Gateway effect from vaping to smoking confirmed among Australian adolescents

An Australian study shows that the use of electronic cigarettes is the main risk factor for smoking among adolescents who say they are likely to become smokers.

Based on the observation that the susceptibility to becoming a smoker is an important predictor of smoking, a team of Australian researchers looked at the risk factors linked, in adolescents, to this susceptibility to becoming smokers.

These researchers relied on data from the Australian Secondary Students' Alcohol and Drug (ASSAD) study, collected in schools between May and December 2017 using self-administered questionnaires.[1]Of the 4,266 students aged 12 to 17 surveyed in the state of Victoria, the focus was on the 3,410 of them who presented risk factors with regard to smoking.

These risk factors have already been identified from other studies and include demographic (sex, ethnicity) and social (presence of smokers in the entourage) factors, as well as criteria such as school attendance, amount of pocket money, social norms (presence in the media, exposure to tobacco smoke), knowledge about smoking, positive or negative perception of smokers, feeling of well-being and use of other substances.

Vaping, the first risk factor for smoking

The results of the study show that 11 % of the adolescents surveyed are likely to become smokers. Among these, experimentation with electronic cigarettes appears to be the main risk factor for the susceptibility to becoming a smoker. The adjusted odds ratio (ORA: 3.26) is of the same order as that established in a meta-analysis, which showed that non-smokers who have vaped are three times more likely to become smokers than other non-smokers.[2].

Other risk factors identified in this susceptibility to becoming a smoker were the impression that smokers are more popular (ORA: 2.87), having a close friend who smokes (ORA: 2.66), not considering the consumption of one or two cigarettes to be dangerous (ORA: 2.56) and having symptoms of depression (ORA: 1.59).

Risk factors to consider

The authors of the study conclude that these different risk factors highlight the social part of smoking behavior as well as the influence of the perception of tobacco products; they consider that these factors should be taken into account more during prevention actions, particularly in schools. The authors also believe that strict regulation should be applied to the sale and promotion of electronic cigarettes, in order to protect the youngest audiences; the anti-tobacco control guidelines defined by the Australian government in May 2023 are moving in this direction, provided that they are strictly observed. Finally, the authors encourage the initiation of communication campaigns and different strategies in order to correct the erroneous perceptions associated with smoking and its consequences on health.

Keywords: Australia, susceptibility to becoming a smoker, adolescents, vaping, e-cigarette.

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[1] Scully M, Greenhalgh E, Bain E, Wakefield M, Durkin S, White V, E-cigarette use and other risk factors associated with tobacco smoking susceptibility among Australian adolescents, Australian and New Zealand Journal of Public Health, published online 22 August 2023, https://doi.org/10.1016/j.anzjph.2023.100076.

[2] Baenziger ON, Ford L, Yazidjoglou A, Joshy G, Banks E, E-cigarette use and combustible tobacco cigarette smoking uptake among non-smokers, including relapse in former smokers: umbrella review, systematic review and meta-analysis, BMJ Open, 11 (3) (2021 Mar 30), Article e045603

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