E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups

Abstract

ObjectiveTo assess whether electronic cigarette (e-cigarette) awareness, ‘ever use’ and current use vary significantly between different sociodemographic groups.DesignSystematic review.Data sourcesPublished and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources.Study selectionSystematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, ‘ever use’ or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria.Data extractionData extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute.Data synthesisResults of narrative synthesis suggest broadly that awareness, ‘ever use’ and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and—particularly in the case of awareness and ‘ever use’—those of intermediate or high levels of education. In some cases, results also varied within and between countries.ConclusionsE-cigarette awareness, ‘ever use’ and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities.

Patterns of awareness and use of electronic cigarettes in Mexico, a middle-income country that bans them: Results from a 2016 national survey

“…1,20 A similar pattern has been found in upper middle income countries (UMIC), where awareness was found to be lower when e-cigarettes are banned (Mexico=34% in 2012; Brazil=35% in 2013) 21 compared to when they are not banned (Costa Rica=52.5% in 2015; 22 Malaysia=62.0% in 2013 21 ). Nevertheless, these levels were significantly higher than in the low-income country of Indonesia (10.9% in 2011).…”

“…1,3,26,27,44,45 Older adolescents (16–17 vs 12 years) and younger adults (18–24 vs 45–65 years) were more likely to have heard, tried and be current users of e-cigarettes. Furthermore, adolescent and adult current smokers, especially those who smoke more than 5 cigarettes per day, were more likely to have heard of, tried and currently use e-cigarettes.…”

“…1–3 E-cigarettes are battery-operated devices that produce an aerosol that can contain different levels of nicotine, which is a highly addictive substance and can affect the neurological development of adolescents. 4–7 In addition, e-cigarette liquids contain flavorings that are potentially hazardous, especially for the respiratory system.…”

“…A systematic review of 26 studies in HICs indicates that e-cigarettes awareness and trial is associated with higher levels of education, 1 with current use additionally associated with younger age and being male. 1,20, 24 Across 27 European Union countries, those who lived in urban areas had higher e-cigarette awareness and trial compared to rural inhabitants.…”

“…A systematic review of 26 studies in HICs indicates that e-cigarettes awareness and trial is associated with higher levels of education, 1 with current use additionally associated with younger age and being male. 1,20, 24 Across 27 European Union countries, those who lived in urban areas had higher e-cigarette awareness and trial compared to rural inhabitants. 3 In general, being a current smoker has been associated with awareness and use of e-cigarettes, 3 with even higher levels found among smokers who have attempted to quit in the last year.…”