US Gateway Closed

Posted 28th July 2020 by Dave Cross
A cross-sectional, matched control study by researchers at University College London (UCL) has been published in the journal ‘Tobacco Control’. It looked to see if there was an association of between vaping and subsequent progression on to smoking, and also factored in other tobacco product use with smoking in American adolescents.

Lion Shahab, Emma Beard, and Jamie Brown conducted the study using data from 78,265 adolescents in the American National Youth Tobacco Survey.

The authors write: “There is considerable debate about the impact of e-cigarettes on youth smoking. A contentious point is whether e-cigarettes act as a gateway and increase the likelihood of subsequent cigarette smoking. A large number of studies have shown that e-cigarette experimentation is longitudinally associated with uptake of cigarettes.”

But they continue to point out that there are two major problems with the previous work claiming to demonstrate the so-called gateway effect: “First, most studies have considered the impact of e-cigarettes on ever use of cigarettes—that is, initiation—but ignore their effect on continued use.”

They explain that this means the studies do not “allow for a more nuanced analysis of the impact of e-cigarette use on smoking trajectories and health implications, as only regular cigarette use will result in subsequent premature death and disability.”

Secondly, they point out: “a causal association between e-cigarette use and subsequent cigarette smoking cannot be tested directly; it would be unethical (and impractical) to conduct a randomised controlled trial allocating non-smoking adolescents to receive e-cigarettes or not to see whether this leads to uptake of smoking.”

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The team concluded: “The NYTS showed a continuing decrease in both cigarette smoking prevalence and in the use of any tobacco product, despite a concurrent increase in e-cigarette use between 2014 to 2017. This suggests that any gateway effect of e-cigarettes, if present, must be small. Further, despite e-cigarettes being more commonly used than any other product from 2015 onwards, cigarettes remained the most prevalent initiation product in 2014 and 2015, followed by other combustibles.”

<1% of adolescents trying an e-cigarette first became established cigarette smokers

The current cross-sectional matched control study estimated that around a quarter of e-cigarette initiators go on to try cigarettes subsequently. However, <1% of adolescents trying an e-cigarette first became established cigarette smokers, significantly fewer than in any other product category.”

The current analysis suggests that the association of e-cigarette initiation with subsequent smoking is largely explained by shared vulnerability such that those who try an e-cigarette first would have gone on to smoke cigarettes anyway.”


  • Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study” by Shahab, Beard, and Brown – [link]

Gateway image by sipa from Pixabay

Kid cartoons by Gustavo Rezende from Pixabay

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 Dave Cross
Article by Dave Cross
Freelance writer, physicist, karateka, dog walker
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