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Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis
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  • Published on: 15 December 2020
    Gateway effect from vaping to smoking likely to be small
    • Colin P Mendelsohn, Tobacco Treatment Specialist University of New South Wales
    • Other Contributors:
      • Wayne Hall, Professor

    NOT PEER REVIEWED
    The meta-analysis by Khouja et al. confirms the strong association in young people between e-cigarette use and subsequent smoking.[1] The critical issue is whether the relationship is causal. If there is a causal relationship, there are several factors which diminish its impact.

    Firstly, most of the studies used ‘ever smoking’ as the outcome. Ever smoking is a poor marker for smoking-related harm as most smoking by vapers who later smoke is experimental and infrequent and few progress to established smoking (100+ lifetime cigarettes). Shahab et al. found that only 2.7% of youth who tried e-cigarettes first progressed to established smoking. Only established smoking is linked to significant smoking-related death and disease.[2]

    Secondly, the absolute number of non-smokers who progress from vaping to smoking is small as smoking precedes vaping in the vast majority of cases (70-85%).[3] If there is a gateway from vaping to smoking, this only affects a minority of young vapers.

    Thirdly, the authors use Bradford Hill’s dose-response and specificity criteria to assess whether the association between vaping and subsequent smoking is likely to be causal.

    They acknowledge that the dose-response criterion is mostly based on nicotine dependence, indicating that that nicotine dependent vapers are more likely to progress to smoking. However, nicotine dependence in non-smoking vapers is rare, less than 4% in the 2018 National Youth T...

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    Conflict of Interest:
    Colin Mendelsohn
    I have received funding from Pfizer Australia, Johnson & Johnson Pacific and Perrigo Australia for teaching, consulting and conference expenses. I have never received or payments from electronic cigarette or tobacco companies. I am a Board member of the Australian Tobacco Harm Reduction Association (ATHRA), a health promotion charity. ATHRA has received unconditional funding for establishment costs from small Australian vape businesses. Vape industry funding has not been accepted since March 2019.

    Wayne Hall
    None