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.

E-Cigarette Use Among US Adults in the 2021 Behavioral Risk Factor Surveillance System Survey

“…This proportion is numerically higher than those observed in prior BRFSS years (63.3% in 2017, 66.1% in 2018, and 70.4% in 2020) . Perceived reduced harm, easy access, and social preference for e-cigarettes over other tobacco products may explain the high e-cigarette prevalence among young adults . Also, with nearly one-half of individuals (46.6%) currently using e-cigarettes reporting daily use, there is an implication of a shift from experimental to established use.…”

“… 5 , 6 Perceived reduced harm, easy access, and social preference for e-cigarettes over other tobacco products may explain the high e-cigarette prevalence among young adults. 30 , 31 , 32 , 33 Also, with nearly one-half of individuals (46.6%) currently using e-cigarettes reporting daily use, there is an implication of a shift from experimental to established use. This observation aligns with patterns observed in prior BRFSS years (34.5% in 2017, 37.3% in 2018, and 44.4% in 2020), 5 , 6 albeit with numerically higher findings in our study.…”

Comparison of attempts and plans to quit tobacco products among single, dual, and triple users

“…The World Health Organization (WHO) has advised caution regarding the use of e-cigarettes, citing a lack of evidence regarding their safety and effectiveness in smoking cessation 15 . Nevertheless, many e-cigarette users perceive these devices to be safe 16 , 17 . Therefore, cessation approaches for dual and triple users need to be designed to lead to the cessation of all tobacco product use, not just cigarettes, by concurrently using other tobacco products.…”

Novel tobacco and nicotine products and youth in the European Union

“…Previous studies suggest that perceptions play a significant role in predicting their use among young people. A recent meta--analysis showed that adolescents, who believed e-cigs were less harmful and less addictive than conventional cigarettes, were twice as likely more likely to have tried these products [13]. Even more concerning is the finding that low harm perception predicts the initiation of e-cigarette use among youth non-smokers [44].…”

“…Although the prevalence of e-cig use and smoking HTPs are currently relatively low in the general population in the EU, these products, especially e-cigs, have rapidly gained in popularity among adolescents and have become the most commonly used tobacco products in some countries [10][11][12]. Their popularity may respond to aggressive marketing to children and youth, accessibility, appealing flavors, high nicotine delivery, and lower risk perceptions [13]. All in all, despite the progress made since the ratification of WHO FCTC, the emergence of novel tobacco products continues to challenge tobacco control efforts globally.…”