Myth: Alternative nicotine products are a gateway to smoking

Is the use of reduced risk nicotine products like vapes, snus, nicotine pouches, etc. a gateway to smoking combustible tobacco? Can the use of these products be a gateway to an addiction to illicit substances and criminal activity to support that addiction? Your Safer Nicotine Wiki (SNW) team explores the answers to those questions below.

The Gateway Hypothesis

Science Hygiene

Nicotine - Retracted Studies, Papers, and Articles

• For commentaries on papers indicating the possibility of a gateway effect, please see the "Gateway" section of the Retractions SNW page.

Papers

2024: The “Gateway” hypothesis: evaluation of evidence and alternative explanations

• Conclusion: "Evidence offered in support of the gateway hypothesis does not establish that ENDS use causes youth to also smoke cigarettes. Instead, this evidence is better interpreted as resulting from a common liability to use both ENDS and cigarettes. Population-level trends are inconsistent with the gateway hypothesis, and instead are consistent with (but do not prove) ENDS displacing cigarettes. Policies based on misinterpreting a causal gateway effect may be ineffective at best, and risk the negative unintended consequence of increased cigarette smoking."
  • Citation: Selya, A. The “Gateway” hypothesis: evaluation of evidence and alternative explanations. Harm Reduct J 21, 113 (2024). https://doi.org/10.1186/s12954-024-01034-6
    • Acknowledgment: The author thanks Joe Gitchell, Sooyong Kim, and Saul Shiffman, all of Pinney Associates, Inc. for their feedback on an early draft of this manuscript, and Floe Foxon and Sooyong Kim for assistance with manuscript formatting. Through Pinney Associates, Inc., AS provides consulting services on tobacco harm reduction to Juul Labs, Inc. (JLI). JLI partially supported the preparation of this manuscript, and reviewed and commented on a near-final version. After the initial submission of this manuscript, AS also began individually providing consulting services on behavioral science to the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) through ECLAT Srl, which received funding from the Foundation for a Smoke-Free World (FSFW). Neither CoEHAR nor FSFW had any role in, or oversight of, this commentary.

2015: Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would)

• "Searching for some signal of a gateway effect amidst overwhelming confounding and reverse causation requires more rigorous methods than are typical in public health epidemiology. This generalizes to any attempt to use cross-sectional data to sort out causation in a particular direction from confounding or reverse causation. When seeking epidemiologic associations where confounding is minimal or relatively simple in its causes, the typical methods used in the field are still far from optimal, but the empirical results might still be basically useful. That is not the case in this context. While it might never be possible to convincingly demonstrate a gateway effect given the challenges, and statistical analyses have no hope of detecting a tiny effect, there are clearly better and worse ways to pursue the question."
  • Citation: Phillips CV. Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would). International Journal of Environmental Research and Public Health. 2015; 12(5):5439-5464. https://doi.org/10.3390/ijerph120505439
    • Acknowledgment: The author’s work on this paper was supported by CASAA. CASAA is a public health NGO that represents the interests of consumers; it is dedicated to protecting consumers’ access to THR products and to promoting THR. Some of the research incorporated here, though not the creation of this paper itself, took place in 2014 when the author was the recipient of an unrestricted grant from British American Tobacco for support of his research. The author is the recipient of grant (unrestricted except for the general subject matter) from Imperial Tobacco Group for research on peer review in the health sciences; that topic is tangential to the main analysis, but some observations address it.

Resources

2023: Summary of Gateway Studies - Mendelsohn

• "There is a longitudinal association between adolescent vaping and smoking initiation. However after adjusting for covariates (common risk factors eg demographic characteristics, use of other psychoactive substances, perceived peer cigarette use, risk-taking, socially maladaptive behaviors, attitude toward smoking, and parental education using propensity scoring), the association reduces substantially or disappears completely."

Articles/Blogs/Op-Eds

2016: How not to be duped by gateway effect claims

• "Sometimes studies appear that can create the appearance of the discovery of a ‘gateway effect’ – the idea that vaping causes young people to progress to smoking...Here is an eight-point guide to evaluating such studies and the politically motivated claims that often go with them."

