Two New Studies Presented—Is Vaping a Smoking Gateway?
Photo by BBC.com
Lynn T Kozlowski, professor of health behavior at The University at Buffalo, The State University of New York, recently posted an article on both The Conversation and Fortune.com regarding two new studies involving teens and vaping as a gateway to smoking.
While the studies found that teens who tried e-cigs were “somewhat likelier to try smoked tobacco products,” Kozlowski said that future work still needs to assess whether it leads to regular smoking.
Here is Kozlowski’s edited version of her assessment of the studies. For her full story, visit http://fortune.com/2015/09/24/e-cigarette-use-vaping-gateway-regular-cigarette-use/.
These studies find evidence for a small association (or limited gateway) between e-cigarette use in nonsmokers and a progression to trying cigarettes in a one-year study period.
The more recent of the two studies was published in September 2015 (authored by Primack et al), in JAMA Pediatrics. Researchers followed 694 12 to 26 year olds for a year. None had tried cigarette smoking at the study’s start, though 16 had tried e-cigarettes. (Perhaps the worthiest headline would be that only 2% of never-smokers tried e-cigarettes.)
A year later, 10% of the never-triers of e-cigarettes had taken at least one puff on a cigarette. But 38% (six of 16) of e-cigarette triers had taken at least one cigarette puff. This study focused on cigarettes and reports no information on prior hookah, cigar, marijuana, alcohol or smokeless tobacco use. If even two of the 16 were discounted because of prior use of other products, these results would likely be statistically insignificant.
The other study (authored by Leventhal et al) was published in August 2015 in JAMA. They followed 2,530 14-year-old school students for one year. None were smokers of any combustible tobacco products, including cigars, hookah and cigarettes at the start of the study, but 222 had tried e-cigarettes.
After 12 months, 25% of the e-cigarette triers had smoked at least one puff of a smoked tobacco product, compared to only 9% of the non-e-cigarette triers.
‘At least one puff’
Both studies found that young people who tried e-cigarettes were somewhat likelier to try smoked tobacco products, but that doesn’t mean e-cigarettes are a substantial gateway to regular smoking.
Rather than reporting usual measures of current smoking (i.e. any cigarettes in the past 30 days) or daily smoking, both studies used “at least one puff” or “just a few puffs” in the past six months or lifetime.
It is as if an apple researcher thought “taking at least one bite of an apple in the past six months” was an important measure of initiation of apple eating.
But, research shows that a puff on one cigarette is crudely linked with daily smoking. Following teenagers who had not yet puffed on a cigarette, they found that 48% took at least one puff in the 12-month follow-up period. But of those, only 20% became daily smokers.
Leventhal et al do acknowledge that future work needs to assess risks of “regular, frequent” smoking. Indeed, until we understand if the observed small gateway is only to experimentation or to frequent, dependent smoking, the more critical question is unanswered. In that only a subset of these observed gateway triers will move on to be regular smokers, it is almost certain that further followup of these samples will be unable to demonstrate a major gateway to heavy tobacco use.
Both studies also used a measure of “susceptibility” to smoking that is even more tenuously connected to becoming a future frequent smoker and also can be greatly discounted by assessing prior use of other drug products, including smokeless tobacco.
The gateways that aren’t
The observed gateway effects in these studies at best indicate some small increased chances of future smoking for the minority of these e-cigarette triers—not large, inexorable movement toward cigarettes for the majority. In fact, drug research has generally turned away from the scientific usefulness of causal drug gateway models.
Gateway models began in the 1950s when drug enforcement authorities warned that marijuana use caused deadly heroin use, which has not been found to be true.
Just as trying beer and liking it (or not) might incline one to try liquor (or not), prior use of one nicotine product can influence use of other nicotine products.
Drug research emphasizes so-called “common liability models” in which personal and contextual factors are taken into account as determinants of use or nonuse of products. While “products” themselves can influence the likelihood of using other products, it is important to consider “persons” as a factor determining use.
For example, if religious beliefs contribute to some teenagers not drinking alcohol, not smoking cigarettes, not using e-cigarettes, and at the same time lack of religious beliefs incline other teenagers to do these things, one would see an association between using these various products. Such an association is caused both by factors that influence nonuse of products as well as factors that influence use.
While these studies both attempted to different degrees to control contextual and personal factors that could be linked to smoking, this is easier said than done. The study from Leventhal et al does try to control for the use of alcohol, marijuana and smokeless tobacco (another nicotine product), but uses only one two-level measure of “any use” versus “no use” of all these products. Blunt tools lead to cruder results.
