E-cigarettes and the gateway hypothesis

This morning I was on the radio discussing electronic cigarettes in response to a headteacher banning their use at Blatchington Mill School, East Sussex (listen from 12 minutes in). The school has every right to make its own rules, of course, and it is as appropriate for a teacher to ban e-cigarettes in the class room as it is to ban mobile phones or bags of chips. E-cigarettes are not designed for children and, although it is not legally binding, a notice reading 'Not To Be Sold To Minors' appears on most e-cigarette packaging.

The ban itself is uncontroversial and inconsequential—the headteacher seemed perplexed by the media attention and conceded that he knew of very few pupils who use e-cigarettes—but the reasons given for it are more concerning. The letter sent to parents claimed that e-cigarettes "may be acting as a gateway into smoking, rather than a way of stopping". In other words, non-smokers start using e-cigarettes and then progress to smoking. E-cigarettes are therefore part of the problem rather than part of the solution.

Since the same fears have been echoed at the EU level where moves are afoot to effectively ban e-cigarettes, separating fact from fiction on the 'gateway hypothesis' is quite literally a matter of life or death. There is increasing evidence that e-cigarettes offer a vastly safer alternative to cigarettes for millions of smokers who cannot otherwise quit and it is possible that this free market solution could improve public health more than the aggressive, neo-prohibitionist legislation seen in recent years.

There are at least 700,000 regular users of e-cigarettes in Britain. The overwhelming majority are smokers or ex-smokers. When Action on Smoking and Health (ASH) issued a report on the subject in January, it found that not only is there "little real-world evidence of harm from e-cigarettes", but that "there is little evidence of use by those who have never smoked". And, in a timely report released today, ASH says that "regular use of e-cigarettes is extremely rare" amongst children. Its survey found that only one per cent of 16-18 year olds—and zero per cent of 11-15 year olds—used an e-cigarette more than once a week. As for non-smoking teenagers...

"Among young people who have never smoked 1% have “tried e- cigarettes once or twice”, 0% report continued e-cigarette use and 0% expect to try an e-cigarette soon... Frequent (more than weekly) use of e-cigarettes was confined almost entirely to ex-smokers and daily smokers."

In short, there is very little evidence that e-cigarettes appeal to non-smokers of any age, let alone that they act as a "gateway" to smoking for young people. We cannot, of course, guarantee that no one will ever take up vaping and later take up smoking. It's a wide world and there is nothing new under the sun. Admittedly, it would require a conscious decision to take up a product that is ten times more expensive and one hundred times worse for their health, but it cannot be ruled out. There is, however, no doubt that, for the vast majority of users, e-cigarettes are a gateway from smoking. The prohibition or over-regulation of these devices will close off a hypothetical gateway from e-cigarettes to tobacco, but it will also close off a very real gateway for people who want to go from tobacco to e-cigarettes, and that is the path most travelled.

I was going to mention the cost element, but the other way round! It is easy to see how a person over 18 could buy twenty cigs and then sell them fo 50p each to young people and make a profit. 50p is pocket money cost. It is hard to see that scenario with respect to ecigs. For a start, a greater initial cost outlay is required, and it is unlikely that youths would pay 'for a puff'.
Thank you for explaining this issue. A similar one is the question of flavours: the accusation that these are used to attract young smokers (or even non-smokers) to e-cigarettes. Again there is no evidence for it; the problem is that since there is no science base or evidence base to use for attacks on e-cigarettes, the only option is propaganda. Since there are more e-cigarette users in their 60s than in their 20s, and since they are the ones using flavours and demanding even more flavours are introduced, again there is no basis in fact. The latest development at EU level is an attempt to ban flavours in Swedish Snus. As this would be likely to decrease the rate of smokers switching to Snus, and therefore protect smoking (or even increase it), we can see the true motives behind such attacks on THR (Tobacco Harm Reduction): protect smoking and protect pharmaceutical industry profits - at any cost. The tobacco control industry and their pharma funders bitterly resent the fact that Sweden is the world leader in the reduction of smoking-related death and disease, and with an expected male smoking prevalence of just 5% in around three year's time, even has a realistic prospect of reducing smoking deaths to insignificant numbers. This has been a disaster for pharma in Sweden and they are desperate to stop the Swedish scenario being spread elsewhere. It is clear who is taking the pharma shilling from the voting to ban ecigs at EU level. We need a forensic accountants' investigation of their personal financial affairs, to root out those paid to protect cigarette sales by restricting access to e-cigarettes. As Prof Britton of the Royal College of Physicians has said, "If all UK smokers switched to e-cigarettes, five million lives would be saved of those alive today". You can't get much clearer than that. It would be more realistic, perhaps, to calculate it based on the very likely 50% switch of smokers to ecigs that will eventually occur if left alone; millions of lives removed from pharma's sick smoker treatment channel (chemotherapy drugs etc) that nets them billions from the UK taxpayer. People need to ask their MEPs how they will vote on this issue; those who vote for regulations on ecigs are voting to protect cigarette sales and protect pharma's income. Now why would they do that?

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