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Research and evaluation

Young people who vape are almost five times more likely to start smoking, research suggests

Authors have concluded that more research is needed to determine whether vaping acts as a gateway to tobacco smoking.

Young person holding an e-cigarette


Researchers from Bristol University found strong evidence for an association between e-cigarette use in young non-smokers and the chance of them taking up smoking at a later stage

Young people who have tried e-cigarettes are nearly five times more likely to go on to try smoking, a review of the evidence suggests. However, it remains unclear whether or not e-cigarettes act as a ‘gateway’ to smoking.

The researchers from Bristol University identified 17 studies looking at use of e-cigarettes. Publishing their findings in Tobacco Control on 11 March 2020, the team said they found strong evidence for an association between e-cigarette use in young non-smokers and the chance of them taking up smoking at a later stage.

Overall, it was 4.5 times more likely that e-cigarette users would go on to smoke compared with those who had never tried vaping.

However, the authors warned that current evidence is reliant on self-reported smoking histories and none of the studies included negative controls that would have helped to show if the relationship was causal.

Jasmine Khouja, a PhD student in the Bristol University Tobacco and Alcohol Research Group, said: “Policymakers have used the findings of studies, including the studies we reviewed in this research, to support the heavy regulation of e-cigarettes, including restrictions on flavours and even total bans, but the evidence that e-cigarette use might cause young people to take up smoking is not as strong as it might appear.”

The authors said research is now needed to work out if e-cigarettes are truly having a ‘gateway effect’ in young people taking up smoking or if there are other reasons why a person who has tried one may be more likely to try the other.

The Royal Pharmaceutical Society (RPS) published an updated policy statement on e-cigarettes in February 2020, which said that sweet flavourings in e-cigarettes should be banned to minimise their appeal to young people.

At the time, Gino Martini, chief scientist at the RPS, commented: “We don’t want young people to be trying e-cigarettes first. What we’re trying to do is stop people smoking and get off nicotine. What we don’t want is e-cigarettes to lead towards smoking. Clearly more research is needed and it is important we understand this link.”

Then, in March 2020, an evidence update from Public Health England found that vaping levels among young people in England has remained fairly steady at around 6% for those aged 11–15 years, and that current vaping is mainly concentrated in young people who have experience of smoking.

Nevertheless, the government body concluded that vaping and smoking prevalence in England should continue to be closely monitored and that more work is needed to understand people’s flavour preferences and reasons for vaping.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2020.20207819

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