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Asian Tribune is published by E-LANKA MEDIA(PVT)Ltd. Vol. 20 No. 73

Convincing analysis that e-cigs are a gateway to cigarette smoking

By Manjari Peiris

Professor Stanton A. Glantz, Director, Centre for Tobacco Research, Control and Education states that the findings of the study in Tobacco Control published by Jasmine and colleagues, titled "Is e-cigarette use in non-smoking young adults associated with later smoking?

A systematic review and meta-analysis" is the most comprehensive meta-analysis to data and convincingly shows that youth and young adults (up to age 30) who initiate nicotine use with e-cigarettes are, much more likely to be smoking cigarettes later.

This paper includes 17 studies from the US, UK, Mexico, Germany, and the Netherlands and every single one page of these studies showed that e-cigarette use was associated with significantly increased odds of subsequent cigarette smoking initiation.

The paper includes impressive sensitivity analysis that presents analyses of unadjusted and adjusted odds (for a wide range of potential confounders) of subsequent smoking, how e-cigarette use and smoking were assessed, where the studies were done (US, UK, other countries), and whether or not studies included only youth (18 years old) or young adults (18+ years old). While these different analyses led to slightly different overall estimates of risk, the results were always statistically significant and positive.

Professor Glantz states; " Given the strength of this analysis, I was surprised that the authors minimized the impact of their own findings, including holding out the promise that e-cigs were a good cessation tool from adults (a question not addressed in the paper):

In conclusion, there is a strong consistent association in observational studies between e-cigarette use among non-smokers and later smoking.

However, findings from published studies do not provide clear evidence that this is explained by a gateway effect rather than shared common causes of both e-cigarette use and smoking.

This emphasizes the need for a scientific forum to discuss the evidence to date and directions for future research.

Future research should consider including relevant potential co-founders, such as better measures of impulsivity and other measures of propensity to risk taking, and objective measures of smoking status in order to better explore the potential role of e-cigarettes as a gateway to smoking.

Studies that explore the genetic underpinnings of these behaviors and use negative control outcomes may also help improve our understanding of the association between e-cigarette use and later smoking.

A scoping review, including qualitative evidence, could provide a clearer understanding of the why e-cigarette use is associated with later smoking.

Importantly, any recommendations regarding e-cigarette regulations to limit the burden of future smoking must consider the potential beneficial impact of e-cigarette use on smoking cessation.

Stay Safe, Stay at Home, Stay Informed, But Don't Forget to Wash Your Hands.

- Asian Tribune -

Convincing analysis that e-cigs are a gateway to cigarette smoking
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