New Study Puts Another Nail in the Coffin of the Gateway Hypothesis
By Lindsay Fox Posted August 26, 2014
The “gateway” hypothesis with e-cigs, which states that vaping will lead to increased smoking among non-smokers and particularly youths, has been contradicted by every piece of evidence on the topic to date. Some may try to distort the evidence they collect by implying that the correlation between smoking and e-cigarette use means that e-cigarettes are leading to smoking, but this stands up to no scrutiny whatsoever, and the numbers of non-smoking vapers are always low. But such arguments don’t go away.
Now, though, a new study looking at data from over 26,500 European respondents has provided further evidence that non-smokers don’t try vaping very often at all. The accusations that e-cigs are a gateway to smoking and the notion of “renormalization” of smoking seem to rest on shakier ground with every relevant study that emerges.
- Researchers used data from over 26,500 participants aged 15 and over from across 27 countries, looking at the prevalence of vaping and the factors that predict e-cig use.
- 20.3 percent of smokers, 4.4 percent of ex-smokers and just 1.1 percent of never smokers had ever tried an e-cigarette. Current smokers were over 10.6 times more likely to have tried an e-cigarette than non-smokers.
- Out of current smokers who had used an e-cigarette, 69.9 percent had used them once or twice, 21.1 percent were occasional users and 9 percent vaped regularly.
- Generally, younger age groups had greater odds of vaping across the sample, with those aged 15 to 24 being 3.3 times more likely to have vaped than over 55s.
- People who “didn’t know” whether e-cigs were harmful were over three times less likely to have vaped than those who thought they were harmless, although participants were quite limited in their choice of answers.
- Heavier smokers and those who’d tried to quit in the past year were more likely to have vaped, with significantly more smokers of 6 to 10 or 11 to 20 cigarettes per day reporting vaping than less than 5 per day smokers.
- The researchers were unable to determine the frequency of use among never-smoking vapers, because the eligible sample size wasn’t big enough to draw valid conclusions.
What They Did – Estimating the Prevalence of E-Cig Use and Who Uses Them
The study (available for free) was based on a survey conducted by the European Commission from late February to early March, and used data from 26,566 adults (aged 15 or over) from across 27 countries. The results of the original survey showed that this group consisted of 50.6 percent never smokers, 27.9 percent current smokers and 21.3 percent former smokers. The researchers used a yes-or-no categorization for whether participants had ever tried an e-cigarette, meaning that the “regular,” “occasional” and “once or twice” vapers were counted as having ever used e-cigarettes, and they also asked about perceptions of risk from e-cigarette and awareness of e-cigs. Smokers were also asked whether they’d tried to quit in the last 12 months, whether they’d used e-cigarettes in a quit attempt and how many cigarettes per day they smoked.
Results – Non-Smokers Barely Ever Start to Vape
The overall results showed that 20.3 percent of smokers, 4.4 percent of ex-smokers and just 1.1 percent of never-smokers had ever tried an e-cigarette. This last statistic is a key factor in establishing the invalidity of the gateway hypothesis. Although around 1 in 100 never-smokers have tried an e-cigarette, this includes “once or twice” users which can reasonably be expected to account for the vast majority of that 1.1 percent. Specific information wasn’t provided for frequency of vaping among non-smokers, but even for smokers “once or twice” use was around 8 times as common as regular use, and other research has indicated that regular vaping among non-smokers is effectively non-existent. In short, the idea that non-smokers are picking up e-cigarettes and becoming regular users in any significant numbers is thoroughly contradicted by all available evidence, so the idea that many would then go on to become regular smokers is beyond dubious. It’s basically not happening.
From the information about the prevalence of vaping in the study, the researchers extrapolated to the whole of Europe, determining that around 23.1 million European smokers aged over 15 years old have used an e-cigarette. 69.9 percent used them once or twice, 21.1 percent used them occasionally and 9 percent used them regularly, meaning there are an estimated 2.1 million smokers who are regular vapers in the EU. Awareness of e-cigs is lowest in Sweden (likely due to the prevalence of snus) and highest in Greece, where 97.8 percent of respondents had heard of e-cigs.
What Factors Affect the Likelihood of Somebody Vaping?
The biggest thing that determines whether or not somebody has tried vaping is whether or not they’re a smoker, with the study estimating that current smokers are around 10.6 times more likely to have ever vaped. Additionally, ex-smokers were also around 6.6 times more likely to have vaped than never-smokers, with 4.4 percent of them having ever tried vaping overall. This is another “gateway” concern – the risk of ex-smokers picking up vaping and going back to smoking as a result.
