A new study published in BMJ Tobacco Control has reignited debate around youth vaping, suggesting that UK teenagers who vape are just as likely to smoke as their counterparts were in the 1970s. But leading public health experts and industry figures are pushing back against claims that the findings prove a ‘gateway’ from vaping to smoking.
The study, which analysed intergenerational data, found that nearly one in three teens who reported vaping in 2018 also said they smoked – a proportion that mirrors smoking rates among youth in the 1970s. This correlation prompted media coverage focused on the risk that e-cigarette use could lead to cigarette smoking, with headlines like The Guardian’s “Third of UK teenagers who vape will go on to start smoking, research shows.”
However, researchers and public health experts have cautioned against drawing causal conclusions from the data. Professor Lion Shahab, Co-Director of the UCL Tobacco and Alcohol Research Group, criticised how the study’s findings have been interpreted.
“While the authors acknowledge the association is not causal, their language implies otherwise, suggesting that vaping may be reversing progress in reducing youth smoking,” Shahab said in a statement via the Science Media Centre.
“This interpretation is problematic for two key reasons. First, the study does not establish the direction of the relationship – whether vaping leads to smoking or vice versa. It’s equally plausible that young people who smoke are more likely to try vaping. Second, even if vaping preceded smoking, this does not prove causality.”
Others echoed Shahab’s concerns. Professor Peter Hajek, Director of the Health and Lifestyle Research Unit at Queen Mary University of London, offered a more behavioral perspective: “…it is more likely that the finding just shows that people attracted to vapes are also attracted to cigarettes, in the same way that compared to teetotallers, drinkers of white wine are more likely to also try red wine.”
The UK Vaping Industry Association (UKVIA) has also responded to the study and the surrounding media coverage. Its Director General, John Dunne, emphasised the positive role vaping continues to play in reducing adult smoking rates.
“The real-world evidence tells us that vaping is a key tool in eradicating smoking, rather than a gateway to it,” Dunne said.
“Data from Action on Smoking and Health UK shows that vaping is driving thousands of additional quit attempts every year, and millions of adults have already used it to cut down on or quit smoking altogether.”
Dunne also voiced concern over the broader implications of how vaping research is reported:
“It is disappointing, but not surprising, that this study has received the national media attention it has. I just wish more consideration were given to the public health consequences this kind of coverage can have – and that the overwhelmingly positive role vaping plays in reducing smoking was given the same spotlight.”
In an effort to address perceived misinformation and bring greater scrutiny to vaping-related research, the UKVIA is preparing to launch a new initiative called VapeVerify. The campaign aims to critically examine vaping studies and ensure they are communicated in an evidence-based and balanced manner. A sister initiative, VapeWatch, will focus specifically on how vaping is portrayed in the media.
Tobacco harm reduction expert Dr Ian Fearon, who is supporting the campaign, argued that broader lifestyle factors – not vaping – are more likely to explain the observed associations between teen vaping and smoking.
“The authors themselves suggest that the study cannot provide evidence for the existence of a ‘gateway’ effect,” Fearon said. “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.”
Fearon added:
“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.”
While teen vaping continues to raise public health concerns, official figures show that youth smoking has continued to decline across the UK – a trend some experts say undermines the idea of a widespread gateway effect.
Details of the UKVIA’s VapeVerify and VapeWatch campaigns are expected to be announced in the coming weeks.
