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Social Science & Medicine 119 (2014) 45e52
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Social Science & Medicine
journal homepage: www.elsevier.com/locate/socscimed
All gates lead to smoking: The ‘gateway theory’, e-cigarettes and the
remaking of nicotine
Kirsten Bell a, *, Helen Keane b
a
b
Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
School of Sociology, Research School of Social Sciences, Building 22, Haydon Allen Building, Australian National University, ACT, 0200, Australia
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 10 February 2014
Received in revised form
8 August 2014
Accepted 14 August 2014
Available online 15 August 2014
The idea that drug use in ‘softer’ forms leads to ‘harder’ drug use lies at the heart of the gateway theory,
one of the most influential models of drug use of the twentieth century. Although hotly contested, the
notion of the ‘gateway drug’ continues to rear its head in discussions of drug usedmost recently in the
context of electronic cigarettes. Based on a critical reading of a range of texts, including scholarly literature and media reports, we explore the history and gestation of the gateway theory, highlighting the
ways in which intersections between academic, media and popular accounts actively produced the
concept. Arguing that the theory has been critical in maintaining the distinction between ‘soft’ and ‘hard’
drugs, we turn to its distinctive iteration in the context of debates about e-cigarettes. We show that the
notion of the ‘gateway’ has been transformed from a descriptive to a predictive model, one in which
nicotine is constituted as simultaneously ‘soft’ and ‘hard’das both relatively innocuous and incontrovertibly harmful.
© 2014 Elsevier Ltd. All rights reserved.
Keywords:
Gateway hypothesis
Gateway theory
E-cigarettes
Nicotine
Drugs
Addiction
1. Introduction
The idea that drug use in ostensibly harmless forms engenders
more harmful drug use took hold in the twentieth century in tandem with increasing efforts to regulate and restrict drugs, reaching
its epitome in the ‘gateway theory’ (also known as the ‘gateway
hypothesis’). As its name suggests, the assumption at the heart of
this concept is that certain drugs act as a ‘gateway’ to the usage of
other drugs. This notion is readily invoked in discussions of a variety of substances, from cigarettes and alcohol, to cannabis and
solvents. It has also featured prominently in debates about newer
products such as electronic cigarettes (or ‘e-cigarettes’). However,
although a seemingly straightforward theory, it is one with a
complicated gestation and history.
In this paper we explore the history of this concept, highlighting
the intersections between academic, media and popular accounts.
We focus on the role of the gateway theory in not just describing
relationships between forms of drug use but in categorizing
different drugs and constituting them as harmful in particular ways.
Our interest in the gateway theory and its effects on public
discourse about drugs has been provoked by the debates about e-
* Corresponding author.
E-mail addresses: kibell@mail.ubc.ca
(H. Keane).
(K.
Bell),
http://dx.doi.org/10.1016/j.socscimed.2014.08.016
0277-9536/© 2014 Elsevier Ltd. All rights reserved.
helen.heane@anu.edu.au
cigarettes and their relationship to smoking. As we aim to show in
the second half of the paper, while the argument that e-cigarette
use could lead to young people taking up smoking explicitly deploys the gateway theory, it is also quite different from earlier
claims about ‘soft’ drugs as a stepping stone to ‘hard’ drugs.
Our exploration of the gateway theory and its re-emergence in
debates about e-cigarettes is based on a critical reading of a range of
texts, including scholarly literature and media accounts. Academic
and policy literature on the gateway theory was found through
searches of Google Scholar and media accounts were found through
a search of LexisNexis. We also conducted Google Scholar searches
to explore the literature discussing e-cigarettes in the context of
gateway usage, along with broader Google searches to examine the
ways the term ‘gateway’ is currently being employed in the
mediadboth in accounts of e-cigarettes and beyond them.
