The gateway theory resurrected

Here we go again. Another ‘gateway’ study has hit the media, only this time, the study originates from the UK and not the gateway crazy US.

I had prior warning that this study was coming late at night, but sadly with work being such a crapfest, I ended up reading it cross-eyed and making ridiculous mistakes in interpretation.

Before we take a closer look at the study itself, I want to draw attention to this statement in the introduction. It’s rather important.

“Although rates of adolescent regular use of e-cigarettes are low, rates of ever use are substantial (13%–22%) and have increased over recent years, whereas rates of cigarette use have decreased over the same period both in the USA and UK.”

So the number of kids that have “ever used” – and you know how much I absolutely abhor that as a measure – are ‘substantial’; most of that ‘ever use’ is plain and simple experimentation. This isn’t exactly journal-worthy in any form.

We have seen it time and time again, kids will experiment. There isn’t anything that can effectively be done to guarantee prevention of experimentation.

The question that the paper poses – “Do electronic cigarettes increase cigarette smoking in UK adolescents?” – suggests that the authors set out to confirm (or deny) the rhetoric that a kid who picks up a vapouriser would then move onto lit tobacco.

Let’s face it, some kids are drawn to certain behaviours – such as smoking/vaping/drinking – while others simply are not drawn to those behaviours in the same way. That is, of course, a fundamental argument, and one that should resonate with a number of my readers; after all a large number of my readers are smokers and former smokers.

The “concern” emanating from public health over the ‘gateway’ theory is simple: if kids are taking up vaping, are they:

a) going to continue (become a regular user)
b) move onto lit tobacco (or other substances)
c) find they don’t like it and stop after one or two tries?

From a libertarian perspective, all of these questions are irrelevant because it isn’t the job of public health to tell us what we can, or can’t, do. Their job is to provide information on the risks and benefits, then let us, the public, decide what to do.

After all, the bulk of the science behind e-cigarettes does suggest that with extended, long-term use, any risks are negligible, therefore, most ardent public-healthers shouldn’t have any problems with either “a” or “c” – but that’s not really true.

The problem they have, their biggest “fear”, is that these impressionable young folk (the very same impressionable young folk that are being “educated” about the ‘risks of smoking’ in schools) will take a puff on an e-cigarette and, hey presto! they’ll become ardent smokers.

Thus far, data from both the US and UK hasn’t lent much credence to that ‘fear’. It’s a valid concern, granted, but the data has yet to support it. So what data does this latest opus add to the pile? (n=2836)

The data from the survey time-points shows (accounting for missing responses and attrition) that at follow-up at twelve months suggests that out of the “never users” of e-cigarettes (at baseline) group, 1259 (72.9%) hadn’t progressed to, or tried a cigarette at the 1-year follow-up.

In the same group, 5% (n=86) that had never used e-cigarettes at baseline had tried cigarettes (at least once). Furthermore, e-cig “triers”, infrequent (1/month-1/week) and frequent users who tried cigarettes totalled 3.8% (n=65) in the “tried e-cigs” group and 0.5% (n=8) in the infrequent user group.

Hardly groundbreaking, or newsworthy figures really. As mentioned before, those that are inclined toward certain behaviours (such as vaping) are more likely to try smoking (and vice-versa). This isn’t a shocking revelation.

Where it gets a little more interesting is the baseline “never e-cig user” and the occasional/frequent cig use at follow-up (n=8), compared with the “tried an e-cig” group (n=4), and infrequent e-cig use at baseline (n=5).

This would tentatively suggest possible dual-use, considering that the frequent e-cig use at baseline, and the frequent cigarette use at follow-up (n=2).

As Linda Bauld commented:

“In fact, out of the relevant sample of over 1,700 young people, 242 had tried a tobacco cigarette at one year. 49% of these happened to have tried an e-cigarette before trying tobacco, but in fact, a slightly higher proportion – 51% – hadn’t tried an e-cigarette first. Which came first – and why – might simply be a matter of chance, rather than anything else.”

This study hasn’t made much of an effort to identify in which order the experimentation occurred. Of course, it is feasible that some tried e-cigs first and then tried smoking, but then there is the lengthy discussion about the limitations of the study.

Primarily the authors had problems matching participants personal codes from baseline to follow-up, coupled with missing data, which indicated modest bias in the final sample compared with the initial sample.

As with any other survey, there is the limitation of self-reported status, in this study, the authors did indeed verify regular smokers but did no such verification of e-cigarette use.

Further limitations, which are not widely publicised in the various articles littering the internet, including the primary analysis which was restricted to ever use of e-cigarettes. This would lend credence to the “kids who try stuff, try stuff” theory as the authors were unable to test whether regular e-cig users would progress to cigarettes.

The final limitation only considered a small, finite, number of covariates that could affect the overall analysis and results. Despite accounting, and measuring for a broad range of variables it is possible (the authors admit) that any third variables could have been responsible for the observed relationships.

In other words, they don’t really know what the cause of the observed results is.


One thought on “The gateway theory resurrected

  1. While junk studies keep appearing that claim toxicity in emissions or that e-cigs do not help smokers quit, anti-vaping tobacco controllers have basically lost these battles. So what other argument is left? the “kids”, whose sciency form is the “gateway” issue. This is basically their last “heroic” stance in terms of counter arguments. However, anti-vapers in tobacco control do not rely on arguments, but on their dominance of public health in the USA, the tobacco control epicenter. This means their capacity to stimulate (through funding inducement) the publication of large number of sciency pieces of gateway excrement. Articles that counter this junk are of much better quality (use larger samples and rely on actual evidence), but they are much fewer. The hope is that a larger quantity of articles will produce the impression that the pro-gateway assessment is wining the debate, when the reality is that scientific debates are not won by number counting of published papers, specially when most of these in the count are junk. Hopefully, things could be different in the UK and in Europe.


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