How do levels of youth vaping relate to smoking levels? This question goes right to the heart of attitudes and policy on e-cigarettes. It is the nub of the ideological chasm that divides those who make, sell or promote vapour products and those regulators all across the world whose instinct is to clamp down on them as something inherently dangerous, even wicked.
On one side we have those who see vaping as the route out of the world’s longstanding addiction to smoking – an addiction which, according to the World Health Organization kills up to half its addicts, adding up to more than 8m deaths a year.
On the other those who fail to distinguish between combustible and electronic cigarettes, generally categorising both as “tobacco products” and regarding e-cigs as the tobacco industry’s means of keeping large swathes of the world population hooked.
From this latter perspective the question above barely makes sense. For those who take this view – and it is the orthodox view of regulators and policymakers in the US and many other regions of the globe – vaping is smoking.
In the view of ECigIntelligence, this is a category error. We neither champion e-cigarettes nor condemn them – but we can see the difference between them and combustibles. No tobacco. And no smoke.
So what are we to make of last week’s report in the US healthcare journal Healio on a survey showing that from 2011 to 2019 smoking and smokeless tobacco use by adolescents fell, while their use of e-cigarettes rose?
Of course, correlation is not causation, but the figures are highly suggestive of a move away from tobacco and towards vapour. Which should hardly be news to anyone.
One might reasonably ask, if there is causal relationship, which is cause and which is effect – and whether it’s as simple as that.
Either way or neither, it leaves you to decide whether this trend is somehow a bad thing (as so much of the public rhetoric suggests) or a shift towards, if not absolute safety then at least relative safety.
Rafael Meza, associate professor of global public health at the University of Michigan, Ann Arbor, who led the research, seems pretty upbeat about the findings.
“Despite the increases in vaping among teens in recent years, adolescent cigarette smoking – the most harmful form of tobacco consumption – continues to decline and has reached historically low levels,” he told Healio. “This is great news and shows that education campaigns and tobacco control interventions are working to reduce youth and overall smoking.”
Which seems fair enough, except for one strange and glaring thing. That word “despite”.
OK, “Because of…” might have been too great a leap towards an assumption of causation. But “despite”?
This curious word choice seems to imply one of two things. Either Meza thinks an increase in vaping might naturally be assumed to go hand-in-hand with an increase in cigarette-smoking – making it a surprise to him to find the opposite is in fact true.
Or he has accepted the prevalence of the “gateway” theory – the idea that vaping somehow leads to smoking initiation – so far as to assume the health professionals who read Healio will have swallowed it whole, even if he himself hasn’t.
He goes on from there along orthodox lines including, sadly, that familiar conflation of vaping with “tobacco products”: “We should remain vigilant and continue efforts to prevent regular use of nicotine and tobacco products among youth.”
He reveals curiosity and perhaps some scepticism about the “gateway” concept when he says: “We need to better understand current patterns of tobacco use among adolescents and how vaping might affect their risk of smoking.” (Emphasis added – note especially the word “might”.)
One can hardly fault his conclusion that “we need more research to figure out how to prevent kids from vaping, without increasing the risk that they would smoke instead”. Nail. Head. Hammer.
Photo: Alexander Russy