Lynn T. Kozlowski, Kenneth E. Warnerba
The debate about electronic cigarettes ranks as perhaps the most divisive in the history of tobacco control. Proponents believe that e-cigarettes could foster widespread abandonment of combusted tobacco products, by far the most dangerous form of tobacco use, and thereby dramatically reduce the disease and death caused by smoking (Abrams, 2014). Opponents fear these products may seduce new generations of youth into nicotine addiction, many of whom may even find a ‘gateway’ to cigarette smoking. They see in e-cigarettes the potential of ‘renormalizing’ smoking (U.S. Department of Health and Human Services, 2016). In striking contrast to supporters’ view, some opponents worry that dual use of cigarettes and e-cigarettes by adults will reduce smoking cessation. And in similarly striking contrast to opponents’ worries about kids, supporters believe that e-cigarettes may be providing young people an alternative to far more dangerous cigarette smoking (Kozlowski, in press; Kozlowskiand Sweanor, in press; Warner, 2016).
- Nicotine-containing vapor is not safe but is much less harmful than cigarette smoke
No one considers vaping risk-free. But neither is there any significant doubt that vaping is much less harmful than smoking cigarettes. The critical issue is how much.
- E-cigarettes as a gateway to smoking: a principal argument against e-cigarettes
The causal gateway theory is straight forward: E-cigarettes attract children who never would have become smokers, perhaps because they view e-cigarettes as potentially “fun” like smoking but with-out the risk.
- Evidence that e-cigarette use by youth is not leading to more smoking
While cross-sectional data do not permit attribution of causality to correlated trends, data from two major surveys on use of both e-cigarettes and tobacco cigarettes by middle – and high -school students are inconsistent with the notion that e-cigarette use is increasing smoking.
- Policies for tobacco/nicotine harm reduction
In this section we propose policies that we support for all nicotine and tobacco products. In so doing, we are forced to diverge from our exclusive focus on youth.
The role of e-cigarettes in the future of youth smoking has yet to be definitively assessed. Prospective studies – the only evidence that e-cigarette use might lead to smoking – do not yet persuade that e-cigarettes are a substantial causal gateway to cigarettes. At best, they sup-port that a minority of the relatively small number of e-cigarette triers – who haven’t also been experimenting with other tobacco products already – will go on to some experimentation with cigarettes. We need to better understand and assess confounding variables, such as other tobacco use, other substance use(marijuana and alcohol), and mental illness, as they influence the behavior of high-risk youth.