Three years ago, Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention (CDC), warned that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes.” That fear is one of the main justifications for the CDC’shostility toward vaping and the Food and Drug Administration’s onerous new e-cigarette regulations, which are expected to cripple the industry. Yet there is no evidence that Frieden’s claim is true and considerable evidence that it’s not, especially since smoking rates among teenagers have fallen to record lows even as more and more of them experiment with vaping. Two new studies cast further doubt on the idea that e-cigarettes are a “gateway” to the real thing.
Frieden and other e-cigarette alarmists make much of the fact that the percentage of teenagers who report vaping has risen dramatically in recent years. They like to focus on the percentage of teenagers who have ever tried e-cigarettes and the percentage who have used them in the last month, without asking how many are experimenters or occasional users and how many are daily vapers—the sort who might get hooked on nicotine and eventually progress to conventional cigarettes. It turns out there’s a good reason for the CDC’s lack of curiosity on this point: Survey data show that few teenagers who have never smoked use e-cigarettes and that even fewer do so on a regular basis.
“Many fear that e-cigarette use by non-smoking students will lead many to nicotine addiction and subsequent cigarette smoking,” notes University of Michigan health economist Kenneth Warner in an American Journal of Preventive Medicine article published last month. But based on data from the Monitoring the Future Study (MTF), which surveys students in the eighth, 10th, and 12th grades, Warner finds that “non-smoking high school students are highly unlikely to use e-cigarettes” and even less likely to use them regularly. Among the 12th-graders who had never tried conventional cigarettes, 94% had not used an e-cigarette in the previous month. Among the never-smokers who reported using e-cigarettes in the previous month, 60% used them on only one or two days. Less than 1% of never-smokers had vaped on 20 or more days in the previous month.
The MTF numbers, which are similar to the findings of British surveys, suggest it is quite unlikely that “many kids are starting out with e-cigarettes and then going on to smoke conventional cigarettes,” because nonsmokers rarely use e-cigarettes often enough to develop a nicotine habit. Another point Warner emphasizes makes Frieden’s claim even less plausible: “A large proportion of students use e-cigarettes containing no nicotine.” Warner cites a 2014 study that found most never-smoking Connecticut teenagers who vaped used nicotine-free e-liquid.
The significance of that point is underlined by another recently published analysis of MTF data. Richard Miech and three of his colleagues at the University of Michigan’s Institute for Social Research (which conducts the survey) report in the journalTobacco Control that nearly two-thirds of teenagers who have tried vaping consumed “just flavoring” the last time they did it. “Nicotine use came in a distant second,” Miech et al. write, “at about 20% in 12th and 10th grade and 13% in 8th grade.” The other options were marijuana and “don’t know.”
The MTF data indicate that the more frequently teenagers vape, the more likely they are to vape nicotine. Among high school seniors, 47% of those who had vaped six or more times in the previous month reported consuming nicotine, compared to 23% of those who had vaped one to five times in the previous month. But “in no case did the prevalence of nicotine vaping reach 50% or greater.” In other words, “the majority of US youth who use vaporisers and e-cigarettes do not vape nicotine,” a fact that “challenges many common assumptions and practices.”