10.2. SR 09-08-2015 - Laserfiche WebLink

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E-cigarettes: an evidence update 38 the gateway theory is often treated as a straightforward scientific theory, its emergence is rather more complicated. In effect, it is a hybrid of popular, academic and media accounts – a construct retroactively assembled rather than one initially a rticulated as a coherent theory” [22]. Despite these serious and fatal flaws in the arguments, the use of the term ‘gateway’ is commonplace both in the academic literature and the lay press, particularly in relation to EC use and whether EC are a gateway to smoking. Some have suggested that if EC use increases at the same time as smoking increases then EC are acting as a gateway to smoking. Similarly, it’s been argued that if someone uses an EC first and then initiates smoking, EC are a gateway. These arguments are clearly erroneous. To give one example of the misuse of the gateway concept, a BMJ news item on the Moore et al., 2014 [18] cross-sectional study discussed above commented that “[EC} could be a gateway into smoking” [25]. Kandel recently argued that evidence from mice offers a biological basis for the sequence of nicotine to cocaine use in people [26], but there is limited evidence for this. In reality, the gateway theory is extremely difficult to test in humans. For example, a clean test of the gateway hypothesis in relation to EC and smoking would require randomising people to an environment with EC and one without, and th en following them up over a number of years to assess uptake of EC and smoking. We strongly suggest that use of the gateway terminology be abandoned until it is clear how the theory can be tested in this field. Nevertheless, the use of EC and smoking requires careful surveillance in young people. The preferred option is that young people do not use EC but it would be preferable for a young person to use an EC instead of smoking, given the known relative risks of the EC and smoking cigarettes [10]. Summary Since EC were introduced to the market, smoking prevalence among adults and youth has declined. Hence there is no evidence to date that EC are renormalising smoking, instead it’s possible that their presence has contributed to further declines in smoking, or denormalisation of smoking. The gateway theory is ill defined and we suggest its use be abandoned until it is clear how it can be tested in this field. Whilst never smokers are experimenting with EC, the vast majority of youth who regularly use EC are smokers. Regular EC use in youth is rare. Summary of findings Adults: Around one in 20 adults in England (and Great Britain) use EC. Current EC users are almost exclusively smokers (~60%) or ex-smokers (~40%), that is smokers