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How Would We Know if Vaping is a Gateway to Smoking?

One of the most commonly-repeated claims about vaping is that e-juice and e-cigarettes are a gateway to smoking. In support of these claims, proponents usually cite the CDC National Youth Tobacco Surveys, which merely show an increase in vaping in middle and high school students from 2011 to 2014, or other studies using that data to assess gateway claims specifically. The problem is that even these gateway-specific studies generally look for an association between vaping and smoking, with no information as to whether the smoking or the vaping came first.

If vaping is a gateway to smoking, then it would be plausible that e-cigarettes could have a negative net effect on public health overall. Making some genuine effort to determine whether this is happening is therefore an important priority, even if the available evidence doesn’t suggest any cause for concern.

CASAA has recently opened a research fund for this very purpose, aiming to raise $7,500 (and contributing an equal amount itself) to conduct the study. The new research proposal and the paper by Carl V. Phillips that it’s based on revolve around a crucial question: how would we even know if vaping was a gateway to smoking?

CASAA’s New Research Proposal

The research proposed by CASAA has two parts. First, their goal is to conduct a systematic review of all the evidence that is claimed to show a gateway effect from tobacco products such as e-cigarettes and snus. The analysis of this evidence will use the framework Carl V. Phillips created in his paper, enabling the authors to sort the good evidence from the inconclusive studies or junk science.

The second part is a little different, but would involve working back from the end-result claims that there is some sort of gateway effect and identifying the source of those claims. When the claim is traced back to a study – if that’s even possible – then the study will be evaluated as above. Undoubtedly, this portion of the study will involve identifying numerous statements made which have no basis in fact.

You can donate to the project through CASAA’s Research Fund page, if you’re interested.

Carl V. Phillips’ Paper: Why the Cited Evidence Doesn’t Support a Gateway Effect for Vaping and THR

The paper this is all based on is a little dry to read (which you can do in full for free, if you’re interested), but raises numerous excellent points that can help anybody investigate a gateway claim for themselves.

The paper opens by pointing out that claiming that a low-risk product (like e-cigarettes or snus, but Phillips also cites marijuana as an example) is a “gateway” to a higher-risk one is a useful rhetorical tactic for those hoping to oppose that low-risk behavior. Simply put: even if you don’t have a reason for opposing the low-risk behavior, you can claim that it leads to a high-risk one and oppose it on that basis.

The specific points raised through the paper are well-summarized by a checklist for evaluating gateway claims near the end, so using these as a guide, here’s how to tell if vaping, snus or pretty much anything else can be legitimately called a “gateway” based on the evidence presented:

1 – Is the Research Science or Propaganda?

The first point refers to two basic requirements of any scientific investigation: a definition of what you’re testing and a clear approach to testing for it.

The definition of a gateway seems simple enough – the use of a low-risk product causing the risk of a high risk product – but the web of cause and effect is really more complicated than that. Imagine that e-cigarettes really did cause people to smoke – how do you know somebody who vapes and then smokes wouldn’t have ended up smoking anyway? They might have been heading there anyway, so would it be fair to say vaping caused it just because that’s the path the individual happened to take? Really, a “gateway” must be defined as a product that causes use of another when the end result wouldn’t have happened otherwise.

The second part is pretty complicated – and much of the paper addresses what sort of data would be needed – but effectively boils down to turning the claim into a clear, testable hypothesis.

This would be aided by two other points. Firstly, why would a gateway even exist? If somebody decided to not smoke – probably due to the health risks – and wouldn’t have consumed nicotine if e-cigarettes hadn’t become available, why would that person then electively take the additional risk? There is a potential explanation in the more efficient nicotine delivery from smoking (and the additional chemicals that heighten its addictive properties), but without such a theory to work from, knowing what to look for is challenging.

Secondly, it would be very useful if there was a testimonial of such a progression to draw upon for the same reason. But so far, no such testimonial has surfaced: could it be that it hasn’t happened often enough for anybody to find one?

2 – Is it a Gateway or Harm Reduction?

Many pieces of research cited to support the gateway effect only find an association: for example, smokers are more likely to have vaped than non-smokers. Anybody could identify two possible reasons for that – either the tobacco e-juice caused the smoking or the smoking caused the vaping – but there are others (e.g. neither caused the other). If there’s no effort to determine which is occurring, then it’s a sign you’re not reading an unbiased analysis of the evidence.

Phillips runs through how this could be done with a Stanton Glantz study, looking at e-cigarette use by how many years participants had been smoking, showing that longer-term smokers (who started before vaping was popular) were more likely to have vaped than shorter-term ones, suggesting (but not proving) that it was harm reduction, not a gateway.

