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E-cigarettes not a smoking gateway

17 Jan 2017

Dear Editor,

The article ‘E-cigs a gateway to smoking for young: study’ (Australian Medicine, 10 November 2016) misinterprets the finding of a recent study and incorrectly claims that e-cigarettes are leading young people to smoking. In fact, the evidence suggests that the opposite is likely to be true.

The study, published in JAMA (Leventhal AM et al), found that young people who use e-cigarettes are also more likely to smoke. This association tells us nothing about whether the vaping caused the smoking. A more likely explanation is that young people who are more attracted to experimentation are more likely to try both products, due to a shared underlying vulnerability.

In fact, it is likely that vaping is diverting young people away from smoking tobacco. In the US, between 2013 and 2015, as e-cigarette use in young people has been rising, the rate of smoking has declined faster than at any time in the last 40 years (Monitoring the Future study). It is obviously better for young people not to use e-cigarettes, but vaping is preferable to smoking tobacco, and is at least 95 per cent safer. Many studies have found that regular use of e-cigarettes is almost entirely concentrated in young people who already smoke.

The UK Royal College of Physicians recently completed a comprehensive review of e-cigarettes. It concluded that there was no evidence that e-cigarettes are acting as a gateway to smoking in young people. In fact, the RCP recommends that “in the interests of public health it is important to promote the use of e-cigarette …  as widely as possible as a substitute for smoking”.

On the other hand, the draconian policy of the Australian Medical Association on e-cigarettes is potentially harmful to public health and should be urgently reviewed.

Conjoint Associate Professor Colin Mendelsohn

School of Public Health and Community Medicine

The University of New South Wales, Sydney Australia


Published: 17 Jan 2017