The analysis that follows is not intended to represent a
comprehensive review of the literature on this topic, although we
have tried to conduct our search of the relevant bodies of literature
in a reasonably organized and logical fashion (further detail is
provided in the relevant sections below). Importantly, our goal is
not to prove or disprove the veracity of the gateway theory; instead,
our approach to this subject matter is influenced by materialsemiotic approaches which take account of the role of both signs
and things in the production of reality (e.g. Latour, 2007; Fraser and
Valentine, 2008; Law, 2009). As Law (2009, p. 142) observes, “If all
46
K. Bell, H. Keane / Social Science & Medicine 119 (2014) 45e52
the world is relational, then so too are texts. They come from
somewhere and tell particular stories about particular relations”. It
is these stories we aim to explicate in the paper, focusing particularly on the ways that the concept has been continuously dismantled, reassembled and reappropriated, and its critical role in
producing the notion of drug harms.
2. The origins of the gateway theory
Any consideration of the origins of the gateway theory must
attend to its predecessor, the ‘stepping stone theory’, which formed
the backdrop against which the notion of the ‘gateway drug’
emerged. The origins of the ‘stepping stone’ view of drugs are
obscure, and sources attribute its roots differently. According to
Sifanek and Kaplan (1995), the notion was initially articulated in a
pamphlet printed by the U.S. Bureau of Narcotics in 1965 and
asserted that drug users who begin with cannabis increase their
risk of involvement with LSD, cocaine and heroin. However, Morral
et al. (2002) suggest that the concern that marijuana use increases
the risk of progressing to other more serious drugs has influenced
US drug policy since the 1950s, and Kandel (2002) and Anthony
(2012) cite research suggesting that such assertions were made
from at least the 1930s. Thus, it seems that the notion of a ‘stepping
stone’ view of drugs drew much of its impetus largely from popular
wisdom, which would have it that “a joint today means a junkie
tomorrow” (Louiselle and Whitehead, 1971, p. 347).
The origins of the gateway theory are similarly opaque. Denise
Kandel is typically credited with introducing the concept in a 1975
paper titled ‘Stages in adolescent involvement in drug use’ published in Science (e.g. van Bilson and Wilke, 1998; Golub and
Johnson, 2002; Reid et al., 2007; Vanyukov et al., 2012). In many
respects, the paper was set up as a rejoinder to the stepping stone
theory, as Kandel began by referencing the widespread view that
marijuana is “the first step in drug use”, suggesting that this view
was both “arbitrary and inadequately documented” (p. 912). Based
on two longitudinal cohort surveys conducted with 6453 students
from 18 New York high schools, Kandel argued that adolescent drug
use has four distinct stages, with adolescents proceeding from beer
and wine, to hard liquor and cigarettes, to marijuana, to other illicit
drugs (see Fig. 1). She concluded that if adolescents progress to
marijuana use (stage 3), this greatly increased their likelihood of
using other ‘harder’ illicit drugsdfrom about 2e3% to between 16
and 26%. According to Kandel, these stages were unaffected by
gender, educational background or ethnicity, although she did
allow that they were “probably culturally determined” (p. 914).
Two features of this paper are worth highlighting. First, in
contrast to the assumption of marijuana as an inexorable stepping
stone to illicit drugs, Kandel made no claims about a causal relationship between the stages of drug use. In her words, “although
the data show a clear sequence in drug use, a particular drug does
not invariably lead to other drugs higher up the sequence” (p. 914).
Second, at no point did Kandel use the term ‘gateway’ in the article.
As far as we have been able to ascertain, the notion of the ‘gateway
Fig. 1. Kandel's stages model.
Modified from Kandel, 1975.
drug’ first appeared in Robert DuPont's 1984 book Gateway Drugs: a
Guide for the Family, a self-help manual aimed at parents. However,
some observers, including DuPont himself, indicate that the term
was in use from the late 1970s (DuPont et al., 1990; see also Zinberg,
1986e1987; Kandel, 1989). Therefore, it is likely that the book
merely instantiated an idea in wider circulation in drug control
discourse and policy. One fact that supports this interpretation is
that DuPont was the Director of the National Institute on Drug
Abuse and the White House Drug Czar for much of the 1970s.
