Evidence map›Paper›PMID 34274048›Full record

SynthesisThe Lancet. Public health2021

Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis.

Sze Lin Yoong, Alix Hall, Alecia Leonard, Sam McCrabb, John Wiggers, Edouard Tursan d'Espaignet, Emily Stockings, Hebe Gouda, Ranti Fayokun, Alison Commar and 6 more

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 6 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 6 syntheses or guidelines pooled it.

  1. The association between self-reported vaping and the human oral microbiome: a systematic review.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2026
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  18. What Strategies Do Healthcare Providers Use to Promote Adolescents' Vaping Cessation? A Scoping Review.International journal of environmental research and public health · 2025
    Article
  19. Article
  20. Biomarkers of Toxicant Exposure among Youth in Canada, England, and the United States Who Vape and/or Smoke Tobacco or Do Neither.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Sze Lin YoongSchool of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia. Electronic address: syoong@swin.edu.au.
Alix HallSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia.
Alecia LeonardSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.
Sam McCrabbSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
John WiggersSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia.
Edouard Tursan d'EspaignetSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia; School of Rural Medicine, University of New England, Armidale, NSW, Australia.
Emily StockingsNational Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.
Hebe GoudaDepartment of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland.
Ranti FayokunDepartment of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland.
Alison CommarDepartment of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland.
Vinayak M PrasadDepartment of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland.
Christine PaulSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Christopher OldmeadowHunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Li Kheng ChaiHealth and Wellbeing Queensland, Queensland Government, Milton, QLD, Australia; Centre for Children's Health Research, Institute of Health and Biomedical Innovation Exercise and Nutrition, Queensland University of Technology, South Brisbane, QLD, Australia.
Bruce ThompsonSchool of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.
Luke WolfendenSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundThere are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years.

methodsIn this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485.

findingsThe most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15-20, I

interpretationThere is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems.

fundingWorld Health Organization and the Bill & Melinda Gates Foundation.

Indexed as

AdolescentChildElectronic Nicotine Delivery SystemsHumansPrevalence

Identifiers

PMID34274048
PMCPMC8390387

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.