From vaping to smoking? First presentation of an explanatory model investigating whether electronic cigarette consumption increases the likelihood of subsequent tobacco smoking

Background: Aggressive advertising campaigns instigated by the e-cigarette (short for electronic cigarette) and the tobacco industry have encouraged adolescents to use e-cigarettes. Since the popularity of e-cigarettes among adolescents is growing, more and more researchers fear that the use of e-cigarettes may increase the likelihood of initiating smoking of tobacco cigarettes. Method: We develop an explanatory model to investigate this new and crucial public health issue. Here, we take into account earlier explanatory approaches. We conclude that the much discussed Gateway-Hypothesis falls short and a more accurate model needs to be developed. This should involve details about preferring e-cigarettes to tobacco cigarettes at initiation as well as about the potential transition from e-cigarettes to tobacco cigarettes. Results: With its elements “flavor”, “health”, “price”, “role model”, “concealment”, and “acceptance” the suggested explanatory „catalyst model” includes arguments which explain why the initiation of e-cigarette use is more likely than the initiation of tobacco smoking. The following elements “addiction”, “experience”, and “accessibility” focus on explaining the subsequent transition to tobacco cigarettes. The suggested „catalyst model“ also takes variations in the nicotine content of e-cigarettes as well as the simultaneous use of different substances into account. Discussion: If the model suggested here is shown to be theoretically plausible, the next step would be to provide empirical evidence for the transition processes illustrated by assessing real initiation processes on the basis of longitudinal observational studies. Thus, we attempt to provide an initial contribution to the process of understanding e-cigarette use of adolescents and its consequences for public health and tobacco control.

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