3 – Are Other Factors (Sensibly) Controlled for?

Of course, there are lots of things that can impact somebody’s chance of becoming a smoker, so researchers try to control for “confounders” in order to “separate the signal from the noise,” so to speak. For example, having friends who smoke is linked to higher odds of smoking yourself, so if somebody both had friends who smoked and vaped, it could be the former that caused the smoking (or at least contributed) and not solely vaping, so you need to take its effect into account. The only problem is that this isn’t always done particularly well. In some cases, he argues, they basically just throw whatever variables they have into the mix and hope for the best. He uses race as an example of one such attempt to control for important variables: there’s no real reason to think it would play a significant role, but it’s often controlled for anyway.

An example of a good set of factors to control for would be based on propensity for smoking, looking at things such as their propensity for risk taking, the area they grew up in and the career path they’re on. If a sensible set of demographic and personality traits is chosen, the pre-existing risk of later smoking would be properly controlled for and the researchers could then focus on the impact of using the low-risk product alone. When this was done for smokeless tobacco, the researchers found no evidence of a gateway.

4 – Would the Data Make Sense if the Hypothesis Was False?

This is a simple one: if you’re looking at some evidence which “supports” the gateway model, it’s hardly compelling if the evidence is also explained by the opposite hypothesis. A perfect example of this is the numerous studies finding a correlation between vaping and smoking: the findings are often equally well explained if smokers are vaping to reduce their risk, so it can’t really be seen as supporting a gateway to smoking – at least not without further evidence.

5 – Do They Find Out Which Came First?

This is an obvious point – it’s unlikely to be a gateway effect if people smoke first and then try vaping – but it has a little more to it than you may think. It’s entirely possible that somebody tried smoking but didn’t like it, took up vaping afterwards, and then their new-found enjoyment of nicotine led them to try smoking (for a more efficient dosing mechanism, for example). Similarly, somebody could be interesting in consuming nicotine any way they can, and in this case, just because they happened to encounter an e-cig first doesn’t really make it a gateway. With these caveats in mind – which basically mean you can’t be certain based on which came first alone – this is still a strong indication of whether it’s a gateway case or a harm reduction one.

6 – Is it the Model or Reality?

Phillips rightfully describes the hunt for the gateway effect as a “highly politicized” issue, and this can have serious impacts on what researchers do and what they report. The simplest example is which other variables they attempted to control for (as in point 3): if you remove a potentially irrelevant factor, such as race, from your model, do the results stay the same? If you change your definition of what constitutes having been a smoker, does it affect the findings? The problem here is that researchers may settle on the model that produces the result they want and basically pretend that using this model was always their plan. If this happens, even peer reviewers won’t be able to tell that’s what they’ve done. The clearest indication of reliability is when the authors present numerous “cuts” at the data and show how this would affect the outcome. An example of this is shown in the paper, where the study from Stanton Glantz was analyzed in numerous ways, all of which were presented, and all of which showed that the harm reduction hypothesis was more likely than the gateway, based on the data.

Why the Research to Date Doesn’t Support the Gateway Hypothesis

The Glantz paper above (available in full for free) is a perfect example of a study that was claimed to offer evidence of a gateway, but could really do no such thing. They used the 2011 and 2012 NYTS data, and their findings can basically be summarized as “there was an association between vaping and smoking.”

Looking through the individual points above doesn’t help the study:

  1. No effort was made to define the gateway effect (it wasn’t even mentioned), and it wasn’t formed into a clear hypothesis.
  2. They didn’t consider the alternative, harm reduction hypothesis at all.
  3. Age and gender (two relevant factors) were controlled for, but they also included race (which is of questionable value) and made no effort to control for propensity or other confounding variables.
  4. The data would certainly make sense if the opposite were true: smokers would be more likely to vape if they were vaping to reduce the harm associated with their habit.
  5. There were no questions about which product came first.
  6. There was no presentation of the effect of using different models or adjusting definitions.

This study was a pretty bad one, admittedly, but the overall problems persist in almost all other studies into the gateway effect. One of the best which addressed vaping did take into account the order of use – and showed no obvious gateway effect – but again the research didn’t try to control for pre-existing risk through propensity scores.

