Systematic Review and Critical Analysis of Longitudinal Studies Assessing Effect of E-Cigarettes on Cigarette Initiation among Adolescent Never-Smokers

Bertrand Dautzenberg (), Stéphane Legleye, Michel Underner, Philippe Arvers, Bhavish Pothegadoo and Abdelhalim Bensaidi
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Bertrand Dautzenberg: Sorbonne Université & ex CHU Pitié-Salpêtrière (APHP), 14 Avenue Bosquet, 75007 Paris, France
Stéphane Legleye: Ensai & Cesp, 35172 Bruz, France
Michel Underner: Centre Hospitalier Laborit, Unité de Recherche Clinique Pierre Deniker, Tabacologie, 86000 Poitiers, France
Philippe Arvers: 7ème Centre Médical des Armées, Quartier De Reyniès, D1075, Consultation Addictologie et Tabacologie, 38760 Varces-Allières-et-Risset, France
Bhavish Pothegadoo: Hôpital Maison Lafitte, Unité de Cardiologie, 78600 Maison Lafitte, France
Abdelhalim Bensaidi: Hôpital de Nanterre, Diabétologie, 92000 Nanterre, France

IJERPH, 2023, vol. 20, issue 20, 1-20

Abstract: Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy. Methods. Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts. Results. A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors’ conclusions that e-cigarettes have a significant effect on the initiation of cigarettes ( Gateway effect ) at the population level. This sub-cohort design prohibits highlighting any Diversion effect , which is the most likely mechanism accounting for the competition between these two products. Conclusions. While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.

Keywords: systematic review; adolescents; cigarette; e-cigarette; gateway effect; diversion effect; longitudinal study; selection bias (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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