Smokeless Products (Excludes Vaping)

2019: Snus: a compelling harm reduction alternative to cigarettes

• "A review of the evidence [106] which examined gateway effects in Sweden suggested that snus appeared to lead users away from smoking rather than towards it and is an important reason why Sweden has the lowest rates of tobacco-related disease in Europe."
  • Citation: Clarke, E., Thompson, K., Weaver, S. et al. Snus: a compelling harm reduction alternative to cigarettes. Harm Reduct J 16, 62 (2019). https://doi.org/10.1186/s12954-019-0335-1
    • Acknowledgement: The review was funded by Imperial Brands Plc. EC, SW, JT and GOC are employees of Imperial Brands Plc. KT is an employee of Elucid8 Holdings Ltd and is acting as an independent scientific consultant to Imperial Brands Plc. KT is a former employee of Gallaher Ltd and Japan Tobacco International UK Ltd.

Evaluates Two or More Reduced-Risk Products

2015: Which Nicotine Products Are Gateways to Regular Use?

• "Though this finding should be interpreted with caution, it potentially indicates that current ETPs are not necessarily strong gateways to regular tobacco use." (Note: ETP=Emergining Tobacco Products such as dissolvables, snus, and electronic cigarettes).
  • Citation: Meier EM, Tackett AP, Miller MB, Grant DM, Wagener TL. Which nicotine products are gateways to regular use? First-tried tobacco and current use in college students. Am J Prev Med. 2015 Jan;48(1 Suppl 1):S86-93. doi: 10.1016/j.amepre.2014.09.018. PMID: 25528714.
    • Acknowledgement: Publication of this article was supported by the Oklahoma Tobacco Research Center (OTRC), with funding from the Oklahoma Tobacco Settlement Endowment Trust (TSET).

Vaping Nicotine

2024: Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults

• Nationally representative population-level data on tobacco product use by US adults continue to support the existence of an association between increasing prevalence of e-cigarette use and decreasing prevalence of cigarette smoking, i.e., possible substitution between cigarettes and e-cigarettes.
  • Citation: Foxon F, Selya A, Gitchell J, Shiffman S. Increased e-cigarette use prevalence is associated with decreased smoking prevalence among US adults. Harm Reduct J. 2024 Jul 18;21(1):136. doi: 10.1186/s12954-024-01056-0. PMID: 39026245; PMCID: PMC11256395.
    • Acknowledgment: Through PinneyAssociates, FF, AS, JG, and SS provide consulting services on tobacco harm reduction on an exclusive basis to Juul Labs Inc. The preparation of the previously-published version of this manuscript was funded by JLI, who reviewed and provided comments on a draft manuscript of the previously-published version. The present, updated version did not receive any funding or review from JLI, and was self-funded by PinneyAssociates. The content and the decision to publish are the responsibility of the authors. JG and SS also own interest in a novel nicotine gum that has neither been developed nor commercialized.

2023: Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes

• Conclusion: Healthy People’s 2030 goal for youth cigarette smoking, which uses the NYTS as its benchmark, has already been achieved and exceeded, years ahead of schedule. Concerns about a potential rise in adolescent cigarette use following the introduction of e-cigarettes to the U.S. market in the early 2010s are not supported by the data. In fact, the emergence of e-cigarettes has coincided with the most rapid declines in cigarette use over the past thirty years. It is important to recognize the possibility that had e-cigarettes not been available, changes in cigarette smoking prevalence among youth may have been different; this includes slower or faster declines. However, given the lack of a counterfactual, it is not possible to empirically evaluate this.
  • Citation: Delnevo CD, Villanti AC. Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes. International Journal of Environmental Research and Public Health. 2023; 20(19):6866. https://doi.org/10.3390/ijerph20196866
    • Acknowledgment: C.D.D. and A.C.V. were supported in part by a grant from the National Cancer Institute of the National Institutes of Health and the FDA Center for Tobacco Products (U54CA229973 and U01CA278695. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH, NCI or FDA.