As its title suggests, Gateway Drugs: a Guide for the Family presented gateway drugs as matters of fact that existed ‘out there’ in
the world and whose major appeal lay in their seeming innocuousness, which served to ensnare unsuspecting young people
(whom he deemed as being uniquely vulnerable to drug use/
abuse). The political utility of the concept must have been readily
apparent to DuPont. With a foreword by Ann Landers, and published as Nancy Reagan's “Just Say No” campaign was building
momentum, the book emphasized the “unique dangers” of “safeseeming drugs” (p. 18), although cocaine and amphetamines were
included along with alcohol and marijuana as gateway drugs. While
acknowledging the multi-causal nature of the “drug epidemic”,
DuPont simultaneously highlighted the role of intoxication in
causing physically-based dependence and ‘harder’ drug use.
DuPont's underlying emphasis on causal biochemical mechanisms
was evident in an interview about the book published in the
Washington Post in 1985, where he warned that: “there's no telling
when the ‘addiction switch’ will turn on” (Weber, 1985).
All this would suggest that what is today labeled the ‘gateway
theory’ represents the convergence of a distinct series of accounts,
from lay models of drug use (the notion of the ‘stepping stone’),
academic theories (Kandel's ‘stages of progression’ model) and
political constructs (DuPont's ‘gateway drugs’). In part, its success
rests on its compatibility with popular views of deviance, in which
escalation is a common theme. Drug use fits particularly well with
ideas of escalation from the seemingly innocuous to the profoundly
destructive because drugs are viewed as causal agents in a wide
range of “calamities and failures of responsibility”, including
violence, crime, school failure, family conflict and illness (Room,
2005, p. 149). In addition, drug use is inevitably linked with
addiction, understood as an inexorable decline from normality to
‘rock bottom’ (Keane, 2002). In this cultural and discursive context,
the gateway concept makes sense as a description and prediction of
problematic behavior.
3. Academic and policy literature on the gateway theory
Interest in the idea of the ‘gateway theory’ or ‘gateway drugs’
has flourished over the past three decades amongst researchers,
clinicians and policy makers. Although it is beyond the scope of this
paper to attempt a detailed analysis of the concept in the academic
and policy literature, in an attempt to identify broad trends, we
conducted Google Scholar searches of both terms in May 2014,
limiting ourselves to documents published between 1975 and
K. Bell, H. Keane / Social Science & Medicine 119 (2014) 45e52
2000, which arguably represents the concept's formative period.
Google Scholar has the advantage of capturing a variety of different
kinds of sources, from academic articles and books to ‘grey’ literature, and the list of citations it generates includes fragments of text
where the search term is being used. After removing irrelevant
citations (e.g. ones on the gateway theory of pain) and those not in
English, approximately 700 citations remained. These citations
form the basis of the discussion that followsdalthough we examined the original source material in instances where it was unclear
how the concept was being used in the textual fragment captured
by Google Scholar.
Our analysis suggests that the notion of ‘gateway drugs’ has
generally resisted becoming a fact in Fleck (1979) or Latour's (1987)
sense, where concepts are invoked without any trace of ownership,
construction, or time and place, as if it “could have been known for
centuries or handed down by God Himself together with the Ten
Commandments” (Latour, 1987, p. 23). Although it was not uncommon to see the term employed in this fashion, in 75 percent of
the citations it was marked in some way. Beyond the many instances where it was explicitly treated as a “theory” or “hypothesis”, it was often placed in scare quotes, and generally preceded by
disclaimers such as “so-called”, “considered” or “supposed”.
Importantly, while the reality of gateway drugs is commonly
treated as questionable, the existence of a named gateway theory
(as with the stepping stone theory before it) is not. Yet, as we have
shown, no such named theory was initially posited. It is therefore
clear that subsequent scholars writing on the topic actively produced the notion of a ‘gateway theory’ to describe a distinct series
of ideas about progression in drug use. For example, in a paper on
adolescent drug use published following DuPont's book, Oetting
and Beauvais (1986) discussed a cluster of “gateway theories”,
noting that numerous scientists had observed:
…a remarkably orderly progression from one drug to another as
young people get more and more heavily involved with drugs.
