Abstract
INTRODUCTIONThe contribution made by e-cigarettes to smoking cessation continues to be controversial. Reports suggest that teenagers are becoming increasingly addicted to e-cigarettes and that e-cigarette use in adolescents is associated with subsequent cigarette smoking.METHODSSystematic searches of eleven databases were conducted (January 2015 to June 2020). Systematic reviews, randomized controlled trials (RCTs) and cohort studies comparing e-cigarettes with placebo e-cigarettes, nicotine replacement therapy (NRT) or no e-cigarette use were included. The two primary outcomes were smoking cessation among smokers and smoking initiation among non-smoking teenagers. The secondary outcome was adverse events. Data were synthesized using risk ratio (RR) or adjusted odds ratio (AOR) with 95% confidence interval (CI).RESULTSSix systematic reviews, 5 RCTs and 24 cohort studies were identified. For smoking cessation, findings from 4 systematic reviews indicated that e-cigarettes contributed to cessation while one found the opposite. Meta-analysis of 5 RCTs suggested that e-cigarettes were superior to NRT or placebo for smoking cessation (RR=1.55; 95% CI: 1.00–2.40; I2=57.6%; low certainty; 5 trials, n=4025). Evidence from 9 cohort studies showed that e-cigarette use was not associated with cessation (AOR=1.16; 95% CI: 0.88–1.54; I2=69.0%; n=22220). Subgroup analysis suggested that intensive e-cigarette use may be associated with cessation. In terms of smoking initiation, adolescents who ever used e-cigarettes had a greater risk for smoking initiation than non-users (AOR=2.91; 95% CI: 2.61–3.23; I2=61.0%; 15 trials, n=68943), the findings were consistent with one included systematic review. No serious adverse events were reported in the included studies.CONCLUSIONSLow certainty evidence suggests that e-cigarettes appear to be potentially effective for smoking cessation. The use of e-cigarettes in adolescents may be associated with smoking initiation. No serious adverse events were reported.
Highlights
The contribution made by e-cigarettes to smoking cessation continues to be controversial
There was no need for approval from an ethics committee or agreement of participants in this study as data were extracted from publications that were in the public domain
This review indicated that ever e-cigarette users were more likely to initiate cigarette smoking at follow-up than never users (23.2% vs 7.2%) (AOR=3.5; 95% confidence interval (CI): 2.38–5.16; I2=56.0%; 7 trials, n=8759)
Summary
The contribution made by e-cigarettes to smoking cessation continues to be controversial. Electronic cigarettes, called e-cigarettes are electronic nicotine delivery systems (ENDS). They can deliver vaporized liquid mainly containing nicotine and propylene glycol through the mouth into the lungs, mimicking the effects of conventional cigarette smoking[1]. Reports have suggested that achieving abstinence by using e-cigarettes was comparable to nicotine replacement therapy (NRT), and e-cigarettes appear to effectively decrease cigarette consumption[5,6]. This has resulted in a dramatic increase in the use of e-cigarettes worldwide. A national large-scale survey from 28 EU member states reported that there were about 48.5 million e-cigarette users in 20168
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