SAN FRANCISCO -- Earlier this month, the University of California San Francisco (UCSF) released the results of what they claimed to be the first study of the relationship between electronic cigarette use and smoking among adolescents in the United States. Using data from the 2011 and 2012 National Youth Tobacco Survey, lead author Laura Dutra and co-author Dr. Stanton Glantz made quite the media splash by claiming the study proved "e-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco."
One problem: Nowhere in the study (which was published in TheJournal of the American Medical Association Pediatrics (JAMA) do they provide any data to suggest e-cigarettes actually serve as a gateway to tobacco products. Yes, the National Youth Tobacco Survey showed that most youth e-cig users also use tobacco products--but the study neglected to track which products adolescents used first. In fact, the authors acknowledged that "the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa."
But that didn't stop Glantz and Dutra from creating a media frenzy by titling their UCSF press release "E-Cigarettes: Gateway to Nicotine Addiction for U.S. Teens" and making multiple unsupported conclusions.
This glaring oversight has been critiqued by e-cig advocates and opponents alike.
The American Cancer Society and the American Legacy Foundation voiced concerns to The New York Times. Dr. Thomas Glynn of the American Cancer Society said "the data in this study do not allow many of the broad conclusions that it draws."
Dr. David Abrams of the Legacy Foundation added that he was "quite certain that a survey would find that people who have used nicotine gum are much more likely to be smokers and to have trouble quitting, but that does not mean that gum is a gateway to smoking or makes it harder to quit."
Meanwhile, tobacco control practitioner and one-time director of Action on Smoking and Health (ASH-UK) took to his The Counterfactual blog to issue a strongly worded cease-and-desist order to Dr. Glantz for spreading unsupported and damaging information.
Bates expressed "dismay at the false, misleading and damaging conclusions you have drawn," adding that "the errors of reasoning are elementary, but have been used to draw conclusions that are relentlessly hostile to e-cigarettes and the important public health concept of 'tobacco harm reduction'."
Specifically, Bates called out two major errors in Glantz and Dutra's statements.
First was the conclusion drawn in the JAMA article, which stated "use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents."
"Somehow you have managed to position this study as showing there is a gateway from e-cigarette use to smoking," he wrote. "NOTHING in the study or the underlying data suggests this. You would need information on how smoking, e-cigarette use and abstinence evolved over time to test these hypotheses, but your study does not have that."
Second was the press release's labeling of e-cigs as a "gateway" to combustible tobacco products. "There is no basis for drawing this unequivocal 'gateway' conclusion from the data presented in the study," he said. "In fact the data are consistent with the opposite hypothesis--that e-cigarettes are primarily used by smokers interested in quitting or cutting down. Indeed the observation that users have a higher intention to quit smoking lends support to that hypothesis more than to your preferred explanation."
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