The E-Cigarette Gateway Myth

Fifty years after the Surgeon General’s landmark report on smoking and health, cigarettes remain the leading preventable cause of death in the U.S., and some 40 million Americans still smoke.

Enter the electronic cigarette, which has enormous potential to improve public health because many smokers can replace the deadly cigarettes that burn tobacco, producing tens of thousands of toxins, including more than 60 know human carcinogens. The e-cigarette is a battery-powered, smoke-free device that delivers nicotine vapor without most of the carcinogens produced by tobacco combustion. Yet it is feared and stigmatized by legislators and health officials, and may even been regulated out of existence.

One reason is the so-called gateway theory, which has been the subject of newspaper headlines and city council meetings, and even promoted  a Senate Investigation. Last September, in an interview with Medscape (a website for medical professionals) Thomas Friden, director of the Centers for Disease Control and prevention said that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” The same month he was quoted by the Associated Press as warning that e-cigarettes are “condemning many kids to struggling with a lifelong addition to nicotine.”

The gateway hypotheses is a myth. The evidence shows that very few nonsmokers “vape”. The primary reason people use e-cigarettes is to quit or cut back on smoking conventional cigarettes. Moreover, of the few nonsmoking youths who do experiment with e-cigarettes, there is currently no evidence that they subsequently progress to cigarette smoking.

The first study to examine the gateway hypothesis was by Dr. Ted Wagener from the University of Oklahoma Health Sciences Center. His research presented at the annual meeting of the American Associate of Cancer Research last October, found only one young person out of a sample of 1,300 college students who initiated nicotine use with vapor products and then went on to smoke cigarettes.

In June, Dr. Constantine Vardavas of the Harvard School of Public Health published a broader analysis of 26,566 European smokers in the journal Tobacco Control. It showed that e-cigarette users are likely to be heavy smokers who have tried to kick the cigarette habit over the prior year. Dr. Vardavas and his two colleagues found that just 1% of nonsmokers tried vaporizing products like e-cigarettes.

Cigarette smoking among young people, whom public-health experts are rightfully focused on protecting from use of either type of product, continues to decline. The CDC’s National Youth Risk Behavior Survey shows that teenage smoking has dropped over the last several years, falling to 15.7% in 2013 from 18.1% in 2011. The smoking rate among U.S. high-school students in 2013 was the lowest level since the survey began in 1991.

By promoting a message that flies in the face of the government’s own statistics – which show a sharp decline in youth smoking concurrent with a dramatic increase in e-cigarette experimentation – someone federal public-health officials appear to be trying to create a “gateway” narrative where none exists.

The government has an obligation to carefully scrutinize any new consumer product that is presented as an alternative to smoking. But government agencies and public-health officials have no business discouraging or disparaging e-cigarettes in the absence of any  data that they are causing harm. This is especially the case when these products have so much potential to curb cigarette smoking, the public health scourge that still claims half a million lives a year.