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11 <br />in e-cigarette use 42. According to a top public health official: <br />This raises concern that there may be young people for whom e-cigarettes could be an entry <br />point to use of conventional tobacco products, including cigarettes. <br />In fact the data do not support a gateway effect and a rise in e-cigarette use among adolescents <br />would be expected to mirror the rise in use among adults. In reality, US teenage smoking prevalence <br />fell sharply as e-cigarette use increased and e-cigarette use was highly concentrated among existing <br />smokers 43. The relevant CDC data are shown in the chart below: <br /> <br />Source: raw data from CDC National Youth Tobacco Surveys (NYTS). Data analysis and graphic by Brad Rodu <br />Similar effects were found in France 44 and confirmed for the United States in the Monitoring the <br />Future survey, which showed a rise in e-cigarette use, but also found record low rates and record <br />annual declines for “daily” and “past 30 day” cigarette smoking by teens from 2013 to 2014 45. In <br />essence we are seeing e-cigarette use rise in line with growth in adults, but cigarette smoking falling <br />sharply. These are reasons to be positive, not to conclude that e-cigarettes a problem. <br />3.2.4 Understanding and defining gateway effects <br />It is difficult to find a proponent of the gateway effect who can rigorously define what they mean <br />and how they would measure it. To establish a gateway effect is in practice difficult. It is necessary <br />to show that a period of e-cigarette use is the reason why someone develops a consolidated <br />smoking habit. It is not sufficient to show rising e-cigarette use coincided with rising smoking 46 – <br /> <br />42 CDC E-cigarette use more than doubles among U.S. middle and high school students from 2011-2012, 5 September <br />2013 [link] <br />43 CDC MMWR Tobacco Product Use Among Middle and High School Students — United States, 2011 and 2012, 15 <br />November 2013. [link] Higher resolution graphic [link] <br />44 Survey reported in English on Le blog de Jacques LeHouezec, 16 May 2014. [link] <br />45 L. D., O'Malley, P. M., Miech, R.A., Bachman, J. G., & Schulenberg, J. E. (2015). Monitoring the Future national results <br />on adolescent drug use: Overview of key findings, 2014. Ann Arbor, Mich.: Institute for Social Research, the University <br />of Michigan [link] <br />46 Goniewicz ML, Gawron M, Nadolska J, Balwicki L, Sobczak A. Rise in Electronic Cigarette Use Among Adolescents in <br />Poland. J Adolesc Heal 2014; 55: 713–5. [link]