Conclusion – Try Harder to Spot a Gateway

So far, the main limitation of research into the gateway effect can be summarized as not trying enough. It doesn’t take a scientist to tell you that smokers also having vaped doesn’t really tell you anything about whether one caused the other, but this simple point limits most of the available studies. The upshot is: if you want to claim vaping is a gateway, we need to make some serious effort to determine if it’s true. CASAA’s upcoming study will undoubtedly be good news for the industry.

Resources

  1. Phillips, C. V. (2015) Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would)
  2. CASAA: CASAA Research Fund Launches Fundraising for Study of Gateway Claims
  3. Dutra, L. and Glantz, S. (2014) E-cigarettes and conventional cigarette use among US adolescents: A cross-sectional study
Michael Grey
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Michael Grey

With a passion to educate through my writings and a passion to help others, I found my place here at Black Note. Being that I am a former smoker who quit smoking because of vaping, I knew I could help others do the same. Working for Black Note is a true blessing. Not only do I help educate vapers on a daily basis through my writings, but I am also enjoying the benefits of working with an amazing team and sharing an authentic tobacco solution with the vaping community.
Michael Grey
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What is E-Juice?

E-juice, also known as e-liquid or vaping liquid, is the liquid that’s placed in the vaping device and subsequently atomized into vapor. When you go to buy e-juice, you’ll notice it contains a mix of several ingredients. These typically include vegetable glycerin (VG), propylene glycol (PG), some type of flavoring, and nicotine.

VG and PG form the base of the e-liquid. VG is a component used in food and personal care products; its role in e-liquid is to create a thick, dense vapor. PG is another popular solvent used in a variety of everyday items. It carries the e-liquid flavor, provides the “throat hit,” and enhances the vaping liquid’s ability to soak into wicks or cartomizer materials.

Nicotine is an optional ingredient, often available in different levels. E-juice also contains some type of flavoring.

Black Note leads the pack of tobacco vaping liquid by using only natural flavoring – extract from real tobacco leaves to produce real tobacco taste. When you go to buy e-juice from other companies, you may find any number of chemicals used to create synthetic flavors that include fake strawberry, manufactured vanilla, and even man-made tobacco flavors.

If your aim when you buy e-liquid is to experience the subtle nuances, genuine flair and authentic taste of real tobacco, then you’ll be on the mark if you buy e-juice from the Black Note lineup.

Best E-Juice

When you’re going to buy e-liquid, it’s only natural you’ll want the best e-liquid. But what, exactly, does it “best e-juice” mean? We’ll tell you.

For starters, you’ll want an e-juice that doesn’t contain all kinds of strange chemicals and concoctions that you can’t even pronounce. True, even the best e-liquid will contain vegetable glycerin (VG) and proplene glycol (PG), which serve as the base of e-juice, but you don’t necessarily need a host of other chemical compounds.

The best e-juice will stick to natural ingredients, like real tobacco extract, rather than rely on synthetic flavorings, colorings and other additives. Diacetyl is one of those synthetic ingredients that has gotten a pretty bad rap, although its use is not all that uncommon for producing sweet e juice flavors.

Definitely read the ingredient list before you buy e-juice to ensure you recognize what’s on it. Better yet, see if the e-juice company offers a lab report to confirm what’s actually inside the e-liquid.

In addition to having as few chemical ingredients as possible, the best e-juice will have an amazing taste. For those who enjoy authenticity over imitation, the most amazing taste is the most natural taste, especially when it comes to tobacco. Since Black Note uses real extract from tobacco leaves, we not only avoid all those weird chemical flavorings, but we also produce the most authentic experience: tobacco vaping liquid that actually tastes like tobacco.

Best E-Liquid on the Market

Anyone looking for the best e-liquid on the market need look no further than Black Note. Black Note tobacco vaping liquid ranks as the best e-juice across the board in every category, starting with the taste.

Black Note’s main claim to fame is producing a tobacco vaping liquid that actually tastes like real tobacco. That because we use real tobacco extract, not chemicals, to create the best e-juice tobacco flavor. Using extract from real tobacco leaves retains tobacco’s nuances and flavor notes, giving you the most authentic and multi-faceted tobacco experience.

In addition to being the best e-juice for tobacco taste, Black Note also has the best e-liquid manufacturing process. We spent years researching and testing various production methods, and finally landed on one that we believe is absolutely perfect.

It starts with growing carefully selected tobacco seeds, followed by an equally precise of steps that include an extensive natural extraction process. Even our bottling and packaging is done with the utmost care, using recycled and recyclable packaging materials to ensure our products are as earth-friendly as they are vapor-friendly.

