Misread signals: a misinterpretation of population-level vaping and smoking trends

Sam Egger; Michael David; Marianne Weber; Qingwei Luo; Becky Freeman

doi:10.1071/PU24007

RESEARCH ARTICLE (Open Access)

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Misread signals: a misinterpretation of population-level vaping and smoking trends

Sam Egger ^A ^* , Michael David ^A ^B , Marianne Weber ^A , Qingwei Luo ^A and Becky Freeman ^C

+ Author Affiliations

- Author Affiliations

^A The Daffodil Centre, The University of Sydney, A joint venture with Cancer Council NSW, 153 Dowling Street, Woolloomooloo, NSW 2011, Australia.

^B School of Medicine and Dentistry, Griffith University, Gold Coast, Qld, Australia.

^C Prevention Research Collaboration, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.

^* Correspondence to: samuel.egger@sydney.edu.au

Public Health Research and Practice 35, PU24007 https://doi.org/10.1071/PU24007

Submitted: 6 May 2024 Accepted: 17 December 2024 Published: 17 March 2025

© 2025 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Sax Institute. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

The increasing prevalence of e-cigarette use (vaping) among adolescents and young adults has ignited debate over its potential role in the initiation of cigarette smoking. Prospective cohort studies at the individual level consistently demonstrate a higher risk of smoking initiation among young people who have previously vaped when compared with those who have never vaped (sometimes called a ‘gateway effect’). On the other hand, several studies analysing repeated cross-sectional data argue that vaping might decrease the risk of smoking through a ‘displacement effect’, as evidenced by an increasing vaping trend coinciding with a decreasing smoking trend. This perspective article examines these conflicting viewpoints in the context of a misinterpretation of these coinciding trends.

Keywords: adolescents, displacement, e-cigarettes, gateway, population-level trends, smoking, vaping, young people.

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