Vaping: popular with young smokers (Image: Isopix/Rex)

The largest study of electronic cigarette use in Europe may help alleviate fears that the devices are a gateway to smoking real cigarettes.

One of the big concerns around the use of e-cigarettes, or “vaping”, is that they tempt people who don’t already smoke, getting them hooked on nicotine. Although they are generally considered safer than smoking, the jury is still out on the long-term health effects of vaping. Some people also worry that e-cigarettes could renormalise smoking, and be a gateway to smoking real cigarettes – especially in young people.

Stanton Glantz at the University of California in San Francisco is convinced that e-cigarettes lead young people to smoke real cigarettes. Research he published earlier this year found that the use of e-cigarettes in US middle and high school students – aged 12 to 18 years old – was associated with a higher likelihood of also smoking real cigarettes.


But his study doesn’t show whether those people already smoked before they tried e-cigarettes, which makes it impossible to say whether vaping really is a gateway to smoking.

Kick the habit

The latest study tries to address this. Constantine Vardavas at the Harvard School of Public Health and his colleagues analysed survey data collected from over 26,500 people across 27 countries in Europe in 2012. Extrapolating from this, they estimate that 29 million Europeans have used an e-cigarette, and that users are likely to be heavy smokers, and to have tried to kick the habit over the past year.

E-cigarette use was highest in smokers aged 15 to 24. But it found scant evidence that e-cigarettes are encouraging those who don’t smoke to pick up the habit. Twenty per cent of smokers had tried e-cigarettes at least once, 4 per cent of ex-smokers had – and just 1.1 per cent of non-smokers had.

Smokers who had attempted to quit smoking in the past 12 months were twice as likely to have tried vaping than other smokers, and e-cigarette use was more common among those smoking at least six cigarettes a day than in those whose daily intake is five or fewer.

“This study verifies that e-cigarette use does not renormalise smoking,” says Konstantinos Farsalinos, a cardiologist at the Onassis Cardiac Surgery Center in Athens, Greece, who was not involved with the work. “The results show minimal adoption by non-smokers.”

Vardavas says the number of young people vaping can be interpreted as both potentially promising and worrying. “On one hand, e-cigarettes could be helping young people to quit. On the other, maintained nicotine addiction at a population level may significantly hinder tobacco endgame efforts,” he says.

Big Tobacco

The study comes as two big cigarette companies – Altria, which makes Marlboro, and Reynolds American, which makes Camel – announced that they would start distributing their own e-cigarettes later this year.

It also coincides with a letter to the World Health Organization signed by 129 doctors and specialists from around the world voicing their concerns about the involvement of Big Tobacco in the rapidly growing industry, urging the WHO to regulate e-cigarettes as though they were tobacco products.

In a sign of how divided those who work in public health are over the issue of e-cigarettes, the latest letter is a riposte to another sent earlier this month by group of scientists, accusing the WHO of either “overlooking or purposefully marginalising” the idea that e-cigarettes could be a low-risk alternative to cigarettes.

Journal reference: Tobacco Control, DOI:10.1136/tobaccocontrol-2013-051394