Vaping as a Gateway ... to Cigarette Smoking?

By Chuck Dinerstein, MD, MBA — Aug 07, 2023
As fewer individuals pick up cigarettes, more are picking up vape cartridges. Over time, some smokers move on to vaping, while some vapers move on to smoking; the gate swings in both directions. Does perhaps the gate swing more one way or another? Authors of a new study offer what they've learned.
Image by Alfi Mahini from Pixabay

ACSH believes that smoking is bad for you and that switching to nicotine vaping is a form of harm reduction for those smoking. We do not advocate for consuming nicotine in any form. But the reality is that those initially entranced by vaping may become dual-users, lighting up and inhaling or just lighting up a cancer stick. A new study in Drug and Alcohol Review looked at the smoking and vaping status of New Zealanders between 2018 and 2020. The underlying concern was whether vaping contributed to or exacerbated the goal of a smoke-free New Zealand.

The dataset was the New Zealand Attitudes and Values Study, a 20-year longitudinal national study of “social attitudes, personality, ideology, and health outcomes.” The researchers looked at the responses of roughly 40,000+ participants to the question of whether they currently smoke and at the 2-3000 participants who responded affirmatively over the interval. Participants were in their early 50’s, and roughly two-thirds were male. [1]

Over time, the number of smokers decreased from 7.4% to 5.2%. The number of vapers increased from 2.8% to 3.4% - a 30% reduction in cigarette smoking and a 21% increase in vapers.

In the initial transition period, more vapers began to smoke, while in the second transition period, more smokers began to vape.

"…those who vaped were just as likely  to  take  up  or  switch  to  smoking  as  those  who smoked were to take up or switch to vaping."

Is the cup half empty or half full?

This is a fair interpretation of the data, but not the only one. Cumulatively, when considering smoking and vaping, there was an overall decrease, and importantly, among those using nicotine, there was a shift to vaping, a safer, although not the safest choice, which would be not smoking or vaping.  

For the researchers, the cup is half empty,

“Contrary to the desired hope, vaping appears to have emerged as just another smoking-related behaviour rather than a substitute for smoking that primarily helps people quit.”

For clinicians, the cup may be half full. More individuals are choosing vaping over more harmful cigarettes, and there is no firm evidence that vaping is a unidirectional gateway to smoking. Individuals who take up smoking and vaping disregard the scientific consensus that nicotine use in either of these forms is harmful. In the struggle to create a smoke-free New Zealand, or US for that matter, more individuals are choosing the lesser of two evils. Sometimes, it is better to achieve your goal incrementally, especially when the only realistic way to create a smoke-free anywhere is to ban cigarettes, and that is a fantasy that comes with its own problems.

[1] Interestingly, unlike US studies, cigarettes, and vaping were used more among the affluent than those less well off.


Source: Effects of vaping on uptake and cessation of smoking: Longitudinal analysis in Aotearoa New Zealand adults Drug and Alcohol Review DOI: 10.1111/dar.13702


Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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