Big Question 8 - Are Smokeless Products a Gateway to Cigarette Smoking?
KEY SUMMARY POINTS
1
The gateway effect proposes that Smokeless Product use leads to cigarette smoking.
2
Methodologies to assess gateway must reflect real world usage and have biochemical verification.
3
While Smokeless Product usage has increased, smoking rates have reduced to an all-time low suggesting the opposite of the gateway effect is occurring.
"We do believe, however, that causal claims about a strong gateway effect from e-cigarettes to smoking are unlikely to hold, while it remains too early to preclude other smaller or opposing effects."
Prof L Shahab
University College London [1]
Measuring the gateway effect
Today there are several studies and review articles of longitudinal questionnaire-based studies with multiple time points, assessing levels of cigarette and Vapour Product usage at an initial time point with later time point follow-ups, again assessing levels of tobacco product usage. Typically, the questionnaires classify participants as a ‘user’ if they had taken one puff in the past 30 days. If a study participant had indicated they were a Vapour Product user at the initial time point and then indicated they were a smoker at a follow-up time point, the conclusion would be that the Vapour Product had acted as a ‘gateway’ to the participant being a smoker.
