E-Cig Studies: The Good, the Bad and the Ugly – Part 1

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Public officials rely on the scientific community for guidance in developing health policies. Ideally, rigorous academic research keeps our laws grounded in hard facts rather than the whims of politicians and special interest groups; however, when lawmakers are presented with shoddy science, it can lead to poor policy-making decisions. To make matters worse, news outlets are quick to report study findings without mentioning important details like research methodologies and limitations. Distinguishing facts from speculation shouldn’t require a degree in social sciences, so here is a quick crash course in academic research standards to help you better understand why there are so many conflicting studies about e-cigarettes.

Epidemiology: A Tale of Two Methodologies

About the two types of epidemiology studies

The study of health outcomes for the purpose of developing public policy is called epidemiology. There are two main types of epidemiological studies: observational and experimental. Observational studies, as the name suggests, are based on researchers’ observations of a targeted group’s behaviors in their day-to-day lives. Experimental studies, on the other hand, are more controlled and often take place in a laboratory. Each approach has its benefits and drawbacks, so careful consideration of both types of studies is needed to form a valid conclusion about a theory or hypothesis.

For example, if you wanted to test the hypothesis “E-cigs are a gateway to cigarette smoking for high school students,” an observational study could involve surveying youth about their experiences with e-cigs and tobacco cigarettes. If you found that young people who have tried vaping have also tried smoking, it’s fair to say, “There is a link between youth vaping and youth smoking.” However, that statement is very different than, “Vaping leads to smoking.” Perhaps some kids are just more likely to try new things than others. You also have to consider why some kids who try vaping do not try smoking.

An experimental study to test for a gateway effect would involve recruiting youth who had never tried e-cigs nor tobacco, instructing them to vape an e-cig in a laboratory, following them for a period of time to see if they tried tobacco cigarettes, and perhaps testing their blood for nicotine levels to confirm their self-reporting. Of course, giving youth e-cigs is highly unethical, so such a study could never be legally performed. Therefore, all we have to go on are observational studies. Observational studies can give us an idea of the relationship between youth vaping and youth smoking, but they must be repeated multiple times across diverse populations to make any broad conclusions. Unfortunately, many journalists and public officials do not have formal training in research methods, so they depend on what scientists tell them.

Sensationalism and Observational E-Cig Studies in the Media

Sensationalism about ecigs in the media

Journalism was once considered a science in itself, but the Internet and 24-hour news networks have made journalism highly lucrative, so reporters are apt to using catchy and controversial headlines to compete for viewer attention. Take for example an article entitled “Yep, E-cigarettes are a Gateway to Smoking.” The author refers to a study published in the Journal of the American Medical Association, or JAMA, that claims youth who reported trying e-cigs were more likely to try smoking within the following year. Of the 694 participants followed, 16 of them had tried e-cigs at the beginning of the study, and six of those youth had tried smoking by the 12-month follow-up. Of the 678 participants who hadn’t tried vaping, 19 percent tried smoking within the next year while 38 percent of vapers tried combustible tobacco.

However, basing conclusions about the behaviors of all American teens on a sample size of 16 would be laughable if it wasn’t just plain sad. The authors of the news article and the study itself should be ashamed of themselves.

Another JAMA study using similar methods evaluated the behaviors of 2,530 students, 222 of which had tried e-cigs at the start of the study. After six months, participants who had previously tried e-cigs were more likely to report “use of any combustible tobacco product” than those who hadn’t tried e-cigs before the study began; however, the authors do not differentiate between students who were simply curious to try cigarettes and those who became regular smokers. Therefore, the only real conclusion we can draw is, “Teens who are curious about one thing may be curious about another.” To their credit, the researchers caution that more research is needed, but an article from PR Newswire about the study makes it sound like e-cigs are creating a public health pandemic. The same article states, “E-cigarette use now exceeds current use of regular cigarettes.” If e-cigs were a gateway to smoking, wouldn’t smoking rates be rising as well?

Observational Studies On E-Cigs as Smoking Cessation Devices and Meta-Analysis

Studies on ecigs for smoking cessation

There have been dozens of observational studies investigating the potential of e-cigs as smoking cessation tools, and they are susceptible to the same flaws as the aforementioned gateway studies. Fortunately, that’s why we have meta-analysis. A meta-analysis is an analysis of multiple studies, a “study of studies” if you will, which seeks to identify patterns of statistical significance. A meta-analysis of six smoking cessation studies published by the American Heart Association concluded that e-cigs can indeed help some people quit smoking. While the authors encourage more research, there is more evidence that point to e-cigs being more of a successful smoking cessation device than a gateway to tobacco use.

The bottom line is that you can’t believe everything you read. Hopefully this article and its follow-ups can help you look at e-cig research with a more critical eye.

Related: The Future of Electronic Cigarettes: Part 1