2022: Association of quarterly prevalence of e-cigarette use with ever regular smoking among young adults in England: a time–series analysis between 2007 and 2018

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2021: High School Seniors Who Used E-Cigarettes May Have Otherwise Been Cigarette Smokers: Evidence From Monitoring the Future (United States, 2009–2018)

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2021: Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study

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2021: Trends in electronic cigarette use and conventional smoking: quantifying a possible 'diversion' effect among US adolescents

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2021: Association of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control study

• "In conclusion, this matched control analysis of NYTS data from 2014 to 2017 suggests that for adolescents initiation with e-cigarettes is associated with a reduced risk of subsequent cigarette smoking compared with initiators with other combustible and non-combustible tobacco products use, and propensity score matched adolescents without initial e-cigarette use. This suggests that, over the time period considered, e-cigarettes were unlikely to have acted as an important gateway towards cigarette smoking and may, in fact, have acted as a gateway away from smoking for vulnerable adolescents; this is consistent with the decrease in youth cigarette smoking prevalence over the same time period that youth e-cigarette use increased between 2014 and 2017.
• PDF of full paper
  • Citation: Shahab L, Beard E, Brown JAssociation of initial e-cigarette and other tobacco product use with subsequent cigarette smoking in adolescents: a cross-sectional, matched control studyTobacco Control 2021;30:212-220.
    • Acknowledgment: This project is funded by Cancer Research UK (C1417/A22962). All authors are members of the UK Centre for Tobacco and Alcohol Studies (UKCTAS), funded under the auspices of the UK Clinical Research Collaboration (MR/K023195/1). LS has received a research grant and honoraria for a talk and travel expenses from manufacturers of smoking cessation medications (Pfizer and Johnson & Johnson). JB has received unrestricted research funding from Pfizer to study smoking cessation.

2020: Does the gateway theory justify a ban on nicotine vaping in Australia?

• Conclusion: The association between nicotine vaping and cigarette smoking provides weak support for a gateway hypothesis. Smoking more often precedes vaping than vice versa, regular vaping by never-smokers is rare and the association is more plausibly explained by a common liability model. If there is a gateway effect, it is small at the population level because smoking prevalence has continued to decline despite an increased uptake of vaping in countries that allow it.
• PDF of full paper
  • Citation: Mendelsohn CP, Hall W. Does the gateway theory justify a ban on nicotine vaping in Australia? Int J Drug Policy. 2020 Apr;78:102712. doi: 10.1016/j.drugpo.2020.102712. Epub 2020 Mar 4. PMID: 32145594.
    • Acknowledgment: Colin Mendelsohn: I have received funding from Pfizer Australia, Johnson & Johnson Pacific and Perrigo Australia for teaching, consulting and conference expenses. I have never received payments from electronic cigarette or tobacco companies. I am a Board member of the Australian Tobacco Harm Reduction Association (ATHRA), a health promotion charity. ATHRA has received unconditional funding for establishment costs from small Australian vape businesses. Vape industry funding has not been accepted since March 2019.

2020: Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019

• This cross-sectional study suggests that, despite the increase in the prevalence of e-cigarette use among adolescents between 2011 and 2019, the prevalence of cigarette and smokeless tobacco use has decreased more rapidly during the same period compared with earlier years.
• Link to PDF on study page
  • Citation: Meza R, Jimenez-Mendoza E, Levy DT. Trends in Tobacco Use Among Adolescents by Grade, Sex, and Race, 1991-2019. JAMA Netw Open. 2020;3(12):e2027465. doi:10.1001/jamanetworkopen.2020.27465
    • Acknowledgement: Research reported in this publication was supported by award U54CA229974 from the National Cancer Institute of the National Institutes of Health and the US Food and Drug Administration Center for Tobacco Products.

2020: Electronic cigarettes, nicotine use trends and use initiation ages among US adolescents from 1999 to 2018

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2020: Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?