One more category where Black Note ranks as the best e-liquid is with the value. Every order comes with free domestic shipping, one-to-three day domestic shipping guarantee, and a 90-day, money-back satisfaction guarantee. If you’re not happy for any reason, or don’t agree we’re the best e-juice on the market, send it back on us and we’ll refund your money.

Vape Juice Ingredients

Vape juice ingredients can be pretty straightforward – or not. At the very least, most vape juice contains propylene glycol (PG), vegetable glycerin (VG), and some type of flavoring. Nicotine has largely become an optional ingredient that can be included at varying levels or left out altogether.

Vegetable glycerin (VG) and propylene glycol (PG) are usually the two main ingredients that make up the base of most vape juice.

VG is a plant-based substance with the ability to produce a dense, thick vapor. PG is an additive found in many food items and certain medicines. It carries the flavoring, provides the “throat hit” and enhances the vape juice’s ability to soak into the wicking materials.

Nicotine levels can vary, as can ingredients that make up the flavorings. The components that make up vape juice flavoring are where ingredients can get rather complicated.

Vape juice that relies on artificial flavorings can contain any number of extraneous chemicals and other additives, whatever it takes to recreate the flavor the ecig juice is going for.

Black Note uses only natural flavorings: extract from real tobacco leaves. That keeps our ingredient list incredibly simple, backed by a lab report to prove it. You won’t find any strange chemical concoctions used to produce our tobacco flavor, just real tobacco extract that delivers a real tobacco experience.

What is the Best Flavor for Ecig Juice?

From strawberry shortcake to banana rum, ecig juice comes in tons of flavors. While folks can debate and discuss all the fruity, sweet or food-like flavors all day long, the best flavor for e-cig liquid is straight-up tobacco.

Why? Vaping was originally created as an alternative for traditional cigarettes, mainly for those who enjoy the taste of tobacco. And when you can find an e-cig liquid that is able to recreate tobacco’s full-bodied yet delicate flavor notes and nuances, but without the harmful chemicals found in cigarettes, then you’ve found the best ecig juice.

Recreating tobacco’s complex flavor isn’t easy, especially when it’s attempted with artificial ingredients. That’s why Black Note sticks to the real thing, extracting the essence of real tobacco leaves to flavor our vaping liquid. Not only does this avoid the harmful chemicals in cigarettes, but it also eliminates the flavoring chemicals found in many ecig juices. The end result is real tobacco taste, an authentic tobacco experience and the best flavor for ecig juice you can find.

Notice also we said the best e-cig flavor was straight-up tobacco, not plain old tobacco. Black Note’s real tobacco vaping liquid happens to come in a variety of different blends, from the light and airy to the peppery and robust. Not all tobacco is created equal, and different blends capture the specialized subtleties that make each tobacco unique.

Best Sweet Tobacco E-Juice

When it comes to sweet tobacco e-juice, your options can be broken down into two categories.

The first category contains tobacco e-juice that overlays the tobacco flavor with artificial chocolate, caramel, vanilla, fruity or other dessert-like flavorings. We wouldn’t classify any such flavors as the best tobacco e liquid, simply because they typically use chemicals and other artificial ingredients to create the tobacco taste, the sweet taste, or both.

The second category of sweet tobacco e-juice is where you’ll find the best tobacco e-liquid, sweet or otherwise. This category contains vaping liquid created using only natural flavorings, which is exactly where Black Note fits in. Instead of concocting flavors using synthetic ingredients, Black Note uses an extensive extraction process that slowly and deliberately extracts the tobacco essence from real tobacco leaves.

The result is the best tobacco e-juice: tobacco vaping liquid that actually tastes like real tobacco. And if you’re going for the best sweet tobacco e liquid, we have a few tobacco blends that offer varying levels of sweetness.

Prelude is our sweetest tobacco e-liquid, containing golden Virginia tobacco. Made from fire-cured dark Virginia tobacco, Sonata is our Cavendish blend with a mildly sweet and nutty flavor. Solo is our menthol blend, giving you a semi-sweet minty taste created from natural menthol crystals extract from dried mint leaves.

For the best tobacco e-liquid that’s naturally sweet and remarkably delicious, Black Note is at your service.

WARNING: Black Note products are not smoking cessation products and have not been tested as such. Black Note products are intended for use by adults of legal smoking age (21 or older in California), and not by children or women who are pregnant or breastfeeding. Black Note products contain nicotine, a chemical known to the State of California to cause birth defects or other reproductive harm. Ingestion of the non-vaporized concentrated ingredients can be poisonous. Keep out of reach of children and pets. For immediate advice, contact poison control center: (800) 222-1222