Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol
2.2. Identification of Studies in Analysis
2.3. Article Inclusion
2.4. Longitudinal Studies
2.4.1. Presentation of Sub-Cohort Results
2.4.2. Reinstating of Smokers Excluded in the Sub-Cohorts to Reconstitute Cohorts
2.4.3. Analysis of the Coherence between Results and Conclusions of Longitudinal Studies
2.5. Other Studies
2.5.1. Epidemiology
2.5.2. Modeling Studies
2.5.3. Studies on Age and Chronology of Initiation
2.5.4. Role of Flavors and Nicotine Concentration
3. Results
3.1. Transition from E-Cigarette Use to Cigarette Initiation among Never-Smokers in the 22 Longitudinal Sub-Cohorts
3.2. Meta-Analysis
3.3. Reinstating of Excluded Smokers in the 22 Sub-Cohorts Analyzed to Reconstitute Original Cohorts
3.4. Causality and Recommendation to Change the Regulation
3.5. Reverse Analysis of the Influence of Cigarette Use at T1 on E-Cigarette Use at T2
3.6. Other Studies
3.6.1. Cigarette Smoking in Adolescents after 11 Years of Vaping (2011–2022)
3.6.2. Escalation to Regular Use According to the First Product Experimented
3.6.3. Modelling of the Evolution of Cigarette Consumption in Adolescents
3.6.4. Age and Chronology of E-Cigarette and/or Cigarette Initiations
3.6.5. Role of Flavor
3.6.6. Role of Nicotine
4. Discussion
4.1. Identification of the Cause of the Discrepancy between Longitudinal Studies and the Others
4.2. Longitudinal Studies of Never-Smokers Are Not Representative of Whole Cohort of Adolescents
4.3. The Unilateral Design of Longitudinal Study Rules out Any Evidence of a Diversion Effect
4.4. The Unilateral Design of Longitudinal Study Rules out Any Evidence of a Diversion Effect
4.5. Reasons for the Error in Design and Interpretation of Adolescent Longitudinal Studies
4.6. Consequence of the Abusive Non-Scientific Misinterpretation of Study by Authors of Longitudinal Studies
4.7. Limitations of the Study
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Authors | Age (Year) | T2-T1 (Month) | Reconstituted Cohort after Reinstating Smokers at T1 (n) | Smokers Excluded to Create Sub-Cohort of Non-Smokers at T1 (n) | Dual-Users Excluded at T1 (With Smoker) * | Non-Smokers in Analysis at T1 (Included in Sub-Cohort) | Only E-Cigarette at T1 | Naïve at T1 |
---|---|---|---|---|---|---|---|---|
Leventhal USA [32] | 14.1 | 6 and 12 | 3298 | 768 | 376 | 2530 | 241 | 2289 |
Primack USA [33] | 20.0 | 9 | 788 | 94 | 694 | 16 | 678 | |
Barrington-Trimis 2016 USA [34] | 17.4 | 16 | 2078 | 390 | 67 | 1688 | 146 | 1542 |
Wills 2016 (2) TAIWAN [35] | 14.8 | 12 | 1009 | 133 | 135 | 876 | 168 | 708 |
Best UK [36] | 14.4 | 12 | 3251 | 571 | 2680 | 183 | 2497 | |
Hammond CANADA [37] | 15.1 | 12 | 19,310 | 1992 | 17,318 | 487 | 16,831 | |
Lozano MEXICO [38] | 12.5 | 20 | 6006 | 1311 | 4695 | 234 | 4461 | |
Miech USA [39] | 14.1 | 12 | 347 | 101 | 43 | 246 | 11 | 235 |
Spindle USA [40] | 18.5 | 12 | 2996 | 833 | 690 | 2163 | 153 | 2010 |
Wills (1) 2017 USA [41] | 14.7 | 12 | 1421 | 351 | 195 | 1070 | 250 | 820 |
Aleyan CANADA [42] | 15.0 | 12 | 11,028 | 1527 | 9501 | 206 | 9295 | |
Barrington-Trimis 2018 USA [43] | 15.5 | 6 and 12 | 5041 | 910 | 4131 | 857 | 3274 | |
Conner UK [26] | 13.5 | 12 | 2088 | 318 | 70 | 1770 | 273 | 1497 |
East UK [44] | 14.5 | 6 | 1152 | 229 | 111 | 923 | 21 | 902 |
Loukas USA [45] | 19.7 | 18 | 4575 | 2017 | 2558 | 558 | 2000 | |
Morgenstern GERMANY [46] | 15.5 | 6 | 3667 | 1141 | 593 | 2526 | 313 | 2213 |
Berry USA [47] | 13.4 | 12 | 6349 | 1270 | 5079 | 527 | 4552 | |
Chien TAIWAN [48] | 14.7 | 24 | 15,124 | 2841 | 12,283 | 661 | 11,622 | |
Kinnunen FINLAND [49] | 15.9 | 24 | 4454 | 1299 | 736 | 3155 | 103 | 3052 |
Sun UK [50] | 14.0 | 12 | 12,631 | 1071 | 11,560 | 1306 | 10,254 | |
Watkins USA [51] | 14.3 | 12 | 12,106 | 1612 | 10,494 | 425 | 10,069 | |
Martinelli NEDERLAND [52] | 13.6 | 6 or 12 | 2803 | 609 | 345 | 2194 | 191 | 2003 |
Osibogun USA [53] | 14.5 | 11 | 8278 | 1837 | 6441 | 38 | 6403 | |
Total (all) | 129,800 | 23,225 | 106,575 | 7368 | 99,207 | |||
* Total with T1 dual-use data | 25,313 | 6172 | 3361 | 1914 | 1870 | 17,271 |
Authors | OR Results (ORa (or OR) and 95% CI) of the Risk of Experimenting with Cigarettes or Smoking at T2 in Non-Tobacco Smokers at T1 According to Experimentation or Use of E-Cigarettes Compared to Non-Users | Main ORa |
---|---|---|
Leventhal USA [32] | Never-smoker (NS) experimenters with e-cigarettes were more numerous than non-experimenters with e-cigarettes at T1 to (1) have experimented with cigarettes at 6 or 12 months (AOR = 1.75 (1.10–2.77)); (2) have used one or more tobacco products (shisha, cigar, or others) (AOR = 2.73 (2.0–3.73)). | 1.75 |
Primack USA [33] | Due to the small number of e-cigarette users at T1 (n = 16), the available results only concern e-cigarette experimenters with no propensity to become smokers (too small number of e-cigarette users with a propensity to become a smoker): e-cigarette experimenters with no propensity to become smokers were more likely to have tried cigarettes 9 months later (AOR = 8.3 (1.2–58.6)) than e-cigarette non-experimenters. | 8.3 |
Barrington-Trimis 2016 USA [34] | Never-smoker users of e-cigarettes, compared to non-users of e-cigarettes, were more likely to have smoked cigarettes without having smoked in the last 30 days at the end of follow-up (AOR = 5.49 (2.68–11.2)) and to have smoked in the past 30 days at the end of follow-up (AOR = 7.50 (2.41–23.4)) if they had used e-cigarettes at T1, but with a lower AOR than in the non-susceptible (AOR = 2.58 (1.30–5.09)). | 5.49 |
Wills 2016 (2) TAI- WAN [35] | E-cigarette experimenters, compared to e-cigarette non-experimenters, were less at risk of having tried cigarettes at T2 when the percentile of the propensity to become a smoker was high: (1) percentile 10 (AOR = 2.23 (1.57–3.17)); (2) percentile 50 (AOR = 1.76 (1.47–2.10)); and (3) percentile 90 (AOR = 1.32 (1.19–1.47)). | 1.76 |
Best UK [36] | More young adults who used e-cigarettes at T1 had tried cigarettes at T2 (12 months) (AOR = 2.42 (1.63–3.60)) than non-users of e-cigarettes at T1. | 2.42 |
Hammond CANADA [37] | Non-smokers who had used e-cigarettes in the past 30 days were more likely than non-users of e-cigarettes in the past 30 days to (1) have smoked at least one cigarette before T2 (AOR = 2.12 (1.68–2.66)) and (2) be a daily smoker at T2 (AOR = 1.79: (1.41–2.28)). | 2.12 |
Lozano MEXICO [38] | E-cigarette experimenters were more likely to experiment with cigarettes at T2 (20 months later) (adjusted RR = 1.41 (1.18–1.70)) than e-cigarette non-experimenters. E-cigarette experimenters were not significantly more likely to experiment with marijuana at T2 (RRa = 1.42 (0.84–2.37)) than e-cigarette non-experimenters. On the other hand, those who had tried tobacco cigarettes were more likely to have tried marijuana (RRa = 2.05 (1.53–2.75)). | 1.41 |
Miech USA [39] | Never-smokers experimenting with e-cigarettes were more likely to smoke cigarettes 12 months later (RR = 4.78 (1.91–11.96)) than non-experimenters of e-cigarettes. | 4.78 |
Spindle USA [40] | Non-smokers experimenting with e-cigarettes were more likely to have experimented with cigarettes 12 months later (AOR = 3.30 (20–9.05)) than non-experimenters of e-cigarettes. Conversely, young people who have used e-cigarettes in the last 30 days were not significantly more likely to have tried cigarettes 12 months later (AOR = 1.15 (0.15–9.06)) than non-users of e-cigarettes in the past 30 days. | 3.3 |
Wills (1) 2017 USA [41] | Non-smokers who used e-cigarettes were more likely to have experimented with cigarettes at T2 (12 months later) (AOR = 2.87 (2.03–4.05)) than non-experimenters of e-cigarettes. Non-smokers who used e-cigarettes at least several times a week were more likely to have tried cigarettes at T2 (AOR = 4.09 (2.43–6.88)) than e-cigarette non-experimenters. | 2.87 |
Aleyan CANADA [42] | Young people with non-susceptibility to become tobacco smokers at T1 were more likely to have tried tobacco cigarettes at T2 (OR = 5.28; (2.81–9.94)). Young people susceptible at T1 were more likely to have tried tobacco cigarettes at T2 (OR = 2.78 (1.84–4.20)); p < 0.001, but with a lower OR than the non-susceptible if they were current e-cigarette users at T1. | 5.28 |
Barrington-Trimis 2018 USA [43] | E-cigarette users were more likely to have tried cigarettes at the end of follow-up (OR = 4.58 (3.56–5.88)) or to have smoked more than three cigarettes in the last 30 days at T2 (OR = 3.51 (1.97–6.24)) than non-e-cigarette users. | 4.58 |
Conner UK [26] | Baseline ever use of e-cigarettes was strongly associated with subsequent initiation of cigarettes (AOR = 4.6 (2.94–5.60)) but not with escalated cigarette use (AOR = 1.9 (0.97–1.82)). | 4.06 |
East UK [44] | E-cigarette use at any point is associated with an AOR = 3.54 (1.68–7.45) to become a smoker compared to e-cigarette use at no point. But there is a bilateral effect: direct effect of e-cigarettes on smoking initiation (AOR = 1.34 (1.05–1.72)) and a direct effect on cigarette use at any point on e-cigarette initiation (AOR = 1.08 (1.01–1.17)). | 3.54 |
Loukas USA [45] | E-cigarette experimenters were more likely to have experimented with cigarettes at T2 (18 months later) (AOR = 1.36 (1.01–1.83)) than non-experimenters of e-cigarettes. The AOR was higher in exclusive e-cigarette experimenters (AOR = 2.26 (2.35–3.76)), but it was not significant in those who had experimented with other tobacco products (shisha, cigar, etc.) in addition to e-cigarettes (AOR = 1.13 (0.81–1.58)). | 2.26 |
Morgen- stern GER- MANY [46] | E-cigarette experimenters were more likely to have tried cigarettes at T2 (6 months later) (RR = 2.18 (1.65–2.83)) than e-cigarette non-experimenters. | 2.18 |
Berry USA [47] | When the first product used was an e-cigarette, an increased risk was observed to (vs. tobacco product or e-cigarette use at no point) (1) experiment with tobacco cigarettes before T2 (AOR = 4.09 (2.97–5.63)) and (2) have smoked in the last 30 days before T2 (AOR = 2.75 (1.60–4.73)). Among e-cigarette experimenters, the risk of experimenting with cigarettes was higher for e-cigarette users with no propensity to become a smoker (AOR = 8.57 (3.87–18.97)) than for high propensity group (AOR = 3.51 (2.52–4.89)). | 4.09 |
Chien TAI- WAN [48] | E-cigarette experimenters were more likely to have tried cigarettes at the end of follow-up (AOR = 2.14 (1.66–2.75)) than e-cigarette non-experimenters. | 2.14 |
Kinnunen FINLAND [49] | Among T1 never-smokers, (1) experimentation or use of nicotine-containing e-cigarettes predicted the uptake of daily smoking at T2 (AOR = 2.92 (1.09–7.85)) and (2) T1 experimentation with non-nicotine e-cigarettes did not predict the uptake of daily smoking at T2 (small sample size). | 2.92 |