This observation has been variously labeled the gateway
(DuPont, 1984), stepping stone (O'Connel and Clayton, 1982), and
precursors (Kandel et al., 1978) hypothesis (pp. 17e18, emphasis
and citations in original).
Although this statement acknowledged that these were distinct
accounts and source material was provided for each one, it simultaneously elided their differences through the framing of these
observations as a singular ‘hypothesis’. Similarly, in an article on
gender and teenage smoking, Gritz (1986) noted that:
The gateway theory of substance use predicts the order in which
licit and illicit drugs are introduced, and analyses have been
performed on continuation and discontinuation patterns (Jessor
and Jessor 1977; Kandel, 1978; Kandel and Logan 1984; O'Malley
et al., 1984) (p. 74, citations in original).
As Latour (1987, p. 29) has shown in his work on fact-making,
“the fate of what we say and make is in later users' hands”. Thus,
facts are made in part out of what we do with prior statements:
taking them up, rejecting them, reopening them, dropping them,
making them more solid by grasping them without further discussion, or transforming them entirely. Oetting and Beauvais (1986)
and Gritz's (1986) statements therefore show us a fact in the process
of being made. For example, although none of the articles cited in
Gritz's statement are about a gateway theory of substance use,
through her “context of citation” (Latour, 1987, p. 35) she treats
these references as developing a “gateway theory of substance use”.
Thus, the descriptive act is actually a productive one, serving to
instantiate the notion of a gateway theory.
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Kandel herself actively contributed to the life of the theory,
titling her 1992 co-authored paper “States of progression in drug
involvement from adolescence to adulthood: Further evidence for
the gateway theory” (Kandel et al., 1992). Subsequent accounts
accepted these statements and they continued to be “eroded and
polished” over time (Latour, 1987, p. 42). And so it was that the
gateway theory became “tacit knowledge” (Latour, 1987, p. 43): a
fact whose existence was universally accepted and required no
citation. In consequence, for the most part it is treated as a timeless,
placeless, ownerless concept whose meaning is both transparent
and self-evident.
Despite this assumption of transparency, given the different
propositions that collectively made up the gateway theory, the
concept means different things to different people. It is no wonder
that Hall and Lynskey (2005, p. 39) observe that,
The gateway hypothesis has been one of the most controversial
hypotheses in the epidemiology of drug use. This has been in
part because proponents and opponents of the hypothesis have
not always been clear about what the hypothesis means and
what policies it entails.
Nevertheless, in general, the theory encompasses a set of related
propositions. According to Kandel (2002, 2003), it involves two
elements: 1) sequencing of initiation of use between drug classes,
and 2) association in the use of drugs, such that use of a drug lower
in the sequence increases the risk of using drugs higher up the
chain. Kandel is careful not to argue for a causal relationship, noting
that: “given the difficulties of establishing true causality in the
social sciences, the term association rather than causation is
emphasized” (Kandel, 2002, p. 4, emphasis in original).
However, as Vanyukov et al. (2012) observe, while those
endorsing the gateway theory (including Kandel herself) often
avoid explicit assertions of causality, it is common to see implicit
causal claims; thus, expressions like “leads to”, “progresses to”,
“predicts”, “increases the risk of”, “stages of progression”, “a causal
chain sequence” are common. This “cavalier approach” towards
association is a common feature of epidemiological studies (Davey
Smith and Phillips, 1992, p. 759). However, even when epidemiologists studying drug use refrain from drawing hasty conclusions
about possible links between causes and effects, their findings are
quickly put to political work. To quote Peretti-Watel (2011, p. 61),
“any figures published are liable to be held up as ‘scientific’ and
immediately reinterpreted in policy-making circles, not to mention
the heavy implications often attached to them when they begin to
circulate in the media”.
