DOI: 10.1101/19007005Oct 8, 2019Paper

Does e-cigarette use in non-smoking young adults act as a gateway to smoking? A systematic review and meta-analysis

MedRxiv : the Preprint Server for Health Sciences
Jasmine N KhoujaMarcus R Munafò


Objective: The aim of this review was to investigate whether e-cigarette use compared to 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 odds ratio could be calculated were included (excluding reviews and animal studies). Data Extraction: Independent extraction was completed by multiple authors using a pre-prepared extraction form. Data synthesis: Of 9,199 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: Whilst 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 sm...Continue Reading


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