Furthermore, later in the paper they reinforce this point more specifically, writing: "the cross-sectional nature of our study does not allow us to identify whether most youths are initiating smoking with conventional cigarettes and then moving on to (usually dual use of) e-cigarettes or vice versa...".

The rest of the story is that Dr. Frieden continues to fabricate scientific evidence in an apparent effort to demonize electronic cigarettes. I have already reported how he that he purported to demonstrate that electronic cigarettes are a gateway to a lifetime addiction to smoking cigarettes. Here, he apparently makes up scientific evidence that large numbers of ex-smokers are returning to nicotine use by taking up vaping. While I follow the electronic cigarette literature extremely closely, I am aware of no studies which have shown that large numbers of ex-smokers are taking up vaping. In contrast, there is much evidence that large numbers of vapers are quitting smoking, and thus becoming ex-smokers.

Any type of smokeless tobacco is considered a form of tobacco harm reduction because it does not involve smoke or tar. This typically includes snus, chewing tobacco, tobacco strips-lozenges-stick-gum, and . These products can provide nicotine without lighting tobacco on fire and inhaling it, thereby reducing the harm caused by the smoke and tar from tobacco. Nobody is going to claim these products are 100% safe, but many claim they are safer than smoking tobacco. It is another way to approach the problem, and it is gaining popularity quickly thanks to e-cigarettes.

Peter Hajek, director of the Tobacco Dependence Research Unit at Queen Mary, University of London, also this critical flaw in the study: ""The authors followed up smokers who tried e-cigarettes but did not stop smoking, and excluded smokers who tried e-cigarettes and stopped smoking," he said. "Like smokers who fail with any method, these were highly dependent smokers who found quitting difficult. The authors concluded that e-cigarette (use) was not helpful, but that would be true for any treatment however effective if only treatment failures were evaluated."

Dr. Ken Warner, a nationally recognized tobacco control expert, doesn't buy it. He was quoted as :

One of the first things you need to decide is if you like a sweeter taste, or a real tobacco taste. At first, many smokers prefer an e-juice with a tobacco taste, but many will gradually shift into sweeter flavors like apple or strawberry.

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