Association between electronic cigarette use and tobacco cigarette smoking initiation in adolescents: a systematic review and meta-analysis

Abstract

Background This systematic review of prospective longitudinal primary studies sought to determine whether electronic cigarette (e-cigarette) use by teenagers who had never smoked conventional tobacco cigarettes (tobacco cigarettes) at baseline was associated with subsequently commencing tobacco cigarette smoking. Methods The review followed the principles of a systematic review and meta-analysis. A key word search identified peer-reviewed articles published between 1 January 2005 and 2 October 2019 from seven bibliographic databases and one search engine. Using pre-prepared inclusion/exclusion criteria two researchers independently screened abstracts, and subsequently, full text papers. Selected articles were quality assessed in duplicate. Data on study participants characteristics, exposure and outcome measures were recorded in an adapted Cochrane Data Extraction Form. Feasibility assessment was done to detect clinical heterogeneity and choose an approach to meta-analysis. Analysis comprised pairwise random effects meta-analyses, and sensitivity and subgroup analyses. Results From the 6619 studies identified, 14 one-off primary studies in 21 articles were suitable for inclusion. The participants ages ranged from 13 to 19 years and comprised teenagers based in Europe and North America. Nine of the 14 one-off studies, with follow-up periods between 4 and 24 months, met the criteria for inclusion in a meta-analysis of the association between ever use of e-cigarettes and subsequent initiation of tobacco cigarette use. Based on primary study adjusted odds ratios, our meta-analysis calculated a 4.06 (95% confidence interval (CI): 3.00–5.48, I2 68%, 9 primary studies) times higher odds of commencing tobacco cigarette smoking for teenagers who had ever used e-cigarettes at baseline, though the odds ratio were marginally lower (to 3.71 times odds, 95%CI: 2.83–4. 86, I2 35%, 4 primary studies) when only the four high-quality studies were analysed. Conclusion The systematic review found that e-cigarette use was associated with commencement of tobacco cigarette smoking among teenagers in Europe and North America, identifying an important health-related harm. Given the availability and usage of e-cigarettes, this study provides added support for urgent response by policymakers to stop their use by teenagers to decrease direct harms in this susceptible population group, as well as to conserve achievements in diminishing tobacco cigarette initiation.

Efficacy and safety of electronic cigarettes as a smoking cessation intervention: A systematic review and network meta-analysis

“…Policy-makers should act now to ensure that they have fully protected children and young people from the harms of e-cigarettes and the potential to undermine progress in tobacco control through facilitating smoking initiation 71 . While determining whether the risk-benefit profile of e-cigarettes in some population groups is best mobilized through their regulation as consumer products or through the same regulation as other licensed medicines 72 , there is much more policymakers can do to immediately support healthcare professionals and patients to maximize the uptake of existing, well-regulated smoking cessation interventions [73][74][75] .…”

Moving targets: how the rapidly changing tobacco and nicotine landscape creates advertising and promotion policy challenges

“…2 Youth uptake of nicotine and other vaporised products may sustain nicotine addiction or lead to smoking and other substance initiation. [3][4][5] An enormous number and variety of electronic nicotine delivery products are in the market, with nearly 16 000 flavours available, 6 and global sales rising to US$15 billion in 2019. 1 7 Heated tobacco products (HTPs) were also available in over 50 markets worldwide in 2020.…”

The Effects of E-Cigarette Aerosol on Oral Cavity Cells and Tissues: A Narrative Review

“…Despite there being extensive information available on the harmfulness of conventional cigarette smoking, electronic cigarettes (e-cigarettes) are regarded as a safer alternative, which are particularly popular among both adults, young adults and teens, and their use has increased rapidly [1]. Furthermore, waterpipe and cigar smoking are also alternatives to traditional smoking.…”

“…A very high prevalence of smoking indicates that there is a need for smoking cessation programs, access to effective quitting treatments and mass media campaigns to diminish smoking among the youth [2]. The results from the systematic review and meta analysis performed by O'Brien group (2021) indicated that e-cigarette use in Europe and North America by teenagers correlates with the initiation of conventional smoking [1]. It was observed that vaping can be a reason for relapse into traditional smoking [3].…”