
E-cigarette use as a predictor of cigarette smoking - doctorpangloss
https://tobaccocontrol.bmj.com/content/26/e2/e106
======
maehwasu
"Smoked a cigarette in the last 12 months" is an incredibly low bar, to the
point where I'd guess the study had a desired outcome.

The important question isn't "were vapers more likely to smoke 1+
times"\--it's "how many cigarettes (from 0 to n) would the average vaper have
smoked in the absence of vape options?"

The latter is a counterfactual, and thus much harder to study. It's almost as
if valuable research is hard, and you can't just slap together a few variables
and toss the "Science!" label on it.

Edit for context: I'm an ex 1-2 packs-a-day smoker, and vaping definitely
helped me substitute a less harmful behavior. I smoke 5-30 cigarettes per year
still, and vape about the same number of times per year. Having substitute
options definitely helps avoid slipping back into cycles of addiction, to the
point where I don't worry about that at all now.

~~~
doctorpangloss
I submitted this partly to see how people would explain away the result.

4.78 RR for smoking one year after vaping for non-smokers is pretty huge.
That’s definitely a clinically significant result. Smoking itself is the
highest OR for lung cancer and therefore mortality of any behavior (in the 60s
for Americans), and using cigarettes really dooms you to that outcome.

Nicotine patches, as transdermal delivery, don’t get people as high as Juul
does, and that’s the likely reason you don’t observe either recreational use
of them nor people becoming smokers from using them.

~~~
stan_rogers
What these studies show is that kids who are likely to try smoking are also
more likely to try vaping. That's it. That's the whole thing. It's
correlation, and doesn't speak in any way to anything like a "gateway drug"
phenomenon - and that has also been recognised in studies that bother to
consider the possibility.

~~~
013a
Oh, right, yeah. Because this line totally isn't directly from the paper's
conclusion:

> These results contribute to the growing body of evidence supporting vaping
> as a one-way bridge to cigarette smoking among youth.

~~~
stan_rogers
I'll see that study and raise you the UVic cohort study that found the
opposite[0], among others if you're willing to look. The "growing body of
evidence" is all about correlations in interview studies.

[0][http://www.uvic.ca/research/centres/carbc/assets/docs/report...](http://www.uvic.ca/research/centres/carbc/assets/docs/report-
clearing-the-air-review-exec-summary.pdf)

~~~
minikites
That link just goes to their homepage.

------
seibelj
I'm trying to follow the logic. E-cigarettes are already banned for those
under-18 in America. Cigarettes and e-cigarettes are legal for those 18 and
over. Because those who smoke e-cigarettes are more likely to smoke real
cigarettes, we should ban e-cigarettes? Even though they are way less harmful
than real cigarettes?

Why not just ban real cigarettes? Wouldn't that solve all the problems?

Oh yes... black markets, prohibition, arrests, expanding prison population,
and on and on...

If we aren't going to throw cigarette smokers in jail, and e-cigarettes are
already illegal for those under-18, then I'm not sure what else we can do. The
state could aggressively fine retail stores who sell to those underage
(although I doubt they sell them illegally). More likely, arrest 18 year old
high school kids who buy them for their friends and underclassmen.

Alcohol and cigarettes were bought for me by the burnout and local junior
college kids when I was in high school.

~~~
antonvs
> Because those who smoke e-cigarettes are more likely to smoke real
> cigarettes, we should ban e-cigarettes?

The conclusion in the article suggests "restricting youth access to
e-cigarettes." It's not talking about a general ban.

> e-cigarettes are already illegal for those under-18,

In the US, individual states have varying laws, and the FDA position has been
evolving. Research like this presumably provides input to that ongoing
process.

> Why not just ban real cigarettes?

They are already restricted at the federal level for under 18.

> Alcohol and cigarettes were bought for me by the burnout and local junior
> college kids when I was in high school.

The problem with personal anecdotes like this is that they give no idea of how
many kids actually didn't do alcohol or cigarettes, or consumed less than they
would have otherwise, because of restrictions.

Your unstated premise seems to be that restrictions like this don't work. If
you look into that, you'll find that's incorrect.

~~~
seibelj
Yes, they are already banned. So why should the FDA ban the sale of Juul
entirely?

------
loudandskittish
But...why? I smoked a pack a day for a little more than 10 years, got an
e-cigarette and haven't looked back. I don't understand why anyone would do
the reverse.

~~~
blihp
The concern is that the e-cig brands have moved well beyond those attempting
to quit smoking. Similar to the old Joe Camel ads, the thinking is that the
e-cig companies are targeting kids with fruit and candy flavors. If they were
really serious about them strictly being a tool for quitting, they should
mandate that the only allowed flavor is wet ashtray. Seriously, what
legitimate reason is there for a quitting tool to be more appealing than the
thing being quit unless the goal is to hook people on the new thing?

~~~
NeedMoreTea
That's ridiculous. One of the reasons nicotine gum isn't that successful is
because of how nasty it tastes.

Why shouldn't those quitting smoking be allowed fruit flavours? I can only
think you want them to fail and end up keeping on smoking tobacco.

~~~
blihp
Failed attempt at humor on my end apparently. No, I don't want those
attempting to quit to fail. The point I was attempting to make is that by
making them taste good (as opposed to at most flavorless) is that it both
makes them more appealing to non-smokers (esp kids) and likely encourages many
smokers to kick cigarettes but pick up a vaping habit rather than a tool to
wean them off of nicotine.