However, as the authors mention in the paper’s discussion, the reasons the ex-smokers had vaped weren’t included in the data, so it could either be that the ex-smokers had given up tobacco before and were tempted back to nicotine use through e-cigs or that they quit smoking because of (or otherwise after) vaping. This study can’t confirm this one way or another, but given existing evidence that e-cigs are effective for quitting smoking and that they don’t really appeal to non-smokers, it seems probable that the “gateway back” hypothesis is as dead in the water as the core gateway hypothesis.
The analysis according to the age groups chosen, 15 to 24, 25 to 39, 40 to 54 and 55 + showed that overall the younger somebody was the more likely they were to have vaped, with those aged 15 to 24 being 3.3 times more likely to vape compared to those aged 55 or over. These figures could be used to argue that e-cigs appeal to youth, but it’s evident that the most of those in the youngest group would be of legal smoking age, and the vast majority of vapers were already smokers, in any case.
Opinion on the Safety of E-Cigs
Another interesting point is that those who answered that they “didn’t know” whether e-cigarettes were harmful were less likely to have vaped than either of the other groups of respondents. The sample was fairly split on this issue, with 40.6 saying they’re harmful, 28.5 saying they’re not harmful and 30.9 percent saying they didn’t know. The phrasing of the question is key (“Do you think that they are harmful or not to the health of those who use them?”), as is the limited choice of responses, either “yes,” “no” or “don’t know.”
Even though it’s without doubt that e-cigarettes are safer than cigarettes, when phrased as a question of absolute harm it’s not too surprising that the most common answer was “yes.” Accordingly, those rating e-cigarettes as harmful were actually slightly more likely to have vaped than those rating them as harmless. Participants answering “I don’t know” were over three times less likely to have vaped than those rating them as harmless, and when the question was asked as relative to the harm of cigarette the same trend occurred – those who weren’t sure were three times less likely to have vaped. The researchers suggest that this shows that a lack of scientific knowledge is a barrier to e-cig use.
Cigarettes Per Day and Quit Attempts
There was also a relationship observed between the number of cigarettes smoked per day and the likelihood of e-cig use. Compared to smokers of five or fewer cigarettes per day, smokers on 6 to 10 cigarettes a day were just over 1.5 times more likely to have vaped and those smoking between 11 and 20 cigarettes per day were about 2.1 times more likely to have vaped. According to the researchers, this general trend continued for smokers of over a pack per day, but wasn’t a statistically significant difference (just under 1.5 times more likely). These findings are in line with that from past research, and offer more evidence that e-cigs are particularly appealing to heavier smokers, which is a huge plus-point for their public health potential.
Additionally, smokers who’d tried to quit in the last year were also around 2.1 times more likely to have used an e-cig, and e-cigs were used in 7.1 percent of all quit attempts. Cold turkey (65.7 percent) and NRT (22.5 percent) were the most common methods of attempting to quit, however.
There were several other factors which could be related to the likelihood of vaping considered by the researchers, including cigarette brand preference, socioeconomic differences, marital status, gender, EU region and general area of residence. Most were non-significant, minor variations, with living in a large town (compared to rural areas) and in Northern and Eastern Europe (compared to Western Europe) being the only significant factors associated with greater odds of having tried vaping.
Conclusion – The Gate is Open, But Nobody Goes Through
There are problems with the study, and for the purposes of the gateway argument the biggest one is that the researchers weren’t able to look at the frequency of occasional or regular vaping among non-smokers, because the small eligible sample size (that is, from an initial sample of 26,566) meant that the confidence intervals for the results were too wide to be validly used. If this information had been available, it would have given this research considerably more strength in showing the absurdity of the gateway hypothesis with regards to vaping, but the basic reason it wasn’t available is that there it’s hard to find enough eligible people in the first place. Combined with existing results and with the fact that only 1 in 100 non-smokers had ever tried vaping in this research, it’s obvious that e-cigs are not much of a gateway to smoking at all.
Keep this in mind: the “gate” is open. Any non-smoker aged over 18 can easily obtain an e-cigarette for little cost, whether online or by walking five minutes to a local store, become addicted and then think, “screw this, I want the real thing.” If the idea proliferated by the ANTZ is true, then this would happen all the time. After all, it’s built on the notions that e-cigarettes appeal to non-smokers and are horrendously addictive, so if all of these things were true, would it really be so hard to even find anybody who’d actually done it? Would a study of over 26,000 people have any trouble finding enough never-smoking vapers to base conclusions on?
It’s much, much simpler to just admit that perhaps the initial assumptions about the appeal of e-cigs to non-smokers and their unavoidable addictiveness were wrong. But they can’t do that, because they don’t have any valid grounds for their opposition in the first place. If they gave up saying things when study after study didn’t go their way, there wouldn’t be much left for them to say.