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Review
. 2021 Jan 13:19:04.
doi: 10.18332/tid/131624. eCollection 2021.

The effect of e-cigarettes on smoking cessation and cigarette smoking initiation: An evidence-based rapid review and meta-analysis

Ying-Ying Zhang  1 , Fan-Long Bu  1   2 , Fei Dong  1 , Jian-Hua Wang  3 , Si-Jia Zhu  1 , Xiao-Wen Zhang  1 , Nicola Robinson  1   4 , Jian-Ping Liu  1
Affiliations
Review

The effect of e-cigarettes on smoking cessation and cigarette smoking initiation: An evidence-based rapid review and meta-analysis

Ying-Ying Zhang et al. Tob Induc Dis. .

Abstract

Introduction: The 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.

Methods: Systematic 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).

Results: Six 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.

Conclusions: Low 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.

Keywords: e-cigarettes; rapid review; smoking cessation; smoking initiation; systematic review.

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Conflict of interest statement

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.

Figures

Figure 1
Figure 1
Flow chart of study selection
Figure 2
Figure 2
Risk of bias summary
Figure 3
Figure 3
Meta-analysis of RCTs comparing e-cigarettes with NRT or placebo on smoking cessation
Figure 4
Figure 4
Meta-analysis of cohort studies comparing ever e-cigarette use with non-use on smoking cessation
Figure S1
Figure S1
Meta-analysis of cohort studies comparing ever e-cigarette use with non-use on smoking initiation
See this image and copyright information in PMC

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References

    1. Kennedy RD, Awopegba A, De León E, Cohen JE. Global approaches to regulating electronic cigarettes. Tob Control. 2017;26(4):440. doi: 10.1136/tobaccocontrol-2016-053179. - DOI - PMC - PubMed
    1. Kaisar MA, Prasad S, Liles T, Cucullo L. A decade of e-cigarettes: Limited research & unresolved safety concerns. Toxicology. 2016;365:67–75. doi: 10.1016/j.tox.2016.07.020. - DOI - PMC - PubMed
    1. Rahman MA, Hann N, Wilson A, Worrall-Carter L. Electronic cigarettes: patterns of use, health effects, use in smoking cessation and regulatory issues. Tob Induc Dis. 2014;12(December) doi: 10.1186/1617-9625-12-21. - DOI - PMC - PubMed
    1. Laverty AA, Vardavas CI, Filippidis FT. Design and marketing features influencing choice of e-cigarettes and tobacco in the EU. Eur J Public Health. 2016;26(5):838–841. doi: 10.1093/eurpub/ckw109. - DOI - PMC - PubMed
    1. Bullen C, Howe C, Laugesen M, et al. Electronic cigarettes for smoking cessation: a randomized controlled trial. Lancet. 2013;382(9905):1629–1637. doi: 10.1016/S0140-6736(13)61842-5. - DOI - PubMed

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