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2019: Examining the relationship of vaping to smoking initiation among US youth and young adults: a reality check

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2019: The Relationship Between Electronic Cigarette Use and Conventional Cigarette Smoking Is Largely Attributable to Shared Risk Factors

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2019 The Impact of Electronic Cigarettes on Cigarette Smoking By Americans and Its Health and Economic Implications

• In this study, we examined the growing use of electronic cigarettes and its implications. The wide use of e-cigarettes is a very recent development, and issues regarding their long-term effects and significance cannot be fully analyzed at this time. Using CDC and other data covering the last decade, however, we examined the relationship between the recent sharp increase in e-cigarette use among Americans and the contemporaneous acceleration in the declining rate of cigarette smoking. We found that the sharp increase in e-cigarette use across many groups can explain as much as 70 percent of the accelerating decline in smoking rates. We also found no reasonable evidential basis for concerns that e-cigarettes are a gateway to cigarette smoking. We further found that e-cigarettes are highly effective in helping people stop smoking cigarettes.
• Finally, we analyzed the impact of the sharp increase in e-cigarette use and the accelerating decline in cigarette smoking on healthcare costs and economic productivity. We found that while e-cigarette users incur lower healthcare costs than cigarette smokers or ex-smokers, the longer lifespans of e-cigarette users and ex-smokers who used e-cigarettes to quit smoking result in higher lifetime healthcare costs. However, we also found that the value of the additional years of life associated with using e-cigarettes instead of smoking is much greater than the additional healthcare costs. Lastly, we found that the increase in e-cigarette use and the associated reduction in smoking rates results in large productivity benefits, mainly from lower rates of illness.
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Letters/Testimony

2021: Testimony in Netherlands pertaining to a potential flavour / flavor ban: Regulation of e-cigarette flavours – a response

• Signed by 24 experts from around the world
• Covers 12 key points, including the theory of a gateway effect

Articles/Blogs

• A collection of articles, press releases, Op-Eds, and blog posts about products being a gateway to smoking. Is there proof? How are concerns about gateway being used to influence policy?

2024: Study: Heated Tobacco Products Increase Smoking Cessation Chances; 99.4% of Users Switched from Traditional Cigarettes

• "They also affirmed that there is no evidence that heated tobacco products serve as a gateway to starting smoking."

2024: Why We Need World Vape Day More Than Ever

• (Talking about misinformation.) "Just since April, the following claims have earned community notes: People who vape have high levels of uranium in their urine; vaping causes seizures; vaping harms your lungs within days; vaping is a gateway to smoking, all nicotine products are extremely damaging to health; and vapes cannot be recycled."

2024: It’s Critically Important to Tell Women the Truth About Nicotine

• "Dire warnings based on debunked myths backed by questionable science continue to make headlines, claiming people who vape nicotine will get popcorn lung, COVID, or “EVALI.” Studies full of methodological flaws portray vaping as a “gateway” to smoking. Or claim that vaping causes cancer, liver disease, myocardial infarction, COPD, and other diseases. Experts are kept busy evaluating these studies and submitting critiques of some of the most egregious papers, and their work has led to some studies being retracted."

2023: Is vaping a gateway to smoking?

• "The gateway theory predicts that vaping will increase smoking rates in young people. However, we are seeing the opposite of this. In countries where vaping is readily available such as the UK, US and New Zealand, the decline in youth smoking rates has accelerated."

2023: French Parliament Unanimously Backs Disposable Vapes Ban

• “This clearly shows that large [youth] experimentation of vaping does not lead to a collective ‘gateway effect’ to smoking,” he said. “In contrast, vaping could have a diversion effect.”

2023: France to Ban Disposable Vapes This Year in “Dangerous” Move

• "But the now-familiar “gateway theory” is contradicted by large-scale evidence. As recent commentary in the International Journal of Drug Policy noted, if the theory accurately described the population-level relationship between youth vaping and smoking, you’d expect vaping increases to produce higher youth smoking rates. On the contrary, rises in youth vaping in the United States, the United Kingdom and New Zealand “have been accompanied by an accelerated decline in smoking.”

