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Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check
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  • David T Levy, Kenneth Warner, K. Michael Cummings, David Hammond, Geoffrey Fong, James T. Thrasher, Maciej Goniewicz and Ronald Borland
    Published on:
  • Stanton A Glantz
    Published on:
  • Published on:
    Response to Dr. Glantz
    • David T Levy, Professor Georgetown University
    • Other Contributors:
      • Kenneth Warner, Professor
      • K. Michael Cummings, Professor
      • David Hammond, Professor
      • Geoffrey Fong, Professor
      • James T. Thrasher, Professor
      • Maciej Goniewicz, Professor
      • Ronald Borland, Professor

    NOT PEER REVIEWED
    We would like to clear up some misconceptions in Dr. Glantz’s reply to our recent article (1). First, our analytic approach did not assume linearity as the title of Dr. Glantz’s response implies. On the contrary, we applied a log linear form, which not only better fit the data, but also incorporates non-linearities. Additionally, we also conducted and provided results using a linear form in the supplementary material, which yielded similar results.

    In his reply to our paper, Dr. Glantz claims that we should have started the vaping period in 2009 rather than in 2014 or 2013. However, we feel this criticism is wrong since we provided extensive data in the paper showing that vaping among youth was minimal until at least 2013.
    Consequently, we focused on when vaping became more widespread and, by most accounts, became a concern. Further, we conducted analyses that considered changes in trend for other years and obtained qualitatively similar results when the transition was specified as dating back to 2013 or 2012. We also conducted analyses which allowed for changes in trend in both 2009 and 2014 and found no change in trend from 2009 onward, whereas the change in trend from 2014 onward continued to hold. We understand that Dr. Glantz and colleagues in another paper (2) used 2009 as a base year for vaping. However, we feel this choice was a poor one since virtually no students were using e-cigarettes in 2009, and hence vaping would not be...

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    Conflict of Interest:
    None declared.
  • Published on:
    The reality may not be linear

    NOT PEER REVIEWED
    David Levy and colleagues’ paper “Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check” used data from all the surveys over time that measured youth and young adult e-cigarette use and smoking and concluded there was a substantial increase in youth vaping prevalence beginning in about 2014. Time trend analyses showed that the decline in past 30-day smoking prevalence accelerated by two to four times after 2014. Indicators of more established smoking rates, including the proportion of daily smokers among past 30-day smokers, also decreased more rapidly as vaping became more prevalent.

    The inverse relationship between vaping and smoking was robust across different data sets for both youth and young adults and for current and more established smoking. While trying electronic cigarettes may causally increase smoking among some youth, the aggregate effect at the population level appears to be negligible given the reduction in smoking initiation during the period of vaping's ascendance.

    The good news is that Levy and colleagues are finally accepting the overwhelming evidence that kids who start with e-cigarettes are more likely to end up smoking cigarettes, the so-called “gateway effect.”

    Now they have fallen back to arguing that the gateway effect is not big enough to overcome the benefits of e-cigs as substitutes for cigarettes.

    The approach they used, interrupted ti...

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    Conflict of Interest:
    None declared.