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•The evidence does not provide strong support for the hypothesis that vaping is a significant gateway to smoking in young people.

•Regular vaping by young never-smokers is rare.

•Most young people who use e-cigarettes have already smoked combustible cigarettes.

•A ban on nicotine vaping prevents adult smokers from accessing a potentially lifesaving alternative to smoking.

•A more nuanced regulatory policy could restrict young nonsmokers’ access to vaping while allowing access for adult smokers.

https://www.sciencedirect.com/science/article/abs/pii/S0955395920300530

Abstract

Australia bans the sale, possession and use of liquid nicotine for vaping. One of the major arguments used to justify Australia’s policy is that the availability of nicotine vaping products will lead a substantial number of young people who would otherwise not have smoked cigarettes to take up regular smoking (the gateway theory). In this article, we provide a critical analysis of the use of the gateway theory to justify Australian policy. We argue first that the evidence that vaping serves as a gateway to smoking is unconvincing. 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. Second, we argue that even if the evidence were stronger it would not justify a ban on the sale of nicotine to adult smokers because there are other ways of preventing adolescent vaping that do not require a ban. We describe an alternative regulatory model for Australia that would address legitimate concerns about preventing adolescent uptake while allowing adult smokers to access these products for cessation or as an alternative to smoking cigarettes.

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