E-cigarettes: Gateway or roadblock to cigarette smoking?

In detailed qualitative interviews with young people aged 16 to 25 across Scotland and England, the majority of participants viewed e-cigarettes as having reduced -- not increased -- the possibility of both themselves and other people smoking.

"There was very little indication amongst the young people interviewed that e-cigarettes were resulting in an increased likelihood of young people smoking," said Dr Neil McKeganey who led the research. "In fact the majority we interviewed, including those who were vaping, perceived smoking in very negative terms and saw vaping as being entirely different to smoking."

During one interview, an eighteen year-old commented: "I think vaping is having an effect on smoking cigarettes in that it's taking away from it. People are moving off cigarettes and moving onto vaping." Another said: "I think if vaping becomes more common, then smoking is going to become more uncommon because it's the aspect of quitting. I think vaping will replace smoking."

Importantly, the overwhelming majority of participants -- who collectively represented current and former smokers, non-smokers, and e-cigarette users -- viewed tobacco as 'extremely harmful' and believed e-cigarettes offered smokers an alternative.

Many also said they thought "vaping will make smoking decline."

Asked whether the opposite might happen; that e-cigarettes might actually lead to smoking, one nineteen year-old said: "I think it's usually people who are trying to stop smoking who vape. I mean there is the odd person who does it because it's cool and that might influence them to want to try smoking, but I think on the whole it's the other way round. It's people vaping who have given up smoking."

Despite the acute awareness of the harms of tobacco however, it was evident that some young people remain confused about e-cigarettes and whether or not they are similarly harmful. Some mentioned they had seen media coverage reporting that e-cigarettes "are just as bad" as smoking and, as a result, they were uncertain and reluctant about using the devices.

"While it is encouraging to see that young people appear to be quite clear about the role of e-cigarettes in society (devices used by smokers who are trying to -- or already have -- quit tobacco)," said McKeganey "It's more concerning, particularly for the young people who currently smoke, that inaccurate perceptions of e-cigarettes could result in the persistent use of combustible tobacco irrespective of the fact that Public Health England has concluded vaping is 95% less harmful than conventional cigarettes."

Where concerns were expressed around e-cigarettes, they were mostly about the uncertainty of long term use: "It took over 40 years for them to find out that smoking was really bad for you so I don't know whether they will come out with something in the long term that will say 'it's bad for you'," said one participant. "I don't think it's going to be any worse than smoking, but for people who don't smoke and who are vaping, I'd say there was a question mark over whether or not it's good or bad in the long term."

This level of uncertainty was shared by others, too; a fact McKeganey finds concerning. "What was apparent is that this persistent view, expressed by some young people, that vaping was just as harmful as smoking, was resulting in some young people continuing to smoke when they might otherwise have quit."

"But what was equally clear from our research is that the much debated 'Gateway' theory is not materialising. There was nothing to suggest that youngsters see vaping as a stepping stone to smoking -- quite the opposite."