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The largest study of electronic cigarette use in Europe may help alleviate fears that the devices are a gateway to smoking real cigarettes.

One of the big concerns around the use of e-cigarettes, or “vaping”, is that they tempt people who don’t already smoke, getting them hooked on nicotine. Although they are generally considered safer than smoking, the jury is still out on the long-term health effects of vaping. Some people also worry that e-cigarettes could renormalise smoking, and be a gateway to smoking real cigarettes – especially in young people.

at the University of California in San Francisco is convinced that e-cigarettes lead young people to smoke real cigarettes. found that the use of e-cigarettes in US middle and high school students – aged 12 to 18 years old – was associated with a higher likelihood of also smoking real cigarettes.

But his study doesn’t show whether those people already smoked before they tried e-cigarettes, which makes it impossible to say whether vaping really is a gateway to smoking.

Kick the habit

The latest study tries to address this. at the Harvard School of Public ÎçÒ¹¸£Àû1000¼¯ºÏ and his colleagues analysed survey data collected from over 26,500 people across 27 countries in Europe in 2012. Extrapolating from this, they estimate that 29 million Europeans have used an e-cigarette, and that users are likely to be heavy smokers, and to have tried to kick the habit over the past year.

E-cigarette use was highest in smokers aged 15 to 24. But it found scant evidence that e-cigarettes are encouraging those who don’t smoke to pick up the habit. Twenty per cent of smokers had tried e-cigarettes at least once, 4 per cent of ex-smokers had – and just 1.1 per cent of non-smokers had.

Smokers who had attempted to quit smoking in the past 12 months were twice as likely to have tried vaping than other smokers, and e-cigarette use was more common among those smoking at least six cigarettes a day than in those whose daily intake is five or fewer.

“This study verifies that e-cigarette use does not renormalise smoking,” says , a cardiologist at the Onassis Cardiac Surgery Center in Athens, Greece, who was not involved with the work. “The results show minimal adoption by non-smokers.”

Vardavas says the number of young people vaping can be interpreted as both potentially promising and worrying. “On one hand, e-cigarettes could be helping young people to quit. On the other, maintained nicotine addiction at a population level may significantly hinder tobacco endgame efforts,” he says.

Big Tobacco

The study comes as two big cigarette companies – Altria, which makes Marlboro, and Reynolds American, which makes Camel – announced that they would start .

It also coincides with a from around the world voicing their concerns about the involvement of Big Tobacco in the rapidly growing industry, urging the WHO to regulate e-cigarettes as though they were tobacco products.

In a sign of how divided those who work in public health are over the issue of e-cigarettes, the latest letter is a riposte to another sent earlier this month by group of scientists, accusing the WHO of either “overlooking or purposefully marginalising” the idea that e-cigarettes could be a low-risk alternative to cigarettes.

Journal reference: Tobacco Control, DOI: