The impact of this confounding is that it will bias the results towards finding that e-cigarettes are much less effective than other approaches. In fact, this is exactly what happened and it is the reason why the evidence that Glantz and others are citing to support their contention that e-cigarettes hinder smoking cessation is invalid.

He states: “If they get another generation of kids more hooked on nicotine and more likely to smoke cigarettes, that’s more harm than good. If they get smokers who would have quit to keep smoking instead of quitting, more harm than good. If they get ex-smokers who have been off nicotine to go back on nicotine and then back to cigarettes, more harm than good. If they get people who want to quit smoking and would have taken medicines to think e-cigarettes are going to help, but they don’t, more harm than good."

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