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expert reaction to research letter on smoking / vaping in young adults

A research letter published by JAMA Internal Medicine looks at smoking and vaping in young adults. 


Dr Sarah Jackson, Principal Research Fellow at the UCL Tobacco and Alcohol Research Group, said:

“There has been substantial concern that vaping may act as a ‘gateway’ to smoking among young people, which could undermine the progress that has been made in reducing smoking rates over recent decades. However, studies are increasingly suggesting that vaping may in fact be displacing smoking, diverting those who would otherwise have smoked toward using a less harmful product.

“These results from the US show that while the proportion of young adults using inhaled nicotine (i.e. smoking or vaping) has remained relatively stable over the past decade, the types of products they are using has changed. There has been a clear shift away from smoking tobacco (a uniquely lethal product that kills half of people who use it as intended) to using vaping products (which pose only a small fraction of the risks of smoking). This will have net public health benefits.

“The data also show an increase in the proportion of young adult vapers who were never established smokers. This is not necessarily cause for concern, as it is likely that many of these people would have otherwise taken up smoking. However, it will be important to continue to monitor this.”


Prof Peter Hajek, Professor of Clinical Psychology, and Director of the Health and Lifestyle Research Unit, Queen Mary University of London (QMUL), said:

“A concern has been often expressed that for young people, e-cigarettes are a gateway to smoking. This new report suggests the opposite, i.e. that e-cigarettes are deflecting young people who would otherwise smoke to doing something much less risky. It also shows that the increase in vaping has been proportional to the decrease in smoking and that nicotine use overall among young people has not increased. This is all good news for finally getting rid of smoking-related lung disease, heart disease and cancer.”


Prof Caitlin Notley, Professor of Addiction Sciences, Norwich Medical School, University of East Anglia (UEA), said:

“This study provides evidence that vaping may be displacing tobacco smoking at a population level. This corresponds to evidence reported in England, where we also observe historically low rates of tobacco smoking but increased vaping by young people. This increase appears to correspond to the widespread availability of disposable e-cigarettes and, as this study notes, nicotine-salt based e-liquids.

“The reduction in smoking reported in this paper is important for public health, since the deadliest way to use nicotine is in the form of tobacco smoking. If populations are replacing smoking with vaping, the net public health gain is substantial. However, it is vital to communicate clearly with the public to convey the fact that vaping is a reduced harm alternative to tobacco smoking.

“Unfortunately in the USA, as seen in this paper, e-cigarettes are incorrectly classified as tobacco products, despite containing no tobacco. This is confusing and may contribute to public misperceptions of the relative harms of vaping, or lead people to incorrectly conclude that vaping and smoking are equivalent.”


‘Shift From Smoking Cigarettes to Vaping Nicotine in Young Adults’ by Brandon T. Sanford et al. was published in JAMA Internal Medicine at 4pm UK time on Monday 13 November 2023.


DOI: 10.1001/jamainternmed.2023.5239


Declared interests

Caitlin Notley is:

  • Director – Faculty of Medicine and Health Sciences Citizens Academy
  • CI Babybreathe Trial, and CI ‘Love my Lungs’ neonatal unit smoking cessation study
  • Co-PI COSTEd trial – smoking cessation in the emergency department & TRAJECT study of e cigarette dual use
  • Area lead for the SCETCh trial – smoking cessation for those experiencing homelessness
  • Non-Executive Director, James Paget University Hospital

Peter Hajek: no conflicts

Sarah Jackson: no COIs


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