Attack on e-cigarettes as gateway products draws from same old playbook
Some men may use snuff to quit smoking, but U.S. men more commonly switch from snuff use to smoking. Some smokers may use snuff to supplement their nicotine intake, and smokers who also use snuff are more likely than nonusers to try to quit smoking but tend to have less success.
At the time, my letter to the editor, which was not published, noted:
Recently, Tomar reported that 1998 National Health Interview Survey data show that snuff users are three to four times more likely to have quit smoking than have-never users. However, he also suggested that more American men switched from snuff use to smoking than vice versa. We disagree with some of Tomar’s interpretations of the available data and offer alternative explanations for his findings.
Tomar suggests that the data show that snuff use is a ‘gateway’ to cigarette smoking among adolescents and young men because ‘former’ snuff users were current smokers in this adult survey. However, Tomar has inferred causation solely from temporal patterns (post hoc, ergo propter hoc). If snuff had been a ‘gateway’ to smoking for some individuals, they would have been much older when they started to smoke than smokers without a snuff history. The survey shows no such difference, suggesting that snuff was merely an adjunct for some smokers. More importantly, Tomar did not evaluate the gateway possibility for other forms of tobacco use. For example, survey data also reveals that pipe smoking was much more of a ‘gateway’ than was snuff. Yet it is obvious that few adolescents initiate tobacco use by smoking a pipe. A more reasonable interpretation of all the available information is that there is a subset of smokers who additionally have used other forms of tobacco.
Tomar interprets his findings as evidence that switching smokers to ST is not a workable public-health strategy. We point out that for more than 20 years, the dominant public health message from tobacco prohibitionists has been that ST use is as dangerous as smoking. This erroneous, even dangerous, message is reinforced by the mandated warning on packages of ST (‘This product is not a safe alternative to cigarettes’). Most smokers have accepted this message and continue to smoke. Tomar’s study only confirms this and suggests further, and unfortunately, that some ST users also accepted it and switched to cigarettes. Tobacco users need to be told the truth – that ST use is associated with only 2 percent of the mortality risks of smoking, and that it is an effective form of nicotine substitution for smokers unable to achieve abstinence. Only then can a harm-reduction strategy be tested and judged.
Prohibitionists today use the same groundless gateway attack to vilify e-cigarettes, even as teen smoking is dropping at an unprecedented rate.