Is adolescent e-cigarette use associated with smoking in the United Kingdom?: A systematic review with meta-analysis

Abstract

INTRODUCTION Though smoking is a public health problem the use of e-cigarettes has been associated with a reduction in smoking in developed countries. However, public health experts have raised concerns about the association of e-cigarette use with an increase in traditional cigarette smoking in adolescents. Reviewlevel evidence is generally supportive of this concern, but as it is mainly based on studies from the USA we investigated if e-cigarette use is associated with traditional cigarette smoking in adolescents (aged 10-19 years) in the UK. METHODS We conducted a systematic review of empirical studies. Databases (PubMed, Medline via ProQuest, CINAHL and SCOPUS) were searched between January 2005 and May 2018 using search terms based on the concepts: adolescents, traditional cigarette smoking, e-cigarettes, and UK. Using predefined inclusion and exclusion criteria, a total of eight studies (involving 73076 adolescents) were included in this review. Three of the included studies were eligible to be combined in a meta-analysis. The CASP appraisal tool was used to assess study quality while risk of bias was assessed using ROBINS-I. RESULTS Studies included in the meta-analysis showed that adolescents who use e-cigarettes are up to six times more likely to smoke traditional cigarettes. Furthermore, results showed that traditional cigarette smoking can also precede e-cigarette use in adolescents and there was increased likelihood of an increase in initial product use (e-cigarette or traditional cigarette) when the alternate product was initiated. CONCLUSIONS Public health policy makers in the UK still need clear conclusions about the effects and safety of e-cigarettes. AFFILIATION

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

“…The results of this up-to-date and comprehensive systematic review are in line with two previous meta-analyses, Soneji et al [16] and Aladeokin and Haighton [18], that also found an association between initiation of e-cigarette use and subsequent smoking. However, this systematic review consolidates and extends the evidence base for public health policy because it used nine studies concentrating on adolescents who resided in a wider geographical region, and the analysis also took account of quality and confounding.…”

E-cigarette use and combustible tobacco cigarette smoking uptake among non-smokers, including relapse in former smokers: umbrella review, systematic review and meta-analysis

“…This review builds on and has findings consistent with earlier systematic reviews and metaanalyses in the peer-reviewed and grey literature [11,16,38,39,58,59] For those who use nicotine-containing e-cigarettes, a resulting addiction to nicotine may leave users at risk of seeking other forms of inhalable nicotine, such as combustible cigarettes [60,61]. Additionally, as e-cigarettes can mimic behavioural (e.g.…”

“…Aladeokin & Haighton (2019) aimed to systematically review the evidence on e-cigarette use and initiation of cigarette smoking in adolescents (aged 10-19 years old) in the UK and included eight studies. [39] Their meta-analysis showed e-cigarette users were much more likely than non-users to go on to smoke combustible cigarettes, even after adjusting for covariates (see Table 1); the substantial heterogeneity in the summary estimate should be noted.…”

Increasing Use of E-cigarettes: A Public Health Concern?

“…Evidence shows that those who use e-cigarettes earlier are more prone to smoke regular cigarettes in the future 2 . A recent study revealed that adolescents who use e-cigarettes are up to six times more likely to smoke traditional cigarettes 3 . E-cigarettes are considered a tobacco product because they contain nicotine, a highly addictive substance.…”