Opponents of e-cigarettes claim that they are acting as a gateway to smoking for young people. However, 10 years of experience in the UK, US and Europe suggests that the opposite is true — that e-cigarettes may be reducing adolescent smoking rates.
Experimentation is a normal part of adolescence and many will try e-cigarettes, mostly out of curiosity. However, it is rare for non-smoking youth to become regular e-cigarette users. In the United Kingdom, less than 0.2 per cent of youth have never smoked “vape” regularly and there is no evidence of progression from vaping to smoking. Regular e-cigarette use is almost exclusively confined to young people who already smoke.
According to a recent comprehensive review by the respected Royal College of Physicians in the United Kingdom “e-cigarettes are being used almost exclusively as safer alternatives to smoked tobacco, by confirmed smokers who are trying to reduce harm to themselves or others from smoking, or to quit smoking completely”.
Another argument claimed to support the gateway effect is the idea that adolescents will become addicted to nicotine from using e-cigarettes and then progress to more dangerous tobacco products for a better nicotine hit. However, the great majority of adolescent e-cigarette users do not use nicotine. In the US, only 20 per cent of adolescent users used nicotine in 2015.
As e-cigarette use by adolescents is rising in many countries, adolescent smoking rates are falling faster than ever. For example, in the US, the National Youth Tobacco Surveys found that e-cigarette use by high school students rose from 1.5 per cent to 13.4 per cent from 2011 to 2014. However, conventional cigarette smoking fell from 15.8 per cent to an all-time low of 9.2 per cent during the same period, the most rapid rate of decline on record. If a gateway mechanism is operating, an increase in smoking rates would be expected.
It is quite possible that e-cigarettes are contributing to this rapid fall in adolescent smoking rates. Young people who experiment with e-cigarettes may otherwise have smoked if e-cigarettes were not available. Using an e-cigarette which may be more enjoyable and socially acceptable may prevent taking up the more harmful behaviour. It is obviously better for young people not to use e-cigarettes, but vaping is preferable to smoking and is at least 95 per cent safer.
Furthermore, there is evidence from the US that banning the sale of e-cigarettes to minors may increase adolescent smoking rates. Two large studies found that banning the sale of e-cigarettes to minors led to a significant increase in adolescent tobacco smoking rates compared to states without such bans.
In addition, some young people use e-cigarettes to help them quit smoking as do adult smokers. E-cigarette bans remove this treatment option altogether.
It is important to monitor electronic cigarette uptake for any potential risks. However, this new technology has the potential to save millions of lives and, according to the Royal College of Physicians, should be widely encouraged in the interests of public health.