Despite media and policy claims to the contrary, the exact
naturedand implicationsdof the association are quite unclear. For
example, Hall and Lynskey (2005) suggest that there are three main
types of explanation for the association between cannabis and
other illicit drug use (arguably the most politicized ‘gateway’
relationship). First, social environment explanations posit that
cannabis users have more opportunity to use illicit drugs because
they are supplied by the same black market, and because of shared
peer networks they are more exposed to illicit drug use. Second,
other explanations focus on the individual characteristics of
cannabis users, suggesting that there is something about users that
makes them more likely to use illicit drugs. In other words, there is
a third variable (e.g. a genetic predisposition to risk taking or a
shared problematic environment) which causes both cannabis and
other illicit drug use. Finally, biochemical/pharmacologic explanations suggest that cannabis use produces changes in the brain that
sensitize users to the rewarding effects of other drugs. These explanations draw much of their impetus from experiments with rats
suggesting that “marijuana manipulates the brain's stress and
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K. Bell, H. Keane / Social Science & Medicine 119 (2014) 45e52
reward systems in the same way as more potent drugs, to keep
users coming back for more” (Wickelgren, 1997, p. 1967).
4. The gateway theory and conceptions of ‘hard’ and ‘soft’
drugs
Questions of causality aside, there is empirical support for a
patterned sequence in drug use in western countries, although this
pattern is certainly not universal (see Degenhardt et al., 2010;
Vanyukov et al., 2012). However, what does this actually tell us
about drug use beyond the fact that some users tend to experiment
with different types of drugs? In many respects, the gateway theory
is a kind of epidemiological “black box” (Peretti-Watel, 2011). As
Vanyukov et al. (2012, p. S5) observe,
The ‘stages’ are defined in a circular manner: a stage is said to be
reached when a certain drug(s) is used, but this drug is supposed to be used only upon reaching this stage. In other words,
the stage both is identified by the drug and identifies that drug.
In effect, the drug is identical to the stage… There is no process
or organismic characteristic, separate from drug use per se,
which is presumed to cause or underlie the supposed developmental staging indicated by, and identical to, drug milestones.
Although the defining characteristic of the gateway theory is a
movement from ‘softer’ to ‘harder’ drugs, closer examination reveals that these categories, while generally treated as self-evident,
are curiously slippery. In many contexts the distinction is treated as
synonymous with the move from licit to illicit drugsda view which
underwrites Kandel's stages model of drug use (see Fig. 1). Yet,
‘hardness’ seems to frequently be conflated with ‘intoxicating’, and
‘softness’ seems to be used as synonymous with readily available/
accessible drugs (e.g. DuPont, 1984). In other treatments, still,
‘hardness’ seems to relate to the idea of ‘addictiveness’ or alternatively hinges on the notion of a ‘less dangerous’/‘more harmful’
binary (Shiner and Newburn, 1997; Hartney, 2012). Distinctions are
also made between different routes of administration, with injected
drugs being identified with ‘hardness’dboth in drug policy (Fraser
et al., 2004) and amongst drug users themselves (Peretti-Watel and
Moatti, 2005). Clearly, depending on the particular frame used, the
actual drugs populating the stages in the progression from softer to
harder drugs might look rather different.
Moreover, it is common to see these multiple and internally
contradictory meanings invoked in a single given account. Getting
Tough on Gateway Drugs is a case in point, as DuPont (1984) seems
to distinguish ‘soft’ and ‘hard’ drugs in at least distinct three ways in
the book. Thus, he initially differentiates such drugs based on “their
most prominent effects on the brain or the central nervous system”
(p. 9); however, later he seems to evoke a cultural model of “safe”
and “scary” drugs based not on their pharmacological properties
but popular perception. In his words:
Another key to understanding which drugs emerged as major
drug problems during the last two decades is the image each
drug had. Drugs that were perceived as ‘safe’ and ‘fun’ shot
ahead of drugs considered ‘dangerous’. Thus, marijuana,
cocaine, anddto a lesser extentdQuaaludes and stimulants like
amphetamines shot far ahead of scarier drugs such as heroin,
LSD, PCP, and even barbiturates (p. 18).
