The most recent MMWR has generated news headlines around the world. The National Post headline read: As more children use e-cigarettes, health officials worry it will lead to regular smoking. Or CDC: E-cigarette use doubles among children courtesy of AlJazeera America. The problem with these headlines is that the study showed nothing of the sort.
The main finding was that there appeared to be an increase in children trying e-cigarettes. What was reported was ever use, a category that ranges from taking one puff to daily constant use. At that age, most of the ever use reported probably was of the one time try.
Authors of and those commenting on these studies forget what those years are like. They are the years of curiosity and experimentation and many things are tried once. If you examine your own history you will find yourself as an ever user of many things – I have tried a few drugs just once, a few foods just once, a few behaviors just once. I jumped out of a plane once but did not repeat the experience and so I might be an ever jumper it would be wrong to call me a skydiver.
And though self reporting is at best only a guideline to actual behavior, if I would have been one of these kids and had just seen my parent with an e-cigarette I just might report I had tried it just to give the impression I was in the know.
But let’s take the numbers at face value for the time being. As Carl Phillips has pointed out, the numbers themselves do not support the conclusion. Among the points he makes that are worth repeating are that (but do go and read his full post):
1. Even if the rate of experimentation or use in a grade year did not increase from one year to the next, polling the following year should show an increase (the only way it could not is if all those who had not already tried e-cigarettes remained abstinent).
2. Hoisting the gateway flag is an admission that you don’t care too much about the actual behavior. (It might not be bad but look at where it leads..).
3. The gateway hypothesis is impossible to prove or disprove. As long as one behavior precedes the other you can make the case. However what is often dismissed is that the connection between the behaviors is how risk seeking or averse the person is.
The gateway hypothesis which states that one behavior makes the second and supposedly worse behavior more likely has three major troubling implications.
1. Invoking the gateway idea suggests that it is reasonable to ban a behavior that might be innocuous or even beneficial in itself.
2. Your odds of engaging in a behavior are motivated more by your past experience than by your present circumstances or state of mind.
3. Once you start something you will not be satisfied until you have pushed it to the limit.
The first really annoys me and is part of the family of nonsense that argues that it is alright to burden typical users (the majority) with costs in order to influence the behavior of extreme users (a minority). Right now in Alberta there is a move on to increase the price of alcohol (already quite high) to counter a perceived increase in binge drinking. While they are at it why not raise the cost of food so the obese will eat less?
In the case of tobacco products every safer alternative to smoking has been decried as a gateway product. So bans have been suggested and in many cases supported for the very products that could remove the health costs from daily nicotine use.
The second point implies that we have no control over our behavior.
If some offers me some heroin I guess I will have to take it because I’m familiar with marijuana. (Surprise – even druggies can Just Say No!)
Thirdly, the idea that the gateway behavior excites a need to take it up a notch means that my experience of drinking beer has to end with imbibing ethanol. What they don’t get is that every member experience of a category has its own distinct pleasures. When I drink beer I have a set of pleasures that are quite distinct from when I drink scotch. Though alcohol is the common appeal, the variety of liquors cannot be reduced to simply drug delivery devices.
But to get back to e-cigarettes, the point is that though vaping is a great alternative to smoking, it is not the same as smoking. The anti-nicotine forces are using every weapon they can think of to obscure the difference between the two in the hope that all the bad baggage from cigarettes tobacco transfers over to e-cigarettes.