Interventions to prevent or cease electronic cigarette use in children and adolescents
- PMID: 37965949
- PMCID: PMC10646968
- DOI: 10.1002/14651858.CD015511.pub2
Interventions to prevent or cease electronic cigarette use in children and adolescents
Abstract
Background: The prevalence of e-cigarette use has increased globally amongst children and adolescents in recent years. In response to the increasing prevalence and emerging evidence about the potential harms of e-cigarettes in children and adolescents, leading public health organisations have called for approaches to address increasing e-cigarette use. Whilst evaluations of approaches to reduce uptake and use regularly appear in the literature, the collective long-term benefit of these is currently unclear.
Objectives: The co-primary objectives of the review were to: (1) evaluate the effectiveness of interventions to prevent e-cigarette use in children and adolescents (aged 19 years and younger) with no prior use, relative to no intervention, waitlist control, usual practice, or an alternative intervention; and (2) evaluate the effectiveness of interventions to cease e-cigarette use in children and adolescents (aged 19 years and younger) reporting current use, relative to no intervention, waitlist control, usual practice, or an alternative intervention. Secondary objectives were to: (1) examine the effect of such interventions on child and adolescent use of other tobacco products (e.g. cigarettes, cigars types, and chewing tobacco); and (2) describe the unintended adverse effects of the intervention on individuals (e.g. physical or mental health of individuals), or on organisations (e.g. intervention displacement of key curricula or learning opportunities for school students) where such interventions are being implemented.
Search methods: We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL, and Clarivate Web of Science Core Collection from inception to 1 May 2023. Additionally, we searched two trial registry platforms (WHO International Clinical Trials Registry Platform; US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov), Google Scholar, and the reference lists of relevant systematic reviews. We contacted corresponding authors of articles identified as ongoing studies.
Selection criteria: We included randomised controlled trials (RCTs), including cluster-RCTs, factorial RCTs, and stepped-wedge RCTs. To be eligible, the primary targets of the interventions must have been children and adolescents aged 19 years or younger. Interventions could have been conducted in any setting, including community, school, health services, or the home, and must have sought to influence children or adolescent (or both) e-cigarette use directly. Studies with a comparator of no intervention (i.e. control), waitlist control, usual practice, or an alternative intervention not targeting e-cigarette use were eligible. We included measures to assess the effectiveness of interventions to: prevent child and adolescent e-cigarette use (including measures of e-cigarette use amongst those who were never-users); and cease e-cigarette use (including measures of e-cigarette use amongst children and adolescents who were e-cigarette current-users). Measures of e-cigarette use included current-use (defined as use in the past 30 days) and ever-use (defined as any lifetime use).
Data collection and analysis: Two review authors independently screened the titles and abstracts of references, with any discrepancies resolved through consensus. Pairs of review authors independently assessed the full-text articles for inclusion in the review. We planned for two review authors to independently extract information from the included studies and assess risk of bias using the Cochrane RoB 2 tool. We planned to conduct multiple meta-analyses using a random-effects model to align with the co-primary objectives of the review. First, we planned to pool interventions to prevent child and adolescent e-cigarette use and conduct two analyses using the outcome measures of 'ever-use' and 'current-use'. Second, we planned to pool interventions to cease child and adolescent e-cigarette use and conduct one analysis using the outcome measure of 'current-use'. Where data were unsuitable for pooling in meta-analyses, we planned to conduct a narrative synthesis using vote-counting approaches and to follow the Cochrane Handbook for Systematic Reviews of Interventions and the Synthesis Without Meta-analysis (SWiM) guidelines.
Main results: The search of electronic databases identified 7141 citations, with a further 287 records identified from the search of trial registries and Google Scholar. Of the 110 studies (116 records) evaluated in full text, we considered 88 to be ineligible for inclusion for the following reasons: inappropriate outcome (27 studies); intervention (12 studies); study design (31 studies); and participants (18 studies). The remaining 22 studies (28 records) were identified as ongoing studies that may be eligible for inclusion in a future review update. We identified no studies with published data that were eligible for inclusion in the review.
Authors' conclusions: We identified no RCTs that met the inclusion criteria for the review, and as such, there is no evidence available from RCTs to assess the potential impact of interventions targeting children and adolescent e-cigarette use, tobacco use, or any unintended adverse effects. Evidence from studies employing other trial designs (e.g. non-randomised) may exist; however, such studies were not eligible for inclusion in the review. Evidence from studies using non-randomised designs should be examined to guide actions to prevent or cease e-cigarette use. This is a living systematic review. We search for new evidence every month and update the review when we identify relevant new evidence. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Copyright © 2023 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Conflict of interest statement
If a review author is also a contributor to a study that may be of interest to the review, that review author will not be involved in the determination of eligibility, data extraction, risk of bias assessment, and GRADE assessment. In such instances, these roles will be carried out by review authors who were not directly involved in these studies, in line with the Cochrane Conflict of Interests policy.
CBa: no interests declared.
HT: no interest declared.
SMc: SMc is Assistant Managing Editor and Method Editor for Cochrane Public Health, but has not been involved in the editorial process or assessment of this review. She has no interest to declare.
RH: no interests declared.
SLY: reports that she has published opinions in medical journals relevant to the interventions in the work. No other declarations of interest to report.
ES: reports that she has previously been contracted (paid to her institution) by the Australian Department of Health to provide a report on e‐cigarette use and trends in Australia to advise government policy, as well as contracted (paid to her institution) by the New South Wales Department of Health to assist in developing educational resources for young people regarding the risks of e‐cigarette use. ES has also published opinions in medical journals relevant to the interventions in the work.
AH: reports that she has undertaken relevant work for the World Health Organization (WHO). Activities included undertaking two systematic reviews: 1) prevalence of electronic nicotine delivery systems (ENDS)/electronic non‐nicotine delivery systems (ENNDS) use of youth; and 2) association between ENDS/ENNDS use and later tobacco uptake by youth. This work was administered to the University of Newcastle of which she is an employee. AH reports that she has published results from the work, which was conducted for the commissioned project by the WHO, in medical journals, and this work has been promoted via several channels (e.g. social media, public press, presentations) and is contributing to a report. AH reports that she is an unpaid member of two Data Monitoring and Safety Boards for National Health and Medical Research Council‐funded trials that are testing vaporised nicotine products in adults. She is an independent personnel on this board and has no connection to the study or funding, and is not compensated for this work, and the outcomes of this trial have no impact (positive or negative) on her. Her role is to act as an independent expert in public health to ensure that the studies are being conducted appropriately and safely. AH is also a Methods Editor for Cochrane Public Health, but has not been involved in the editorial process or assessment of this review.
CBi: no interests declared.
JM: no interests declared.
LW: declares that his institution has received research grants to undertake trials likely to be included in this review. LW also reports that he is the Co‐ordinating Editor of Cochrane Public Health, but has not been involved in the editorial process or assessment of this review.
Update of
- doi: 10.1002/14651858.CD015511
References
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References to ongoing studies
ACTRN12623000079640 {published data only}
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- ACTRN12623000079640. Efficacy of a text-message based intervention in preventing adolescent e-cigarette use. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385130 (first received 18 December 2022).
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