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.

<h4>Background</h4>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 <20 years with subsequent tobacco use.<h4>Methods</h4...

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Main Authors: Sze Lin Yoong, Alix Hall, Heidi Turon, Emily Stockings, Alecia Leonard, Alice Grady, Flora Tzelepis, John Wiggers, Hebe Gouda, Ranti Fayokun, Alison Commar, Vinayak M Prasad, Luke Wolfenden
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Language:English
Published: Public Library of Science (PLoS) 2021-01-01
Series:PLoS ONE
Online Access:https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0256044&type=printable
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author Sze Lin Yoong
Alix Hall
Heidi Turon
Emily Stockings
Alecia Leonard
Alice Grady
Flora Tzelepis
John Wiggers
Hebe Gouda
Ranti Fayokun
Alison Commar
Vinayak M Prasad
Luke Wolfenden
author_facet Sze Lin Yoong
Alix Hall
Heidi Turon
Emily Stockings
Alecia Leonard
Alice Grady
Flora Tzelepis
John Wiggers
Hebe Gouda
Ranti Fayokun
Alison Commar
Vinayak M Prasad
Luke Wolfenden
author_sort Sze Lin Yoong
collection DOAJ
description <h4>Background</h4>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 <20 years with subsequent tobacco use.<h4>Methods</h4>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 < 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.<h4>Findings</h4>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<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<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<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).<h4>Conclusion</h4>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.
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spelling doaj-art-537f1ae3c71d4e9a82f516a25d4aacf52025-08-20T02:22:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01169e025604410.1371/journal.pone.0256044Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.Sze Lin YoongAlix HallHeidi TuronEmily StockingsAlecia LeonardAlice GradyFlora TzelepisJohn WiggersHebe GoudaRanti FayokunAlison CommarVinayak M PrasadLuke Wolfenden<h4>Background</h4>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 <20 years with subsequent tobacco use.<h4>Methods</h4>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 < 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.<h4>Findings</h4>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<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<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<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).<h4>Conclusion</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0256044&type=printable
spellingShingle Sze Lin Yoong
Alix Hall
Heidi Turon
Emily Stockings
Alecia Leonard
Alice Grady
Flora Tzelepis
John Wiggers
Hebe Gouda
Ranti Fayokun
Alison Commar
Vinayak M Prasad
Luke Wolfenden
Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
PLoS ONE
title Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
title_full Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
title_fullStr Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
title_full_unstemmed Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
title_short Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged &lt; 20 years. A systematic review and meta-analysis.
title_sort association between electronic nicotine delivery systems and electronic non nicotine delivery systems with initiation of tobacco use in individuals aged lt 20 years a systematic review and meta analysis
url https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0256044&type=printable
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