The results were reported as follows: "Increased duration of e-cigarette use was associated with fewer cigarettes smoked per day and differing patterns of dependence to e-cigarettes contingent upon smoking history. Additionally, increased duration of e-cigarette use was associated with increased frequency of use; however, this finding became nonsignificant when current tobacco cigarette use was accounted for, suggesting that individuals may increase e-cigarette use frequency as they decrease cigarette use. Overall, e-cigarette users tended to decrease the strength of nicotine in their e-cigarette products regardless of duration of use."

Think of it this way: Individual X has smoked 2 packs per day for 30 years. She has tried, unsuccessfully, to quit smoking using the nicotine patch and nicotine gum. Finally, she has successfully quit smoking using electronic cigarettes.

mat cost anywhere from 20 up over 50 and the replacement cartridges will set you back around 700-1000 for a year. This is based on smoking the equivalent of 20 e-cigarettes a day. Analogue smoking would set you back well over 2,500 per annum for the same amount of puffing.

Neither the survey approach or the RCT approach is perfect. Both have major strengths and significant limitations. The best way to proceed is to conduct both types of studies and to synthesize the results across study designs, keeping in mind the methodological strengths and limitations of each individual study. Only by looking at this totality of the evidence can we draw valid scientific conclusions.

The truth is that this paper provides no evidence whatsoever that e-cigarette use is a gateway to smoking. Instead, it is entirely possible - and quite likely - that youths who use e-cigarettes are more likely to be heavier and more resistant smokers.

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