Association of E-cigarettes with adolescent alcohol use and binge drinking-drunkenness: A systematic review and meta-analysis

Abstract

Background: E-cigarette (ECIG) use has increased substantially in the past decade. Co-use of alcohol and ECIGS may have serious consequences in adolescents. Objectives: To evaluate the association of e-cigarettes (ECIGs) with alcohol use in adolescents. Methods: Searched databases included PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were included if they contained a non-E-cigarette group (NON-ECIG), an ECIG group, detailed rates of alcohol use, binge drinking, or drunkenness and included adolescents. Two independent reviewers extracted data using MOOSE guidelines. Evidence quality across studies was assessed using Cochrane GRADE methodology. Summary effects of ECIG vs. NON-ECIG use on any alcohol use and a composite of binge drinking/drunkenness were calculated using a random-effects model. Results: 28 of 3768 initially identified studies were included: 25 cross-sectional, 3 cohort studies, N = 458,357 total subjects (49.6% females). Pooling of data showed that ECIG users had a higher risk for any alcohol use compared to NON-ECIG users (Odds Ratio/OR 6.62, 95% confidence interval/CI 5.67-7.72) and a higher rate of binge drinking/drunkenness compared to NON-ECIG users (OR 6.73, 95% CI 4.5 − 10.07). The subset of high school ECIG users had higher rates of alcohol use (OR 8.17,) and binge drinking/drunkenness (OR 7.98, 95% CI 5.98-10.63) compared to NON-ECIG users. Conclusion: ECIG users had a higher risk of alcohol use and binge drinking/drunkenness compared to NON-ECIG users. Our findings indicate that interventions to reduce ECIG use should be coupled with measures to reduce alcohol use in adolescents.

Youth vaping: a review and update on global epidemiology, physical and behavioral health risks, and clinical considerations

“…Three longitudinal studies suggested a temporal relationship in which EC use predates cannabis use [ 55 – 57 ], suggesting that addressing EC use is an important means of preventing youth cannabis use and of mitigating the adverse neuropsychological effects of cannabis [ 58 , 59 ]. Additionally, another meta-analysis found EC use associated with a six-fold risk of alcohol use and binge drinking in adolescents, though most included studies were cross-sectional and did not sufficiently adjust for confounders [ 60 ].…”

“…Some ECs lead to very high doses of nicotine used, creating stronger addiction risk • Youth who vape are at risk of acute health problems such as EVALI [ 67 ], seizures [ 69 ]. bad oral health [ 70 ], or injury from exploding devices [ 105 , 106 ] • Vaping appears to increase the risk of becoming a CC smoker [ 44 , 46 , 3 , 60 • EC aerosols contain heavy metals, fine particles, and other substances that may be toxic or cancer-causing to vapers and bystanders [ 71 ], so vaping indoors should be avoided • Nicotine and cannabis both affect neurodevelopment and may lead to problems with sleep, concentration, memory, and mental health [ 76 ]. Earlier substance use likely increases these risks [ 51 , 54 ] • Peer influence is important [ 31 ], and adolescents’ perceptions of the importance of peer influence predicts EC use [ 107 ].…”

Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis

“…However, evidence from animal and in-vitro studies show that nicotine, a key component of ENDS, is damaging to the developing brain of children and adolescents. 9 Further, meta-analyses of prospective cohort studies found that use of e-cigarettes in non-smoking children and adolescents might increase the risk of future cigarette smoking 10 and use of other addictive sub stances 3,11,12 ; although at present data are sparse and it remains uncertain whether ENDS or ENNDS use is associated with a gateway effect toward use of tobacco and other substances in children and adolescents.…”

Alcohol and Vapourized Nicotine Co-Exposure During Adolescence Contribute Differentially to Sex-Specific Behavioural Effects in Adulthood

“…Alcohol and nicotine are frequently used sequentially and simultaneously by adolescents 3 with a high prevalence of concurrent e-cigarette vaping and alcohol consumption 4 . Vaping high school students also showed greater alcohol drinking compared to non-vapers 5 , and alcohol and e-cigarette use is the most common type of co-use in this population 6 . The long-term effects of vaping are currently unknown, as are the consequences of e-cigarette/alcohol co-use 6 .…”

“…Despite the epidemiological findings indicating frequent associations between e-cigarette use and alcohol consumption 4,5 , there is a scarcity of information regarding the long-term behavioural consequences of their co-use during adolescence. Using a preclinical model of moderate voluntary adolescent alcohol intake and passive nicotine vapour administration, the current study found that exposure to alcohol and vapourized nicotine during this critical developmental period promotes unique sex-specific effects on incentive and associative learning processes.…”