29 January 2019

Are never-smokers really picking up the vaping habit?

Addiction Research Smoking

The e-cigarette debate has exploded again, with public health advocates taking opposite stances on whether vaping is a gateway to nicotine addiction for non-smokers.

A study by researchers at The University of Newcastle showed that a quarter of young Australian women who used e-cigarettes had never smoked a cigarette.

In an online survey of around 9,000 women aged 19-26, about one in 10 had used an e-cigarette, and 6.4% had vaped in the past year.

“The really interesting group of women are those that have never smoked any tobacco products, but are reporting using e-cigarettes,” Dr Catherine Chojenta (PhD), a public health researcher at University of Newcastle who co-authored the paper, said. 

“They are a group of people that we really need to think about targeting some health promotion messages to about the potential dangers of e-cigarettes.”

Associate Professor Colin Mendelsohn, the chairman of the Australian Tobacco Harm Reduction Association and a tobacco treatment specialist affiliated with UNSW, however, disagreed strongly with this interpretation of the results. If you flip the study statistics around, it becomes clear that only a tiny proportion of non-smokers are actually picking up vaping – around 1.6%.

This mirrors other studies, which have reported rates of e-cigarette use among non-smokers ranging from 0.1% to around 1.3%.

Professor Mendelsohn called out media coverage of the study as “misleading and exaggerate the risks and uptake of vaping”.

“The effect of this scaremongering is to confuse and alarm the public about a potentially life-saving alternative to smoking.” 

The research profiled female vapers as being more likely to be younger city-dwellers with higher levels of alcohol consumption and past experiences of intimate partner violence.

But these risk factors “paled into insignificance” compared with smoking status, Professor Mendelsohn said.

Vapers were five times more likely to be ex-smokers and 10 times more likely to be current cigarette smokers in the study.

“The profile is that vapers are smokers,” he said.

“And that’s what the international literature shows – that regular vaping by non-smokers is very rare.”

Some studies provide evidence in favour of the theory that vaping is a gateway to smoking for young adults. For instance, a large US study found that young adults who vaped were more likely to go on to smoke. However, it was impossible to show causation from these kinds of cross-sectional studies,  Professor Mendelsohn said.

“You can’t say that because people are vaping first and smoking later on that the vaping caused the smoking,” he said. “Those people probably would have smoked anyway.”

If anything, vaping was a gateway out of smoking rather than a gateway into smoking, he said.

“There was one study in 2016 in Europe where they estimated from a survey of around 27,000 people that over six million people self-reported having quit smoking via vaping,”  Professor Mendelsohn said.

In the UK, the official NHS figure is that an estimated 1.5 million vapers have stopped smoking cigarettes.

This latest vaping skirmish is unlikely to be the last. Despite endorsement by the UK and many other countries, the WHO still doesn’t recommend e-cigarettes as a quit method, and supports a ban on vaping products.

Possession of liquid nicotine without a prescription remains illegal in many states of Australia. Vaping-related activities attract fines of $45,000 in Western Australia and a prison sentence of up to two years in the ACT and Tasmania.

American Journal of  Preventative Medicine

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