Missing the elephant in the vaping transition room.

Abstract

We respond to a paper by Coleman B et al Transitions in electronic cigarette use among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 1 and 2 (2013-2105). Tobacco Control 2018; doi:10.1136/tobaccocontrol-2017-054174 which reports on the vaping and smoking status of 2932 adult e-cigarette users followed for 12 months in a national, stratified US study. For every person vaping at Wave 1 who benefited across 12 months by quitting smoking, there are 2.1 who either relapsed to smoking to or took-up smoking. Most disturbingly, in this adult cohort nearly one in four of those who had never been established smokers took up smoking after first using EC. Concern about putative gateway effects of ECs to smoking have been dominated by concerns about youth. These data showing transitions from EC to smoking in nearly a quarter of exclusive adult EC users with no histories of established smoking should widen this debate to consider adult gateway effects too.