Home > Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis.

Khouja, Jasmine N and Suddell, Steph F and Peters, Sarah E and Taylor, Amy E and Munafo, Marcus R (2021) Is e-cigarette use in non-smoking young adults associated with later smoking? A systematic review and meta-analysis. Tobacco Control, 30, pp. 8-15. doi: 10.1136/tobaccocontrol-2019-055433.

External website: https://tobaccocontrol.bmj.com/content/early/2020/...

Objective The aim of this review was to investigate whether e-cigarette use compared with non-use in young non-smokers is associated with subsequent cigarette smoking.

Data sources PubMed, Embase, Web of Science, Wiley Cochrane Library databases, and the 2018 Society for Research on Nicotine and Tobacco and Society for Behavioural Medicine conference abstracts.

Study selection All studies of young people (up to age 30 years) with a measure of e-cigarette use prior to smoking and an outcome measure of smoking where an OR could be calculated were included (excluding reviews and animal studies).

Data extraction Independent extraction was completed by multiple authors using a preprepared extraction form.

Data synthesis Of 9199 results, 17 studies were included in the meta-analysis. There was strong evidence for an association between e-cigarette use among non-smokers and later smoking (OR: 4.59, 95% CI: 3.60 to 5.85) when the results were meta-analysed in a random-effects model. However, there was high heterogeneity (I2=88%).

Conclusions Although the association between e-cigarette use among non-smokers and subsequent smoking appears strong, the available evidence is limited by the reliance on self-report measures of smoking history without biochemical verification. None of the studies included negative controls which would provide stronger evidence for whether the association may be causal. Much of the evidence also failed to consider the nicotine content of e-liquids used by non-smokers meaning it is difficult to make conclusions about whether nicotine is the mechanism driving this association.

Item Type
Publication Type
International, Open Access, Review, Article
Drug Type
Tobacco / Nicotine
Intervention Type
Prevention, Harm reduction
Identification #
doi: 10.1136/tobaccocontrol-2019-055433
Page Range
pp. 8-15
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made.

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