liability’ theory
- Epidemic of youth nicotine addiction? What does the National Youth Tobacco Survey 2017-2019 reveal about high school e-cigarette use in the USA?
Fails to give evidence of gateway
- The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors
- Gateway effects and electronic cigarettes