Science aside, gateway rhetoric has long been an important political tool. Fears that e-cigarettes are gateways to smoking are being used to justify policy or regulations. Yet, arguments for product regulations can be made forcefully, without needing to wave the gateway flag.
Where should research about e-cigarettes go?
Let’s flip the question these studies asked. Instead of only asking whether nonsmoking e-cigarettes users move to smoking, why not explore whether higher-risk e-cigarette triers who have also smoked products are prevented from becoming established smokers? Such a question surely needs better than the “one puff” measures of product usage and recruitment to smoking.
Leventhal et al found that 75% (the large majority) of baseline e-cigarette users did not smoke at 12-month follow-up, compared to 91% of nonusers of e-cigarettes. But we don’t know how many smokers who tried e-cigarettes in these age groups were still smoking (beyond a puff) in the future. By the limited logic of the current gateway research, patterns of reduced smoking for e-cigarette users compared to smokers could be interpreted as evidence of preventive effects.
What research should we be doing?
The tobacco and nicotine products are often already illegal for youth to purchase. But these products are legal for adults. The focus on minor gateway effects for youth should not distract from the need to explore policy and clinical questions about harm and disease risk from adult use of legal tobacco products.
Cost, convenience, perceived risks (and official messages about risks) as well as personal preferences can influence which among many products are most used.
It is important to understand interrelationships in tobacco/nicotine product use by adolescents and adults, but both the questions and measures need to be broadened. In addition to concerns for lower-risk youth, we need to assess patterns of product use in higher-risk youth who have tried multiple drugs (alcohol, marijuana, cigarettes, cigars, smokeless tobacco and hookahs) and often have mental health issues. We need to understand how best to prevent these youth from becoming regular users as adults of deadly smoked products.
VapeMentors to Host Webinars, Sponsorship Deadline Oct. 16
VapeMentors is thrilled to share an exciting sponsorship opportunity with you and a unique way to reach thousands of vape space owners and employees. Please read this and make your decision quickly, as this opportunity will be only available until Oct. 16.
VapeMentors will be hosting two one-hour webinars entitled, “Knock, Knock. It’s the FDA Calling,” which will address how vape shop owners and other businesses can “future-proof” their vape shop (or e-liquid company, etc …) and not get shut down or hampered by the FDA.
- On Mon., Oct. 26, at 5 p.m. PST, part I of this jam-packed one-hour FREE* webinar will be presented by Azim Chowdhury, an attorney with the DC-based firm Keller and Heckman and head of the firm’s FDA e-cigarette practice. Chowdhury has represented many e-cigarette and e-liquid manufacturers, suppliers and trade associations in matters of FDA regulatory and corporate compliance.
- Two nights later, on Wed., Oct. 28, at 5 p.m. PST, Bryan Haynes with Troutman Sanders, from Richmond, Va., part II will discuss the e-cig/closed systems/c-store market future scenarios. If you market to convenience stores or are concerned about the “open system vs. closed system” controversy, this is a must-attend session.
VapeMentors already has several sponsors lined up and are seeking other businesses that also see this as an incredible pr opportunity and way to reach vape shops with a great value-add. The VapeMentors team is reaching out to a limited number of potential sponsors at this time and will limit the number of sponsors at each level. The participation levels are as follows:
Gold Sponsorship ($3,000):
• Top billing in all webinar promotions and emails to several mailing lists (VapeMentors and many others)
• 15-second live ad and one page slide in the live webinar and 30-second ad in the archived replay
• Logo and link to your website
Silver Sponsorship ($1,500):
• Secondary billing in all webinar promotions and emails
• 5-second live ad and listed among Silver Sponsors in the live webinar and 30-second ad in the archived replay
• Logo and link to your website
Bronze Sponsorship ($500):
• Mention in all webinar promotions and emails
• Listed among the Bronze Sponsors in the live webinar and replay
• Logo and link to your website
* This program will be free to any business or individual that verifies in its registration that they work for a vape shop, e-liquid or similar type company. The public is invited to join each webinar for $47, or $79 for both.
Regardless of whether you choose to sponsor this webinar, VapeMentors would love your support. VapeMentors will follow up with a draft of an email you may use to alert your followers to this important and timely webinar.
For more information, visit http://vapementors.com/.