2023: The Slow-Moving Train Wreck of Australian Vaping Policy

• "A case study is how Health Minister Butler frames his proposed harsher crackdown on vaping as youth protection. Despite the evidence to the contrary, he repeatedly claims that “vaping is a gateway to smoking.” He states that, “Vaping is creating a whole new generation of nicotine dependency in our community,” when Australian studies show that among youth who don’t smoke, less than 2 percent vape nicotine weekly or more."

2023: With youth vaping hitting a 10-year low, policymakers should focus on harm-reduction

• "Youth vaping in the United States has hit a 10-year low, according to new data from the Centers for Disease Control and Prevention (CDC). The so-called youth vaping epidemic appears to be a thing of the past, with historical lows in youth smoking dispelling fears of a gateway effect."

2023: No “Epidemic,” But CDC Delivers New Dose of Youth-Vaping Alarmism

• "In “What Are the Health Risks of Vaping for Youth?” the CDC states that youth are more susceptible than adults to nicotine addiction, which “may put youth at a risk for addiction to other substances in the future”—a version of the “gateway theory” that simply isn’t supported by meaningful evidence."

2023: Venezuela Bans All Vape Products, in Latest Blow to THR in Latin America

• "In 2022, the board of Brazil’s National Health Regulatory Agency (ANVISA) unanimously decided to uphold the country’s vape ban. They justified this with a series of false claims, saying that vapes are not shown to reduce harm and are a “gateway” to cigarette smoking for young people."

2023: It’s Time to Change the Way We Look at Youth Vaping

• "Young people who try vaping are more likely to try smoking. But this simply tells us that people who are more likely to try nicotine products are also more likely to try other nicotine products. There is no evidence that vaping causes people to smoke if they would not otherwise have done so (the “gateway theory”)."

2023: Situation Looks “Dire,” Say Opponents of Oregon Vape Flavor Ban

• "In commentary published by the Journal of the American Medical Association in March, for example, the director of the Rutgers Center for Tobacco Studies, Cristine Delnevo, wrote that “concerns about a gateway effect and a potential increase in youth cigarette use following the introduction of e-cigarettes to the US market are not supported by the data.”

2023: Is Canada Turning the Corner on Tobacco Harm Reduction?

• "The justifications were a highly debatable belief that flavors increase youth vaping, and the notion, refuted by population-level data, that vaping is a “gateway” into cigarette smoking."

2023: Anti-Vaping Sensors and CCTV in Schools: Is the UK Joining In?

• “At the population level,” she concluded, “e-cigarettes do not appear to be a gateway to cigarette smoking.” ... "Yet in justifying the measures at Baxter College, Carpenter, like many international public health figures, cited this supposed “gateway” effect."

2023: Taiwan Is About to Ban the Use of Nicotine Vapes

• "...the government has listed many reasons for the ban—alleging that vaping is bad for health, causes “EVALI,” includes cannabis use, has “gateway” potential, leads to a youth epidemic, and so forth."

2022: End Vape Misinformation, Tobacco Control Experts Urge Surgeon General

• "Cliff Douglas, one of the coauthors and the director of the University of Michigan Tobacco Research Network, told Filter. “The surgeon general’s website implies, for example, that e-cigarette use causes young people to become smokers, but this is strongly contradicted by widely available evidence"...The authors argue, therefore, that Surgeon General Vivek Murthy has helped perpetuate the myth that vapes are a “gateway” to cigarettes. In fact, they’re a well-trodden path to smoking cessation."

2022: Supreme Court Refuses to Block California’s Nicotine Flavor Ban

• " “Flavored tobacco products have hooked a new generation of young smokers at a time when tobacco is already the number one preventable killer in the United States,” the attorney general of California, Rob Bonta, said in a press statement. Vapes’ inclusion as “tobacco products” in US nomenclature means that he wrongly implied vaping is a “gateway” to smoking. And cigarette smoking is the number one cause of preventable death—not tobacco per se, which is also found in harm reduction products like snus or “heat-not-burn” devices. "

2022: California Votes to Ban Sales of Almost All Flavored Nicotine Products

• "Vaping nicotine, however, has in no way been established as a “gateway” to combustible cigarette use. Actually, the opposite looks to be true: A study published in JAMA Pediatrics by the Yale public health researcher Abigail Friedman showed that teenagers were more likely to start smoking than those in other US school districts after San Francisco’s flavored vape ban passed; another study by Brown’s Natasha Sokol and Harvard’s Justin Feldman, which appeared in Nicotine & Tobacco Research, suggested that youth who do vape are typically those who would have been smoking were vapes unavailable."