Finally, he seems to differentiate addictive drugs from intoxicating ones, focusing on the latter as ‘gateways’. It is for this reason
that he downplays the role of tobacco as a gateway drug, because it
does not produce intoxication (p. 32).
All this would suggest that a kind of collapsing of socio-legal,
cultural and pharmacological categories has happened in the
notion of gateway drugs, without adequate recognition of this
conflation. The slipperiness of what constitutes a softer vs. harder
drug also means that the theory has considerable utility in directing
attention towards whichever drug happens to be the focus of political ire. Indeed, as we have already seen, the origins of the ideas
promulgated in the form of the ‘stepping stone theory’ and
‘gateway drugs’ were fundamentally political. As Anthony (2012, p.
S101) highlights, the origins of the gateway theory lie in “the
imaginations of politicians and policy makers”. Drug control policy's system of classifications relies on a vision of drugs as more or
less harmful because of internal properties such as ‘abuse potential’. Thus, one of the most important effects of these different iterations of the gateway theory is to produce and naturalize the
identity of certain substances as ‘soft’ (i.e. less inherently harmful
but dangerous because of their role in the path of drug use) and
other substances as ‘hard’ (i.e. inherently harmful).
5. The seductiveness of the ‘gateway’ trope: the media's
uptake of the concept
As the preceding account makes clear, the notion of the ‘gateway
drug’ was never a purely academic concept, but rather a hybrid of
political, popular and academic accounts. The media has therefore
had an important role to play in disseminating and popularizing the
term. A LexisNexis search of media references to “gateway AND
drug” in October 2013 placed the first reference to the concept in a
Washington Post article in 1985 discussing DuPont's book (Weber,
1985). “Gateway drugs” were also mentioned in US newspaper
articles in both 1986 and 1989 (Braham, 1986; Schissler, 1989), with
alcohol, cigarettes and marijuana all singled out as “gateways” or
“bridges” to drugs such as heroin and cocaine. These accounts
tended to highlight the biochemical properties of these drugs as
explanations for their “gateway effects”. For example, a 1989 New
York Times article emphasized the ways in which alcohol “accustoms young people to the feelings of mood alteration, so they are
often wide-eyed to try other drugs, a colorful assortment of pills,
potions and powders” (Schissler, 1989). In each instance, the existence of gateway drugs were taken as given, rather than presented
as a hypothesis or theory.
Although sporadic mentions occurred in the early 1990s, it
wasn't until 1994 that the term was referenced more frequently in
print news, and from 1997 gateway drugs were frequently discussed, with cigarettes and marijuana most commonly singled out
as culprits and explanations tending towards the biochemical, an
orientation that likely reflects the increasing prominence of
neuroscientific research during “the decade of the brain” (see
Keane, 1999). Gateway drugs, the reader was often informed,
“prime the brain” or create “neuro-chemical pathways” for addiction (e.g. Morgan, 1997; Dayton, 1997). The emphasis on cigarettes
as a gateway drug in media reports seems to be partially an artifact
of proposed changes in tobacco control legislation and the political
utility of the concept in promoting them. Thus, in 1996 when the
Clinton administration took steps to assert FDA jurisdiction over
tobacco, arguments about tobacco as a gateway drug were common
(e.g. Fagan, 1996; Siemaszko, 1996; Sims and Brogan, 1996). For
example, an article published in the Canadian national newspaper
The Globe and Mail discussing the FDA regulation quoted an official
stating that: “The gateway drug in all substance abuse is basically
smoking” (Fagan, 1996).
Nevertheless, in contrast to earlier references to the term, from
the mid 1990s gateway drugs were often presented as contested
substances, although this was more common in accounts of
cannabis than tobacco (e.g. Massing, 1996; Brighton, 1997). For
K. Bell, H. Keane / Social Science & Medicine 119 (2014) 45e52
example, a New York Times article published in 1996 stated that
there was “Little evidence to support the claim that marijuana is a
‘gateway drug’” (Massing, 1996). In 1997 a letter to the editor
published in The Gazette argued that characterizations of pot as a
gateway drug could also be made for cigarettes, coffee, sex, regular
jogging, and “a great plateful of fries and gravy” (Korhonen, 1997).
