Teens Who Vape Would Be Smoking If Vapes Weren’t Invented, Study Suggests

    A new study suggests that teens who vape would probably be smoking cigarettes instead if vapes had never become available.

    The academic article, published in Nicotine & Tobacco Research, set out to determine whether youth who vaped between 2014 and 2018 would, in the absence of e-cigarettes, likely have become smokers. In other words, the social epidemiologists who co-authored the study—Dr. Natasha Sokol, a fellow at Brown University’s Center for Alcohol and Addiction Studies, and Dr. Justin Feldman, a fellow at Harvard’s François-Xavier Bagnoud Center for Health and Human Rights—wanted to question the so-called “gateway” theory: the idea that vaping, for teenagers, is a path toward smoking.

    Sokol and Feldman ran a regression analysis of 12th-graders with data culled from the “Monitoring the Future” report—a survey conducted by the federal government’s National Institute on Drug Abuse (NIDA) that measures different forms of drug use by adolescents nationwide. Their modeling examined variables including age, race and ethnicity, geographic region of residency, grade point average, alcohol consumption and parents’ educational attainment, among several others.

    “Our model predicted smoking prevalence quite accurately prior to the availability of e-cigarettes,” Sokol told Filter. “But once e-cigarettes became available in a widespread way, it increasingly overestimated the prevalence [of smoking]. So the prevalence was decreasing, but our model based on a pre-e-cigarette era was predicting a decrease but not as steep.”

    “[The youth] who had a low propensity to smoke after e-cigarettes were available were exceedingly unlikely to use e-cigarettes,” Sokol said.

    In other words, the youth who do vape are generally those who would have been smoking were vapes unavailable. “The decline in youth smoking,” Sokol continued, “really accelerated after the availability of e-cigarettes.”

    “There are two bits of good news in this,” Clive Bates, a tobacco control expert and former director of Action on Smoking and Health (UK), told Filter. “The first is that young smokers will be diverted into vaping and probably spared a life of smoking. The second is that most of the vaping among kids who never would have been smokers will be pretty transient and likely not persist after a period of experimentation.”

    According to the most recent figures from the Centers for Disease Control and Prevention (CDC), 4.6 percent of high schoolers currently smoked cigarettes and 19.6 percent vaped in late 2020. (“Current use” is defined as respondents indicating their use of these products “on at least 1 day during the past 30 days.”) Teen vaping rates have recently fallen, too.

    In general, there are two sides of the vaping debate. One—powered by wealthy philanthropists, mainstream public health organizations and influential nonprofits like the Campaign for Tobacco-Free Kids (CTFK) and Parents Against Vaping E-cigarettes (PAVE)—concerns itself with youth use and the fear of a new generation “hooked” on nicotine. The other—a mixed coalition of former smokers, members of the harm reduction community, libertarian tax reformists, a growing contingent of scientists and industry players—emphasizes how switching users of combustible tobacco to lower-risk alternatives can save lives.

    Sokol and Feldman’s findings might be unsettling for those in the former camp, who have ensured that the US is years-deep in a youth vaping “epidemic” narrative. CTFK and their allies have been encouraging flavor vape bans in towns, cities and states across the US. They continue to cite that “some studies have found that young people who use e-cigarettes are more likely to become smokers.”

    This may reflect nothing more than the fact that teenagers who are more prone to one behavior that involves some risk—vaping—are also more inclined to take other risks. But if more of these teenagers are substituting far-less-harmful vapes for the cigarettes they would otherwise have been smoking, that should be a source of great relief.



    Photo by Vaporesso on Unsplash

    • Alex was formerly Filter’s news editor. He previously worked as a reporter and copy editor at VICE, and has been published in the New York Times Magazine, the Columbia Journalism Review, the Los Angeles Times and the New Republic, among other outlets. He was also previously a freelance editorial consultant for the Foundation for a Smoke-Free World; The Influence Foundation, which operates Filter, has received grants from the Foundation for a Smoke-Free World. He is currently based in Los Angeles.

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