Pierce County, Wash. Facing Ban, City Council Taking Public Comments
Photo by Epodunk.com
For those who live in Pierce County, Wash., now is the time to speak up. Kirotv.com reports that a proposed ban on vaping in public and work places (or 25 feet away from the property) has been brought to a Tacoma Pierce County Health Department meeting late last month. The ban includes stores that sell nicotine products and selling to minors
“The health department says it wants to bring electronic cigarette regulations in line with cigarettes, in part to cut down on teenagers using e-cigs,” the story says.
Vape shop owners were strongly opposed, saying that they do not sell to minors. The health department cited supposed chemicals found in e-cigs as another reason, while only one person in the crowd spoke in favor of the proposed bans.
The health department will take public input until Oct. 19, and the five-member board will vote in November.
For the full story, visit http://www.kirotv.com/news/news/ban-vaping-pierce-county-met-heavy-opposition/nnmrp/.
City of Chicago Facing Higher Tax Threat
Photo by vapesquad.com
Chicago is the highest-taxed cigarette city in the United States, according to a recent article on ATR.org, the Americans for Tax Reform site. And, according to the story, the taxes may go even higher in the form of e-cigarette taxing.
Democrats in the city are moving to tax electronic cigarettes the same as analog, tobacco filled cigarettes.
Alderman Proco “Joe” Moreno is looking at an excise tax on e-cigs, amounting to $1.25 for each e-cigarette and 25 cents per mL of e-liquid. A hole in the budget is cited as one of the main reasons for the tax hike proposal, however ATR’s writer said that “Moreno’s proposal would do very little to fill the budget hole—it is projected to bring in less than $1 million, compared to the hundreds of millions of dollars needed to balance the budget and make public employee pension payments.”
For the full story, visit http://www.atr.org/smoke-clears-real-reason-chicago-e-cig-tax.
FIVAPE Supports Totally Wicked Challenge of Article 20 of the EU Tobacco Products Directive
Agent VAPE received this press release regarding the latest in the challenge and FIVAPE’s support of Totally Wicked’s fight:
FIVAPE, the French Vaping Federation, supports Totally Wicked’s challenge of Article 20 of the EU Tobacco Products Directive (TPD), at the Court of Justice of the European Union (CJEU) in Luxembourg today.
At both the national and the European level, our organization is committed to supporting the vaping revolution, a disruptive innovation that has the power to end the global smoking epidemic, which constitutes the first European cause of preventable death.
Despite its potential, the vaping revolution is currently facing serious challenges. We believe that misleading information, fear of change and assimilation to tobacco products have already endangered vapor products, thereby jeopardising further harm reduction for the 10 million of European vapers. Today’s hearing of Totally Wicked at the CJEU might mark a starting point for a more appropriate legislation, aiming to prevent subjecting e-cigarettes to a stricter regulation than that for conventional tobacco products.
As expressed by Totally Wicked, Fivape believes that the health and well-being of millions of Europeans is at stake today in Luxembourg. Article 20 of the TPD might cripple efforts to offer a 95% less harmful alternative to tobacco products: vapers and independent vaping companies have the right to call for proportionate and reasonable regulations.
Today, making available high-quality and secure electronic cigarettes as well as e-liquids is the independent vaping sector’s highest priority: Fivape and many other European companies have committed themselves to long-term and open partnerships with universities, laboratories and public authorities. The independent vaping companies have further initiated national standardization procedures, which have already considerably raised product standards in France and the UK, and have moreover established a new technical committee at the European Committee for Standardization. All these efforts reflect the determination of our sector to engage itself in favour of a renewed and proportionate legal framework, at both national and European level.
Jean Moiroud, President of Fivape, said:
Fivape believes that sustainable open systems, freedom of choice and responsibility for consumers are key to successfully reduce tobacco-related harm. In order to achieve these aims, a sound legal framework is indispensable. Fivape maintains that Article 20 of the TPD is disproportionate and jeopardises the promising future of electronic cigarettes and professionals vapers in which European private sector, scientists, universities are showing a growing interest.
Fivape represents more than 500 French vape companies, among them the leading French producers and distributors. We strive to provide highest-quality electronic cigarettes and e-liquids to the currently three million French users. Fivape has committed itself to full independence from the tobacco industry and therefore has each member sign a declaration of absence of interests with manufacturers of conventional cigarettes and other tobacco products.
Vape Radio Hits All-Time High in September
Vape Radio hit an all-time one month high in September of 82,563 worldwide downloads, a 25 percent increase from the August total of 65,549.
Norm Bour, host of the podcasts, thanks all of his faithful listeners—700,000 coming up soon!
To become a listener, visit http://vapenewsradio.podbean.com/.