Indeed, over time there has also been a broadening of the concept
and the trope of the “gateway substance” now extends well beyond
the realm of drugs into other ‘suspect’ practicesdalthough such
accounts are informed by ideas about addiction, compulsion and
deviance. Thus, conservative commentators characterize video
games as a “gateway drug” to real-life violence (Wilkie and
Blumenthal, 2013). Likewise, pornography is described as a
“gateway drug” to promiscuity (Sexandthestate.com, 2013) and
conservative Christians now talk of “gateway sins”, defined as “an
unhealthy habit that at first seems innocent, but its continuation
may
lead
to
the
indulgence
of
other
sins”
(Urbangospelmission.com, 2012). Indeed, today it appears that
e to
pretty much any activity seen to ‘encourage’ or ‘facilitate’ entre
another activity (generally one deemed to be compulsive or socially
undesirable) can be conceptualized through the metaphor of the
gateway drug; for example, articles talk of LinkedIn as a “gateway
drug” to social media (Rudin, 2012).
Clearly, as an account of human behavior, there is a degree of
seductiveness to the idea that exposure to a single substance will
lead people inexorably down a path of vice they would not otherwise have succumbed to (whether it be addiction, promiscuity,
violence, and so on). For if the substance is the problem, the answer
then becomes simple: limit exposure. Although the breadth of the
gateway trope would suggest a dampening of the meaning of the
concept, its potency nevertheless comes in part from its veneer of
scientific credibility. This is particularly evident in the ways the
concept has been re-energized in the context of debates about ecigarettes.
6. The resurrection of the gateway theory in e-cigarettes
Electronic cigarettes are a product launched in 2006 by a Chinese electronics company. While some models resemble cigarettes,
they do not involve combustion but are battery-powered devices
that deliver nicotine via an inhaled mist. Opinion on e-cigarettes
has quickly polarized. While some tobacco harm reduction advocates have embraced e-cigarettes as a safer alternative to smoking
cigarettes, for many working in the field of tobacco control they are
merely the latest incarnation of the tobacco ‘menace’: an untested
product with the potential to enslave ever-greater numbers of
peopledespecially adolescentsdto a dangerous addiction (see Bell
and Keane, 2012). As Borland (2011) observes,
People who argue that research is needed first focus primarily
on the risksdthe lack of research on product safety and on the
efficacy of e-cigarettes as cessation aids or as substitutes, and
concern about them being a potential gateway to nicotine
dependence for the young.
Despite these concerns, evidence that e-cigarettes lead one
inexorably down a path towards smoking is very limited. One
highly-publicized study by the Centers for Disease Control and
Prevention (CDC) found that the percentage of US high school
students who reported ever using an e-cigarette rose from 4.7
percent in 2011 to 10.0 percent in 2012 and high school students
using e-cigarettes within the past 30 days rose from 1.5 percent to
2.8 percent and doubled among middle school students (Corey
et al., 2013). Although only 9.3% of e-cigarette users had never reported smoking a cigarette (i.e. less than 1% of the total
49
respondents), the report ends with an ominous warning about the
“risk for nicotine addiction and initiation of the use of conventional
cigarettes or other tobacco products”. In a press release about the
study, Tom Frieden, the CDC Director, stated: “Nicotine is a highly
addictive drug. Many teens who start with e-cigarettes may be
condemned to struggling with a lifelong addiction to nicotine and
conventional cigarettes” (CDC, 2013). The press has been quick to
take up the study's findings, with headlines screaming: “E-cigarettes: healthy tool or gateway device?” (CNN, 2013) and “E-cigarettes: a gateway to nicotine addiction?” (The Week, 2013).
This leap from e-cigarette usagedor even awarenessdto fullblown cigarette usage is readily made in other empirical research.
For example, in a recent study of US adolescent males' awareness of
and willingness to try e-cigarettes, Pepper et al. (2013) found that
very few adolescents had used the devices (