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Int. J. Environ. Res. Public Health 2015, 12(5), 5439-5464; doi:10.3390/ijerph120505439

Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would)

The Consumer Advocates for Smoke-Free Alternatives Association (CASAA), P.O. Box 652, Wilbraham, MA 01095-0652, USA
Academic Editors: Igor Burstyn and Gheorghe Luta
Received: 15 April 2015 / Revised: 6 May 2015 / Accepted: 11 May 2015 / Published: 21 May 2015
(This article belongs to the Special Issue Methodological Innovations and Reflections)
View Full-Text   |   Download PDF [727 KB, uploaded 21 May 2015]

Abstract

It is often claimed that low-risk drugs still create harm because of “gateway effects”, in which they cause the use of a high-risk alternative. Such claims are popular among opponents of tobacco harm reduction, claiming that low-risk tobacco products (e.g., e-cigarettes, smokeless tobacco) cause people to start smoking, sometimes backed by empirical studies that ostensibly support the claim. However, these studies consistently ignore the obvious alternative causal pathways, particularly that observed associations might represent causation in the opposite direction (smoking causes people to seek low-risk alternatives) or confounding (the same individual characteristics increase the chance of using any tobacco product). Due to these complications, any useful analysis must deal with simultaneity and confounding by common cause. In practice, existing analyses seem almost as if they were designed to provide teaching examples about drawing simplistic and unsupported causal conclusions from observed associations. The present analysis examines what evidence and research strategies would be needed to empirically detect such a gateway effect, if there were one, explaining key methodological concepts including causation and confounding, examining the logic of the claim, identifying potentially useful data, and debunking common fallacies on both sides of the argument, as well as presenting an extended example of proper empirical testing. The analysis demonstrates that none of the empirical studies to date that are purported to show a gateway effect from tobacco harm reduction products actually does so. The observations and approaches can be generalized to other cases where observed association of individual characteristics in cross-sectional data could result from any of several causal relationships. View Full-Text
Keywords: gateway hypothesis; tobacco harm reduction; e-cigarettes; smokeless tobacco; causation; testimonial evidence; hypothesis testing; cross-sectional data analysis; scientific inference gateway hypothesis; tobacco harm reduction; e-cigarettes; smokeless tobacco; causation; testimonial evidence; hypothesis testing; cross-sectional data analysis; scientific inference
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Phillips, C.V. Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would). Int. J. Environ. Res. Public Health 2015, 12, 5439-5464.

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