Prospective association between use of electronic cigarettes and use of conventional cigarettes - a systematic review and meta-analysis
- 1Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- 2Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- 3Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- 4Centre of Epidemiology and Community Medicine, Stockholm, Sweden
- 5Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
- 6Department of Public Health and Clinical Medicine, Division Sustainable health, The OLIN Unit, Umeå University, Umeå, Sweden
- 7Department of Health Sciences, Division of Nursing, Luleå University of Technology, Luleå, Sweden
- Louise Adermark (louise.adermark{at}gu.se)
Abstract
Objective The aim of this systematic review and meta-analysis was to assess the association between e-cigarette use and subsequent initiation or recurrence of cigarette smoking.
Data sources A systematic literature search was finalised November 11, 2019 using PubMed incl. Medline, EMBASE, Cochrane Library, Scopus, PubMed Health, NICE evidence search, PROSPERO, CRD, and PsycInfo.
Study selection Studies were included if meeting the following criteria: reporting empirical results; longitudinal observational design with a minimum of 3 months of follow-up; including general population samples; allowing for the comparison between users and non-users of e-cigarettes. Studies rated as having high risk of bias were excluded. Studies were independently assessed by at least two authors. The procedures described by PRISMA were followed, and the quality of evidence was rated using GRADE.
Data synthesis Thirty longitudinal studies from 22 different cohorts assessing e-cigarette use among non- or never-smokers at baseline, and subsequent use of cigarette smoking at follow-up, were included in this review. A random-effects meta-analysis based on 89 076 participants showed a pooled unadjusted odds ratio (OR) of cigarette smoking among baseline non-smokers e-cigarette users compared with non-users of 4.68 (CI 3.64–6.02), while the adjusted OR was 3.37 (CI 2.68–4.24). These results were consistent irrespective of whether the outcome was measured as ever smoking or as past 30-day smoking. The evidence was graded as moderate.
Conclusions Use of e-cigarettes may predict the initiation or recurrence of cigarette smoking.
Footnotes
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Conflict of interest: Dr. Adermark reports grants from Swedish research council, during the conduct of the study.
Conflict of interest: Galanti has nothing to disclose.
Conflict of interest: Dr. Ryk has nothing to disclose.
Conflict of interest: Dr. Gilljam has nothing to disclose.
Conflict of interest: Dr. Hedman has nothing to disclose.
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- Received January 2, 2021.
- Accepted May 5, 2021.
- Copyright ©The authors 2021
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