Cool or Fnool?

“Teenagers smoke e-cigarettes because they deem them ‘cool and fun’, alarming report claims” – makes for an interesting, click bait type headline doesn’t it? So what is all the fuss about? Well as you would expect a new “study” from Canada has been released – with an accompanying op-ed from none other than Matthew Stanbrook, by far the most ideological and idiotic anti-vaper “researcher” there is, who claims that “e-cigarettes are a gateway that must be shut”. More on that later in the post.

Before I go through the new study, the first thing that caught my eye was the declaration of interests:

has received consultant fees from Janssen Pharmaceuticals, Aergerion Pharmaceuticals, Merck and Bristol-Myers Squibb, and grants from Janssen Pharmaceuticals, Amgen and Daiichi Sankyo.
No other competing interests were declared.

It isn’t clear from this particular co-authors declaration how much involvement in the design and/or analysis he had, but to list no less then five pharmaceutical companies that he has received “consultant fees” and “grants” should have raised some eyebrows.


Use of electronic cigarettes (e-cigarettes) among adolescents has not been fully described, in particular their motivations for using them and factors associated with use. We sought to evaluate the frequency, motivations and associated factors for e-cigarette use among adolescents in Ontario.

To be fair, the reasons for youth using e-cigarettes isn’t fully understood by many. However, the reasons that youth take to smoking are also unclear so already this study is kinda shooting in the dark.


We conducted a cross-sectional study in the Niagara region of Ontario, Canada, involving universal screening of students enrolled in grade 9 in co-operation with the Heart Niagara Inc. Healthy Heart Schools’ Program (for the 2013–2014 school year). We used a questionnaire to assess cigarette, e-cigarette and other tobacco use, and self-rated health and stress. We assessed household income using 2011 Canadian census data by matching postal codes to census code.

Note the type of study used (emphasis mine):

In medical research and social science, a cross-sectional study (also known as a cross-sectional analysis, transversal study, prevalence study) is a type of observational study that involves the analysis of data collected from a population, or a representative subset, at one specific point in time

This type of study is what I would term “snapshot” as the information gathered doesn’t really tell the whole story prior to the snapshot, nor does it describe what is going to happen. These types of studies can be useful, but their usefulness is woefully limited. Mostly they are used to guide opinion.


Use of e-cigarettes is common among adolescents in the Niagara region and is associated with sociodemographic features. Engaging in seemingly exciting new behaviours appears to be a key motivating factor rather than smoking cessation.

Well we know from a lot of other studies, that sociodemographic features are rather meaningless – the appeal, or desire to use an e-cigarette transcends those boundaries. Also, and let’s be perfectly blunt here – kids will try stuff. So to broadly state that “engaging in seemingly exciting new behaviours” is a key motivating factor suggests to me that these researchers have completely missed the point. Pleasure principle folks. Get with the program.

So, is the interpretation supported by the study data?

Closer Look

For the smoking and tobacco portion of the questionnaire, students were asked to select only 1 option for each question. Questions for this section included “Have you ever taken at least one puff from an electronic cigarette?” and “If yes, why did you try an e-cigarette?” (options: “a. It’s cool/fun/something new; b. For the buzz; c. To help me quit smoking; d. To help me smoke less; e. To help me when I’m not allowed to smoke”). 

OK let’s take a closer look at this. “Have you ever taken at least one puff from an electronic cigarette?” is generally regarded as experimentation. Kids try stuff, and in general the more exotic and fun that stuff is, the better. I note that there is a distinct lack of “I just wanted to try it” in answer to that question, so you can probably guess how participants that answered yes to this question were classified can’t you?

So 5% (134) of the total number of participants that answered at least one “smoking related question” only used an e-cig once. That’s called experimentation folks, not actual use, while out of this group (n=238 out of the total number of participants 2278) only five (less than 1%) used an e-cig daily – which is regular use.

Hardly groundbreaking is it?

But then, that wasn’t the point of the research was it? The point was to try (badly) to understand the motivations behind said use.

With so much emphasis being placed on the “not smoking” aspect of e-cig use, there were only two (three if you count “no answer”) answers of any significant relevance. The phrasing of “cool/fun/new” is, shall we say more than a little weird, but let’s take a look at the figure break-down:

  • Cool/fun/new = 171 (71.8%)
  • Helps to quit smoking = 9 (3.8%)
  • Helps to smoke less = 5 (2.1%)

But consider the “no answer” figure – a shade over 10%  – what do you do if none of the provided answers fit? You say “none of these” or “no answer” – so at least 24 of the 238 ever used group had other reasons for using an e-cig. It’d be nice to have known why, but of course that wasn’t the point of this study was it?

But consider this, those answer “cool/fun/new” are most likely sub-consciously invoking their own pleasure principle. They are using the devices because they enjoy it.

Of course, no study such as this would be complete without citing some random “gateway” arguments (hence Stanbrook’s op-ed alongside it):

We found strong associations between e-cigarette use and recent cigarette smoking, a finding that has been shown both in adults and youth. Despite these strong associations, we found 82.5% of respondents who had used e-cigarettes had not smoked cigarettes during the previous 30 days.

That doesn’t actually tell us anything as the authors did not provide any kind of smoking history baseline – just because they haven’t used cigarettes in the last 30 days doesn’t mean that they have never used them – just saying “80% of the participants haven’t used cigarettes in the last 30 days, but had used e-cigs, so e-cigs are bad” is quite frankly, utterly ridiculous.

Further studies are required to assess whether e-cigarette use is a contributing factor toward increased future tobacco uptake among youth.

There’s the call for more funding. They haven’t really proven anything, or provided anything particularly useful – unless you count the fact that they’ve highlighted (though completely misunderstood) the pleasure principle.

There are Limits

Our study had a number of limitations. Because it was cross-sectional, we derived associations rather than causations.

In other words A does not necessarily equal B, but we think it does.

We administered the questionnaire in only 1 region

So we can’t extrapolate this to the broader population.

We evaluated use of cigarettes during the previous 30 days rather than rates of ever having used cigarettes.

So we have no idea about the history of those that haven’t smoked in the last 30 days but are (or have) used e-cigarettes.

Although the questionnaire was structured such that parental involvement was only required at the beginning (consent and family history assessment), it is possible that parents may have been able to see the students’ responses.

In other words, those little brats could have lied on the questionnaire.

Other issues of note:

No questions on whether or not the e-cigarette was being used with nicotine or not. This is a rather fatal flaw – especially for the “tried once” group.

Also, there was no attempt at defining whether the participants meant “cool”, “fun” or “new” – I suspect there would be a wider variance of answers if those were separate answers.

Smoking reduction and cessation do not appear to be motivating factors for the use of e-cigarettes among these respondents. Adolescents in this population appear to be motivated by the appeal of trying something new. Future studies will be required to assess the short- and long-term health impact of e-cigarettes and whether they play a role in the adoption of future tobacco use. Our findings support the ongoing implementation of strict regulations to help reduce e-cigarette use among adolescents.

Well, if you phrase the questions in such a way to lend heavy bias to a particular answer, then you are bound to come to that conclusion aren’t you? The findings provide nothing new, have no understanding of the reasons why youths use these devices (or smoke), the only thing it provides is “evidence” to legislators to enforce even more draconian measures that will inhibit the products from a) evolving to meet the needs of the consumer, b) stop kids from having fun, and most importantly c:

Will prevent current smoking youth from moving away from tobacco.

But then, it’s never been about health has it? May as well have entitled the paper “We discovered kids try stuff”.

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