Now one might say 'who in their right mind would want to start a nicotine
habit?' Well centuries of tobacco use to more recent times with people eating
detergent pods, huffing glue etc should readily provide the answer. Also, the
tobacco industry knows what they're doing and I suspect it's not about getting
people off nicotine but rather changing the delivery mechanism. (You do know
big tobacco is big into vaping, right?)

~~~
NeedMoreTea
I can see your point, but some kids are always going to try some of what's
available - weed, tobacco, alcohol, vaping, glue sniffing etc. I doubt the
flavour mattered much when cigs were the only choice, or before they'd learnt
to like beer / vodka. It's far more peer pressure than advertising. yes, of
course ads play a part too.

I would be comfortable with discouraging kids as far as possible, requiring ID
and so on. For some of the adult ex smokers I know, including myself, I doubt
they'd have quit without vaping with some of the sillier sounding flavours.
Some of the quitters will be kids who regret starting smoking 5 years
previously. I don't have good answers to balance the conflicting needs or to
prevent it becoming a growth sector far beyond smokers wanting out.

When I first tried vaping one of the few flavours I got was tobacco - which
was awful, and never tried again. It took some months to step down the
strengths to zero, and kept on vaping a while at 0 nicotine. That was 7 or 8
years ago, and no vaping or tobacco since.

Regulation in the US and UK is very different for vaping, but here big tobacco
seems to be badly failing at vaping. Every shop that sells cigarettes now has
a selection of the tobacco company's cartridge style "pretend cigarettes"
vaping at five or ten times the cost of the simple juice bottles. I've only
ever seen one person using one. Most towns have gained a juice stall selling
cheap flavours.

------
pavanlimo
As a vaper (ex-smoker), let me assert that vaping is like driving Tesla Model
S P100D and smoking is akin to driving 2003 Ford Focus. I'd never gateway to
Ford Focus 2003 from Tesla Model S P100D. Cheeky but true.

------
innocentfelon
The biggest flaw in this study has gone unmentioned: smokers lie.

No one’s following these kids around to verify their responses are accurate. A
sizable percentage of high school kids lie about anything for any number of
reasons. Yeah man, I vape, can I go now? Yeah man, I smoke, are we done?

That alone is plenty to throw out this data. The agenda here is clear: more
research funding to justify harebrained regulations supported by halfassed
written surveys.

~~~
minikites
So we shouldn't research anything related to the social sciences because some
people might lie about it? What leads you to believe that smokers lie more
than nonsmokers if not social science research?

~~~
innocentfelon
The term for this situation is ”streetlighting”, where the possible reigns
over the correct.

“It’s dark in that alley. I’d never find my keys there.”

Doesn’t matter if it’s extremely difficult to get good data here. What matters
is we can’t substitute bad data if that’s all we can come up with.

And although I stated it as smokers lying, the implication is that the
nonsmokers are lying (by claiming to smoke).

~~~
sigmaprimus
It is my understanding that most surveys will include a margin of error. This
story does not mention this, I wonder if this is just slight of hand while the
east coast of the US falls into the sea?!

~~~
sigmaprimus
Or maybe the cable news sites are distracting me from this?!?

------
ajaimk
Where does hookah play into this? I seriously want to know as I’ve never
smoked cigarettes or have a nicotine dependence.

~~~
aldoushuxley001
Hookah is unfortunately one of the absolute worst offenders health-wise. Think
one hookah session is easily multiple cigarettes, likely on the much higher
side too

------
village-idiot
Nicotine addictive, vaping seen as a way to hook the next generation by
tobacco execs, and other unsurprising facts tonight at 11.

------
abootstrapper
Vaping: MAYBE it's not as unhealthy as smoking, but it's definitely not as
cool.

~~~
LyndsySimon
Interestingly enough, vapers themselves seem to be the ones reinforcing this.
Every vape shop I've ever seen is filled with thick clouds, run by teenagers
or burnouts, and just generally a pretty low-class place.

On the other hand, I know several people who are successful professionals that
vape. They order their stuff online, and don't advertise the fact that they
vape.

------
widowlark
Increase tax on tabacco products and include e-cigs

------
exabrial
Why the heck are e-cigs illegal for anyone? They're as harmless as theater
haze.

~~~
mrob
The carrier liquid might be the same thing as theater haze, but theater haze
doesn't contain nicotine (which has known health risks even without combustion
products), doesn't contain flavorings that are only tested for food use (and
the example of "popcorn lung" from diacetyl shows that inhaling flavorings
directly is not the same as using them in food), and is inhaled in much lower
concentrations. E-cigs are safer than smoking, but to call them "harmless" is
a strong claim that requires evidence.

~~~
shermanyo
(Full disclosure: I run a small business making and selling flavoured
e-cigarette liquid) The levels of diacetyl from a conventional cigarette can
be around 750x that of what you'd get from an e-cigarette containing such a
flavouring. Most concentrate manufacturers have removed or replaced any
flavours that contain this or other known irritants wherever possible, and
provide material safety data sheets for all ingredients. As far as I am aware,
there have been no reported cases of "popcorn lung" from vapers or smokers.

If I am mistaken or unaware of any contradictory information, I would really
appreciate being pointed in the right direction.

[http://tobaccoanalysis.blogspot.com/2015/12/new-study-
finds-...](http://tobaccoanalysis.blogspot.com/2015/12/new-study-finds-that-
average-diacetyl.html)

------
minikites
I'm not sure why we collectively decided to trust the tobacco industry on this
issue, this can't be overly surprising given their level of interest in this
emerging market.

