E-cigarettes: Gateway or roadblock to cigarette smoking?

New research suggests e-cigarettes act as 'roadblock' to tobacco among young people

UK Centre For Substance Use Research

A new study from the UK Centre for Substance Use Research, being presented at the Global Forum on Nicotine, shows e-cigarettes are playing an important role in reducing the likelihood of young people smoking, in many cases acting as a 'roadblock' to combustible tobacco.

In detailed qualitative interviews with young people aged 16 to 25 across Scotland and England, the majority of participants viewed e-cigarettes as having reduced - not increased - the possibility of both themselves and other people smoking.

"There was very little indication amongst the young people interviewed that e-cigarettes were resulting in an increased likelihood of young people smoking," said Dr Neil McKeganey who led the research. "In fact the majority we interviewed, including those who were vaping, perceived smoking in very negative terms and saw vaping as being entirely different to smoking."

During one interview, an eighteen year-old commented: "I think vaping is having an effect on smoking cigarettes in that it's taking away from it. People are moving off cigarettes and moving onto vaping." Another said: "I think if vaping becomes more common, then smoking is going to become more uncommon because it's the aspect of quitting. I think vaping will replace smoking".

Importantly, the overwhelming majority of participants - who collectively represented current and former smokers, non-smokers, and e-cigarette users - viewed tobacco as 'extremely harmful' and believed e-cigarettes offered smokers an alternative.

Many also said they thought "vaping will make smoking decline."

Asked whether the opposite might happen; that e-cigarettes might actually lead to smoking, one nineteen year-old said: "I think it's usually people who are trying to stop smoking who vape. I mean there is the odd person who does it because it's cool and that might influence them to want to try smoking, but I think on the whole it's the other way round. It's people vaping who have given up smoking".

Despite the acute awareness of the harms of tobacco however, it was evident that some young people remain confused about e-cigarettes and whether or not they are similarly harmful. Some mentioned they had seen media coverage reporting that e-cigarettes "are just as bad" as smoking and, as a result, they were uncertain and reluctant about using the devices.

"While it is encouraging to see that young people appear to be quite clear about the role of e-cigarettes in society (devices used by smokers who are trying to - or already have - quit tobacco)," said McKeganey "It's more concerning, particularly for the young people who currently smoke, that inaccurate perceptions of e-cigarettes could result in the persistent use of combustible tobacco irrespective of the fact that Public Health England has concluded vaping is 95% less harmful than conventional cigarettes."

Where concerns were expressed around e-cigarettes, they were mostly about the uncertainty of long term use: "It took over 40 years for them to find out that smoking was really bad for you so I don't know whether they will come out with something in the long term that will say 'it's bad for you'," said one participant. "I don't think it's going to be any worse than smoking, but for people who don't smoke and who are vaping, I'd say there was a question mark over whether or not it's good or bad in the long term."

This level of uncertainty was shared by others, too; a fact McKeganey finds concerning. "What was apparent is that this persistent view, expressed by some young people, that vaping was just as harmful as smoking, was resulting in some young people continuing to smoke when they might otherwise have quit."

"But what was equally clear from our research is that the much debated 'Gateway' theory is not materialising. There was nothing to suggest that youngsters see vaping as a stepping stone to smoking - quite the opposite."

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Abstract

E-cigarettes have been characterised by Public Health England as being up to 95% less harmful than combustible tobacco products whilst playing a key role in supporting smokers attempts to quit. Nevertheless, e-cigarettes have been quick to attract controversy with concern being expressed, particularly within the US, that the use of these devices might act as a gateway to smoking. In research which we have undertaken in the UK 167 young people (average age 21) who were vaping were interviewed about their vaping experience and their views of vaping. The aim of the research was to determine how close young people viewed vaping and smoking. The study identified that for the majority of the people interviewed vaping was seen as socially very distant to smoking. The predominant view was that vaping was much less harmful than smoking, that the availability of e-cigarettes had made smoking much less attractive and that e-cigarettes had further served to de-normalise smoking. Where there was concern expressed around e-cigarettes this tended to have to do with the uncertain long term impact of vaping. On the basis of the qualitative research undertaken it is unlikely that e-cigarettes are acting as a gateway to smoking and more probable that for young people within the UK they represent a route away from smoking.

About The Centre for Substance Use Research

The Centre for Substance Use Research (formerly the Centre for Drug Misuse Research) opened in 1994 and is based at the West of Scotland Science Park Glasgow Scotland. The Centre and has undertaken a wide range of research related to drug use and drug users with funding provided by the Economic and Social Research Council, the UK Department of Health, the Scottish Government, the United Nations, the World Health Organisation, the United States Department of Justice, the Joseph Rowntree Foundation.

More information

The research undertaken by Dr Neil McKeganey and his team in Glasgow was funded by Fontem Ventures who have had no role in the study design, in the collection or analysis of the data, nor in the decision to present the research findings. Young people aged 16 to 25 participated in the interviews lasting up to 30 minutes.