The ‘gateway hypothesis’ - that young people who vape are more likely to move on to more dangerous cigarettes - has long been cited as a reason to ban nicotine alternatives.
However, a new review of evidence published in the Harm Reduction Journal concludes that vape use does NOT act as a gateway to teens taking up smoking.
The study titled ‘Gateway hypothesis: evaluation of evidence and alternative explanations’ finds that anti-vape policies based on the gateway effect could in fact have the “unintended consequence of increased cigarette smoking.”
Researcher Arielle Selya writes: “A major concern about ENDS [electronic nicotine delivery systems] use is the hypothesis that they may act as a gateway to cigarette smoking among youth. Evidence supporting this gateway explanation is based on findings that youth who use ENDS are also more likely to smoke cigarettes.”
But Selya says a more accurate interpretation of previous findings is that young people who are likely to vape are also more likely to smoke cigarettes.
An important flaw
“..this evidence suffers from an important flaw,” she writes. “These studies fail to fully account for some youths’ pre-existing tendency to use nicotine products - either by not including sufficient common liability variables, or not accurately measuring common liability - and inappropriately interpret the results as ENDS use causing some youth to smoke.”
The review finds that vaping and smoking trends are “inconsistent with the gateway hypothesis” and in fact point to vapes “displacing cigarettes.”
Selya says: “Policies based on misinterpreting a causal gateway effect may be ineffective at best, and risk the negative unintended consequence of increased cigarette smoking.”
The report says that based on the more likely “common liability explanation,” where vaping youths have a pre-existing tendency to use nicotine products, the case against ENDs is weakened “to the point where, in some studies, ENDS use poses no additional risks”.
Selya adds: “Different lines of evidence also contradict the gateway explanation and support the common liability explanation, namely population-trend modelling studies that show smoking to be less common among youth now, than would be expected if ENDS had never become available.
“This raises the question about whether ENDS are diverting youth away from ever smoking cigarettes, which is an important area for future research.”