2022: How to Respond Sensibly to an Increase in Youth Vaping

• "The ASH briefing went on to firmly refute myths that had been promoted by garish headlines. It stated categorically that, “Disposable vapes DO NOT contain as much or more nicotine as a packet of 20 cigarettes.” It added that, “There is NOT strong evidence that vaping is a gateway into smoking,” with no evidence for the “gateway hypothesis.” And it asserted, correctly, that “An outbreak of serious respiratory disease (known as ‘EVALI’) in the US in 2019 WAS NOT caused by vaping nicotine.” "

2022: Why Aren’t We Celebrating the End of Teenage Smoking?

• "I believe this raises serious questions about the motivations of health “experts” who continue to insist that teen vaping is a gateway to smoking, that we’re in the midst of a teen vaping epidemic, and that a “whole new generation” is now “addicted to nicotine.” All of those claims bear an uncanny resemblance to 1930s Reefer Madness."

2020: Study: Vaping Looks Like a Gateway Out of—Not Into—Smoking

• “Just like sugar substitutes help people to reduce their sugar intake, e-cigarettes help people to quit smoking,” Chaplia continued. “We don’t blame sugar substitutes for increased sugar consumption, yet doing so for e-cigarettes seems to be acceptable.”

2019: Unfounded E-Cigarette Panic Puts Public Health at Risk

• "More important, the latest CDC data reveal nothing about underage smoking, which is the single most important data point in evaluating the harms or benefits of teenage vaping. Since the introduction of e-cigarettes to the U.S. market, adolescent use of cigarettes has more than halved, from 15.8 percent in 2011 to 7.6 percent in 2017. Rather than e-cigarettes acting as a gateway to smoking, as is assumed by government and advocacy groups, this indicates that teenage e-cigarette use is more likely diverting would-be smokers toward a less harmful means of nicotine consumption and potentially away from nicotine consumption altogether."

2019: Addicted to fear, the FDA is hurtling toward a historic mistake

• "In essence, the FDA is planning a massive regulatory onslaught against products that are significantly safer than cigarettes based on an unproven hypothesis and an alleged gateway that is as poorly defined as it is elusive."

2018: Expert Debunks Vaping ‘Gateway’ Myth, Ripping ‘Bad Science In Service Of Bad Theories’

• " A leading expert in the field of tobacco harm reduction is criticizing a wave of recent studies claiming electronic cigarettes are a “gateway” to smoking as “bad science in service of bad theories.” "

2017: Vaping Study Sinks Claims E-Cigarettes Are Hooking Teens On Tobacco

• The hysteria over vaping allegedly serving as a gateway to smoking for teens is unfounded and goes against scientific evidence, according to a new study.

2017: Feds Owe the Public 'Corrective Statements' on Vaping

• "In the U.S., by contrast, former Surgeon General Vivek Murthy's 2016 report on youth vaping raised a range of concerns, including the risk of a “gateway” effect whereby teen vapers allegedly progressed to smoking. That would be a grave concern if it were happening – but it’s not."

2017: Huffington Post author claims vaping could be gateway to drugs and crime

• "E-cigarettes are under fire for being a possible gateway to a life of crime and crippling addiction to hard drugs in one of the most lurid attacks on the products yet."
• “E-cigs can easily become a gateway to trying and developing an addiction to more serious drugs,” warns Sudip Bose, a physician, in an article for the Huffington Post. “Addiction correlates to crime. People need to feed their habit, they break into homes to steal things to resell, they commit robberies on the streets, all to get money to feed their addiction.”
• "The jump from experimenting with e-cigarettes, to nicotine addiction, to hard drugs and crime stretches Bose’s credibility to a breaking point: There is precisely zero evidence for any gateway effect of e-cigarettes on drugs or crime, and none is cited in the article."
• "Not only that, but there is no evidence that vaping acts as a gateway to regular tobacco smoking despite the best efforts of some anti-e-cigarette campaigners."