Sun UK [50] | E-cigarette experimenters were more likely to have tried cigarettes 12 months later than e-cigarette non-experimenters for the 2014 wave (AOR = 2.10 (1.33–3.30)), 2015 wave (AOR = 2.09 (1.26–3.48)), and 2016 wave (AOR = 2.25 (1.55–3.27)). The effect of e-cigarettes was no longer significant in the 2017 wave (AOR = 1.40 (0.91–2.14)) and the 2018 wave (AOR = 1.35 (0.84–2.16)). | 2.1 |
Watkins USA [51] | Non-smoker experimenters of e-cigarettes at T1 were more likely to have experimented with cigarettes at T2 (AOR = 2.53 (1.80–3.56)) than non-experimenters of e-cigarettes as well as e-cigarette users in the last 30 days (AOR = 1.87 (1.15–3.05)). Non-smokers who experimented exclusively with e-cigarettes were more likely to have tried cigarettes at T2 (AOR = 2.99 (1.98–4.53)), as e-cigarette users in the past 30 days (AOR = 2.12 (1.11–4.03)). Compared to the use of any tobacco product other than e-cigarettes, poly-consumption of tobacco products at T1 increased the probability at T2 of initiating smoking (AOR = 3.95 (2.65–5.90)) and to cigarette 30-day use (AOR = 3.81 (2.22–6.54)). | 2.53 |
Martinelli NEDER- LAND [52] | The Gateway effect goes in both directions: (1) in a never-smoker at T1, use of e-cigarettes was associated with an AOR = 5.63 (3.04–10.42) to use cigarettes at T2, (2) smoking at T1 is associated with an AOR = 3.10 (1.58–6.06) to e-cigarette use at T2. | 5.63 |
Osibogun USA [53] | Using the e-cigarette at T1 is associated with an increased risk of experimenting with cigarettes in non-smokers (AOR = 5.0 (1.9–12.8)). | 5 |
Mean | 3.5 | |
median | 2.92 | |
min | 1.41 | |
maxi | 8.3 |
Authors [Reference] and Number of Studies in Meta-Analysis | OR (95% CI) | AOR (95% CI) | Heterogeneity (I2) for AOR | AOR Fully Adjusted (See Notes) | (95% CI) | Heterogeneity (I2) for AOR |
---|---|---|---|---|---|---|
3.83 (3.74–3.91) | 3.5 (2.38–5.16) | 56% | 3.16 * | (2.14–4.66) | ||
Soneji [21] | 3.03 ¥ | (1.65–5.55) | 80% | |||
7 | 4.11 ¥¥ | (2.63–6.41) | ||||
2.77 § | (1.67–4.60) | 52% | ||||
4.48 §§ | (3.06–6.57) | |||||
4.17 (3.53–6.29) ° | 3.13 (2.35–4.16) | 84% | ||||
Khouja [22] | 4.35 (2.95–6.42) °° | 2.21 (1.72–2.84) | 5% | |||
14 | 4.59 (3.60–5.85) °°° | 2.92 (2.30–3.71) | 85% | |||
4.31 (3.33–5.58) | 2.93 (2.22–3.87) | 84% | ||||
Chan [23] | 6.68 # | (3.63–12.31) | ||||
11 | 2.49 ## | (1.97–3.15) | ||||
4.81 (3.79–6.12) | 4.06 (3.00–5.48) | 68% | 2.81 § | (2.45–3.72) | 78% | |
O’Brien [24] | 3.71 (2.83–4.86) | 35% | 5.16 §§ | (3.69–7.21) | 38% | |
9 | 11.32 ~ | (5.35–23.95) | 0% | |||
3.54 ~~ | (2.70–4.65) | 62% | ||||
3.18 { | (2.26–4.47) | 65% | ||||
6.22 {{ | (3.73–10.38) | 54% | ||||
Yoong [25] 17 | 3.44 (2.91–4.08) | 3.01 (2.37–3.82) | 82% |
Score of Requests to Change the E-Cigarette Regulation | ||||||
---|---|---|---|---|---|---|
0 | 1 | 2 | 3 | Total | ||
causality score | 0 | ① | 1 | |||
1 | ① | 1 | ||||
2 | ③❷ | ① | ❹ | ❸ | 13 | |
3 | ①❸ | ❸ + 1 | 8 | |||
total | 7 | 1 | 8 | 7 | 23 |
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Dautzenberg, B.; Legleye, S.; Underner, M.; Arvers, P.; Pothegadoo, B.; Bensaidi, A. Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers. Int. J. Environ. Res. Public Health 2023, 20, 6936. https://doi.org/10.3390/ijerph20206936
Dautzenberg B, Legleye S, Underner M, Arvers P, Pothegadoo B, Bensaidi A. Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers. International Journal of Environmental Research and Public Health. 2023; 20(20):6936. https://doi.org/10.3390/ijerph20206936
Chicago/Turabian StyleDautzenberg, Bertrand, Stéphane Legleye, Michel Underner, Philippe Arvers, Bhavish Pothegadoo, and Abdelhalim Bensaidi. 2023. "Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers" International Journal of Environmental Research and Public Health 20, no. 20: 6936. https://doi.org/10.3390/ijerph20206936