Smoking levels in Britain have plummeted in the last century. In 1974, nearly a third of 16-year-olds were smokers, but by 2018 that figure had fallen to 2.5%.
That is a huge public health success story!
And yet, counterintuitively, something has happened: the return of teenage vaping. A research in the BMJ's Tobacco Control journal reveals that teens who vape are much more likely to smoke cigarettes than other teens, who don't vape. According to the research, about 40% of teen vapers said they smoked while only 12% in non-vapers did.
The researchers point out that causality is not apparent, but the correlation is concerning.
The gateway debate
Has vaping become a "gateway" to cigarette smoking....?
In 2018, the National Academies of Sciences, Engineering, and Medicine issued a report stating that there is "substantial evidence" that e-cigarette use increases the risk of future cigarette smoking in youth and young adults.
This does make sense even if young people aren't using nicotine vapes, it's the action of simply puffing on something (oo er) that could lead to you just feeling like you need to be doing that (oo er) in order to feel normal....
And obvs if they are on the nicotine vapes, this means addition to real cigarettes becomes more likely.
The marketing influence....
Teenagers' appeal for vaping is fueled partly by aggressive marketing and sweet, youth-centric flavors. In a 2020 Pediatrics study, flavour choice was among the explanations teenagers first used e-cigarettes. The authors concluded that flavoured e-cigarettes increased initiation and persistent use, which in turn has the effect of raising the likelihood of combustible cigarette trial. Flavoured products remain widely available online and on black markets even as regulators imposed an intensity of crackdowns.
Social Pressures...
With mental health problems among adolescents are also increasing, vaping can be an escape, a stress reliever, something to look forward to after a stressful period at work or school.
And then there's the fact that it's affordable and accessible, relatively easily concealable, and something teens can do together as small act of rebellion, it's easy rebellion.
Where is policy at?
What then should teachers and policymakers do?
There's a tricky balance between allowing teens to vape and pushing them towards tobacco, which is probably worth in terms of its negative health impacts.
Options include strengthened enforcement against youth-directed advertising, stricter restrictions on flavoured products, and more intensive school-based teaching on the addictiveness of nicotine. But equally critical, tackling the mental health pressure which brings young people to nicotine use in the first place could be part of the package.
Final thoughts
The reduction in youth smoking during the last five decades is a success story of public health. But the increase in youth vaping is set to muddy that achievement.
Vaping does not necessarily translate to smoking, but the commonality between the two is too high to dismiss. To save the next generation, Britain needs to make sure that vaping is a means of adult harm reduction and not a gateway into the world of nicotine for its young people.