Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis

Abstract

Background: Recognising the association between the perceived risks of e-cigarettes and e-cigarette usage among youth is critical for planning effective prevention and intervention initiatives; thus, a systematic review and meta-analysis were performed.

Methods: Fourteen databases were searched for eligible studies from the Inception of database until March 2022 to examine the effect estimates of the association between perceptions of harmfulness and addictiveness and overall e-cigarette usage among adolescents and youth.

Results: The meta-analysis showed that in comparison to non-users, young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful (OR: 2.20, 95% CI: 1.41-3.43) and perceived e-cigarettes as less harmful than tobacco cigarettes (OR: 2.01, 95% CI 1.47-2.75). Youths who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive (OR: 2.28, 95% CI: 1.81-2.88) or perceive e-cigarettes as more addictive (OR: 1.82, 95% CI: 1.22-2.73) than tobacco cigarettes, as compared with non-users. The subgroup analysis reported that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise.

Conclusion: the risk perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth and could be the focus of health promotion to prevent and curb the uptake of e-cigarettes among young people.

Keywords: addictive; adolescent; e-cigarette; harmful; risk perception; young people; youth.

Figure 1

PRISMA flow diagram summarizing the search, identification, and selection of the included studies.

Figure 2

Risk of bias of the cross-sectional studies included in the review using the AHRQ tool [,,,,,,,,,5960,61,62,63,64,65,66,67,68].

Figure 3

Risk of bias assessment of the cohort studies included in the review using the NOS tool.

Figure 4

Forest plot of the meta-analysis for perceived harmfulness (a–c) and ever e-cigarettes use in young people (adolescent and youth) [37,42,53,54,55,56,57,58,60,61,62,63,64,65,66,67,68]. Each study is identified by their first author. The individual effect estimates are identified as odds ratios with lower and upper limits (95% confidence interval). Funnel plots of the meta-analysis of the association between perceived harmfulness and ever e-cigarette use. (d) less harmful vs. equally harmful group. (e) more harmful vs. equally harmful group.

Figure 4

Forest plot of the meta-analysis for perceived harmfulness (a–c) and ever e-cigarettes use in young people (adolescent and youth) [37,42,53,54,55,56,57,58,60,61,62,63,64,65,66,67,68]. Each study is identified by their first author. The individual effect estimates are identified as odds ratios with lower and upper limits (95% confidence interval). Funnel plots of the meta-analysis of the association between perceived harmfulness and ever e-cigarette use. (d) less harmful vs. equally harmful group. (e) more harmful vs. equally harmful group.

Figure 5

Forest plot of the meta-analysis for perceived harmfulness (a–c) and ever e-cigarettes use in young people [42,51,52,54,56,57,58,59,66]. Each study is identified by their first author. The individual effect estimates are identified as odds ratios with lower and upper limits (95% confidence interval).

Figure 5

Forest plot of the meta-analysis for perceived harmfulness (a–c) and ever e-cigarettes use in young people [42,51,52,54,56,57,58,59,66]. Each study is identified by their first author. The individual effect estimates are identified as odds ratios with lower and upper limits (95% confidence interval).

Figure 6

Forest plot showing the age group effects for perceived harmfulness and ever e-cigarette use in young people according to age groups [37,52,53,56,58,60,61,63,66,67,68]. (a) Less harmful versus equally harmful group and (b) more harmful versus equally harmful group.