2017: Merchants Of Doubt: How Public Health Uses Tobacco Tactics Against E-Cigarettes

• "Several years of the background noise of claim and counterclaim has contaminated the public's understanding of relative risk and harm reduction. Constant panics of teen vaping and unproven "gateway" effects take prominence in media coverage over the potential benefits of smokers switching to vaping."

2017: Vaping Is Not a Gateway to Smoking, New Study Shows

• "But far from being the smoking gun finally proving e-cigarettes are a gateway to their tobacco-filled rivals, the study itself finds there is still absolutely no evidence of a gateway effect from vaping to regular cigarette use."

2016: New CDC Report on E-Cigarettes Shatters Gateway Myth, Suggests Shift from Hazardous Smoking to Much Safer Vaping among Youth

• "However, today's CDC report reveals that something very different appears to be occurring. It appears that rather than serving as a gateway toward cigarette smoking, e-cigarettes may actually be acting as a diversion away from cigarettes."

2015: World Lung Foundation Disseminates Conclusion that E-Cigarettes are a Gateway to Smoking Based on a Bogus Study

• "More importantly, nowhere in the study does it conclude that e-cigarettes are a gateway to smoking."
• "However, the most embarrassing and irresponsible behavior in this story is that of the World Lung Foundation, which disseminated the conclusion that e-cigarettes are a gateway to smoking based on the barely comprehensible quote of a single kid in Fife."

2015: 2014 Anti-Smoking Myth of the Year Award Goes to CDC, Dr. Stan Glantz, and Dr. Michael Fiore

• "...for publicly spreading the myths that electronic cigarettes have been found to be a gateway to smoking..."

2014: New Study Refutes Claim that Electronic Cigarettes are a Gateway to Smoking

• "This study found only three students, in a sample of 1,300, who had initiated nicotine use with e-cigarettes and progressed to smoking...These findings refute the claim that electronic cigarettes are a gateway to smoking. "

2014: Glantz Tells Public There is No Question that E-Cigarettes are a Gateway to Smoking, But Today's Monitoring the Future Data Show the Opposite

• "It is clear that experimentation with electronic cigarettes among youth has increased dramatically from 2011 to 2014. But despite this dramatic increase, the prevalence of current smoking among youth decreased dramatically. And the sharpest decline in smoking occurred concurrently with the largest increase in electronic cigarette use."

2014: Columbia Scientists Claim that E-Cigarettes May Be Gateway to Illicit Drug Use and Addiction

• "There is no justification for drawing this sweeping conclusion based solely on studies of mouse brains, without a shred of clinical or epidemiologic evidence that suggests e-cigarettes serve as a gateway to smoking or illicit drug addiction."

2014: Spurred On By CDC/Glantz Propaganda, Two U.S. Senators Claim that Electronic Cigarettes are a Gateway to Smoking

• "The assertions by the CDC, by Stan Glantz, by Senator Blumenthal, and by Senator Schumer are completely unsubstantiated by actual scientific data. In fact, there is no scientific evidence to support the conclusion that they have all disseminated to the public: that electronic cigarettes are a gateway to smoking."

2013: Cambridge Public Health Department Follows the CDC's Lead, Claims that Electronic Cigarettes are a Gateway to a Lifetime of Tobacco Use

• "There is, in fact, no evidence that electronic cigarettes serve as a gateway to a lifelong tobacco habit. In fact, there is not even any evidence that electronic cigarettes serve as a gateway to a short-lived tobacco habit. The only study to examine this hypothesis found that electronic cigarettes are not currently serving as a gateway to cigarette smoking among young people."

2013: E-Cigarettes May Not Be Gateway to Smoking: Study

• "It didn't seem as though it really proved to be a gateway to anything," said Wagener, who presented his findings at a meeting of the American Association for Cancer Research, in National Harbor, Md."