Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis

Abstract

Background This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged &lt;20 years with subsequent tobacco use. Methods We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged &lt; 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use. Findings A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p&lt;0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p&lt;0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p&lt;0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035). Conclusion There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.

El cigarrillo electrónico podría contribuir a la cesación tabáquica aunque permanece incierta su seguridad a largo plazo

“…En el principal estudio de este meta-análisis, el 80 % de los participantes que dejaron el cigarrillo convencional continuó utilizando el CEN al año de seguimiento, en comparación con el 9 % de los participantes en la rama TRN 4 . Otra desventaja de los CE es que una mayor disponibilidad de este tipo de dispositivos podría facilitar significativamente la iniciación tabáquica en los jóvenes y los adolescentes, como lo indican los resultados de un meta-análisis reciente 5,6 . Por otro lado, con respecto a la seguridad de la intervención evaluada en la revisión de Hartmann-Boyce et al, encontramos una importante limitación que resulta de haber incluido estudios de corto seguimiento para evaluar los efectos del uso crónico.…”

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.…”

“…While cigarettes continue to be the dominant form of tobacco use, the number, variety and uptake of more recently developed products are increasing,1 particularly among youth 2. Youth uptake of nicotine and other vaporised products may sustain nicotine addiction or lead to smoking and other substance initiation 3–5. 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.…”

eHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review

“…Moreover, data from the UK Household Longitudinal Study found that e-cigarette use was greater among socioeconomically disadvantaged youth, particularly among never-smokers [ 39 ], and the 2018-2019 Kansas Communities That Care Student Survey—a large, cross-sectional, school-based survey of middle and high school students in Kansas (N=132,803)—found that adolescents from rural areas were more likely to report current e-cigarette use than those living in urban areas [ 40 ]. A recent meta-analysis of 23 studies found that among people aged <20 years, e-cigarette use triples the risk of initiating tobacco smoking [ 41 ]. Although not all individuals who use e-cigarettes will progress to tobacco smoking, they are at risk of experiencing e-cigarette or vaping-associated lung injury [ 42 , 43 ].…”