Experts challenge ‘gateway’ concerns amid new research on UK teen vaping and smoking

New research, published in BMJ Tobacco Control, suggests that UK teens who vape are just as likely to smoke as their peers were in the 1970s.

The intergenerational study reportedly found that young people who said they vape in 2018 had nearly a one-in-three chance of also reporting smoking – matching the overall proportion of teen smoking 50 years ago.

The findings sparked a wave of media stories warning of the potential ‘gateway’ effect – with headlines such as The Guardian’s: ‘Third of UK teenagers who vape will go on to start smoking, research shows’…

…but some experts have taken a different view. Commenting on the research, our VapeVerify panel members said:

“In this study, data from several UK surveys have been examined to look at associations between the cigarette smoking and e-cigarette use among adolescents.

“The analysis performed was cross-sectional, meaning that the authors can only look at associations and not causation i.e., they cannot determine whether e-cigarette use led to cigarette smoking, or vice-versa. They can only assess whether smoking and e-cigarette use are associated.

“The authors themselves suggest that the study cannot provide evidence for the existence of a ‘gateway’ effect. Looking at the data, we can see that while there is an association between youth smoking and e-cigarette use, there are equally strong associations with alcohol use and a lack of engagement at school.

“Overall, this suggests that the most likely cause of the association is the ‘common liability’ principle – that some individuals have a predisposition or “liability” to use tobacco and nicotine products, including both cigarettes and e-cigarettes, as well as to engage in other risky behaviours.

“This aligns with historical youth smoking data, which clearly show that while e-cigarette use may be increasing, youth smoking has been in decline for many years. That would not be the case if the so-called gateway effect were real.”

Dr Ian Fearon

Tobacco Harm Reduction Expert and Director of whatIF? Consulting

“This study offers important historical context on youth smoking trends in the UK, but its central limitation is the inability to determine whether e‑cigarette use causes cigarette smoking or merely reflects shared underlying risk behaviour.

“Without clarity on product sequencing, conclusions suggesting that e‑cigarettes may reverse decades‑long declines in youth smoking should be interpreted with caution.

“It’s also key to note that over the same period, adult cigarette smoking in the UK has continued its steady decline.

“From a population health perspective, policies should support responsible access to lower‑risk nicotine products for adults, while rigorously preventing youth uptake through strong regulation and enforcement.”

David Lawson

Chief Executive Officer of Inter Scientific

“The idea that vaping causes teenagers to start smoking just doesn’t hold up when we look at the bigger picture.

“Many young people who try vapes would likely have tried cigarettes anyway due to shared risk factors. Nonetheless, teen smoking rates have continued to fall even as vaping has become more common.

“If vaping were truly a gateway to smoking, we’d expect to see rates rise – not drop. What’s more likely is that both behaviours share common risk factors, and vaping may actually be replacing smoking for some young people rather than encouraging it.

“In other words, people who try stuff, try stuff. Indeed, recent studies have shown that rather than substance use changing the structure of the adolescent brain making adolescents more likely to try other stuff, adolescents who try stuff tend to have pre-existing brain structural differences that make them more inclined to experiment in the first place.”

Dr Marina Murphy

PhD Chemist and Senior Director of Scientific Affairs at Haypp Group

Read about the original study here: UK teens who currently vape as likely to start smoking as their peers in the 1970s – BMJ Group

Experts challenge ‘gateway’ concerns amid new research on UK teen vaping and smoking

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