Fears over e-cigarettes leading to smoking for young people unfounded – study

Young people who try e-cigarettes are not more likely to take up smoking as a result, according to a substantial new study.

Public health experts have been divided over e-cigarettes. Some believe they will help millions quit their deadly tobacco habit, while others are convinced they are little more than a stalking horse for the tobacco industry. Some of the big international tobacco companies have invested in manufacturing e-cigarettes. Philip Morris International has even spoken of a “smoke-free future”, where it would make its money from liquid nicotine for vaping devices rather than tobacco.

But other anti-smoking campaigners accuse the big companies of an ambition to promote their cigarettes by stealth, arguing that the promotion and advertising of vaping could help smoking shed its pariah status.

The biggest concerns have been that young people who have been smoking in fewer and fewer numbers over recent decades will experiment with e-cigarettes and move on to old-style cigarettes which kill because of the tar content, not the nicotine.

But the largest study yet undertaken of young people’s use of e-cigarettes and smoking in the UK concludes that fears of e-cigarettes becoming a gateway to tobacco for young people are largely unfounded. The study, which was based on five separate surveys gathering data from 2015 to 2017, is from a collaboration including experts from Public Health England.

A tenth to a fifth of 11- to 16-year-olds had tried e-cigarettes, but only 3% or less used them regularly and those were mostly already tobacco smokers. Among young people who have never smoked, regular use of e-cigarettes was negligible, say the authors, at between only 0.1% and 0.5%.

“This pattern was consistent across different surveys from around the UK and suggests that, for now, experimentation with e-cigarettes does not necessarily translate into regular use, particularly among never smokers,” say the authors of the study, published in the International Journal of Environmental Research and Public Health.

Lead author Linda Bauld, professor of health policy at the University of Stirling, said: “Recent studies have generated alarming headlines that e-cigarettes are leading to smoking. Our analysis of the latest surveys from all parts of the United Kingdom, involving thousands of teenagers shows clearly that for those teens who don’t smoke, e-cig experimentation is simply not translating into regular use.

“Our study also shows that smoking rates in young people are continuing to decline. Future studies on this subject need to continue to monitor both experimentation and regular use of e-cigarettes and take into account trends in tobacco use if we are to provide the public with accurate information.”

The harm to health of e-cigarettes is tiny compared to that of tobacco, she said. A recent study by the Royal College of Physicians, in which she was involved, found that e-cigarettes carried only about 5% of the risks of smoking. Another found they had about 1% of the cancer risk. That makes them very useful for those who already smoke and would like to use e-cigarettes to quit, but nicotine is highly addictive and e-cigarettes do contain chemicals with potential effects on the body. Young people who do not smoke should not be encouraged to use them. “They are not risk-free,” she said.

Martin Dockrell, tobacco policy manager at Public Health England, said that the study suggested the UK was broadly getting the balance right in the protection of children. “We have a regulatory system that aims to protect children and young people while ensuring adult smokers have access to safer nicotine products that can help them stop smoking. This includes a minimum age of sale, tight restrictions on marketing, and comprehensive quality and safety requirements. We will continue to monitor the trends in e-cigarette use alongside those in smoking.”

Deborah Arnott, chief executive of Action on Smoking and Health, said: “ASH will continue to monitor the potential impact of e-cigarettes on young people, however this study provides reassurance that to date fears that they are a gateway into smoking are just not born out by the facts on the ground. A small proportion of young people do experiment with e-cigs, but this does not appear to be leading to regular vaping or smoking in any numbers, indeed smoking rates in young people are continuing to decline.”

Graham Moore, deputy director of the DECIPHer Centre at the University of Cardiff, which was also one of the collaborators, said that, alongside other evidence, “concerns that e-cigarettes are leading large numbers of young people into addiction and tobacco use increasingly seem to be implausible”.