SynthesisPloS one2021
Association between electronic nicotine delivery systems and electronic non-nicotine delivery systems with initiation of tobacco use in individuals aged < 20 years. A systematic review and meta-analysis.
Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 9 of them syntheses that pooled 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.
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.
Who cites it
36 citing papers in PubMed, 9 syntheses or guidelines pooled it, 68 citations in OpenAlex.
- Interventions to prevent or cease electronic cigarette use in children and adolescents.The Cochrane database of systematic reviews · 2026Pooled it
- Vaping cessation interventions: a systematic review and meta-analysis.Tobacco control · 2026Pooled it
- The impacts of e-cigarette flavours: An overview of systematic reviews.Addiction (Abingdon, England) · 2025Pooled it
- Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review.Addiction (Abingdon, England) · 2025Pooled it
- A Systematic Review and Meta-analysis of School-Based Preventive Interventions Targeting E-Cigarette Use Among Adolescents.Prevention science : the official journal of the Society for Prevention Research · 2024Pooled it
- A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes.Harm reduction journal · 2024Pooled it
- Interventions to prevent or cease electronic cigarette use in children and adolescents.The Cochrane database of systematic reviews · 2023Pooled it
- 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 · 2023Pooled it
- E-cigarettes and nicotine abstinence: a meta-analysis of randomised controlled trials.European respiratory review : an official journal of the European Respiratory Society · 2022Pooled it
- Factors Associated With Victorian Adolescents' Harm Perceptions and Attitudes About e-Cigarettes.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2026Article
- The geographic distribution and community correlates of electronic cigarette use in Canada.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- Trends in adolescent smoking prevalence before and after the emergence of vaping in Australia: an interrupted time series analysis, 1999-2023.The Medical journal of Australia · 2025Article
- Trends in smoking prevalence before and after the emergence of vaping in Aotearoa/New Zealand among 14-15-year-olds identifying as Māori, Pacific, European, or Asian: an interrupted time series analysis of repeated cross-sectional data, 2003-2024.The Lancet regional health. Western Pacific · 2025Article
- Unreliable evidence from problematic risk of bias assessments: Comment on Begh et al., 'Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review'.Addiction (Abingdon, England) · 2025Article
- Caution is always needed when interpreting population-level vaping and smoking trends-authors' reply.The Lancet regional health. Western Pacific · 2025Article
- The epidemiology and burden of smoking in countries of the Association of Southeast Asian Nations (ASEAN), 1990-2021: findings from the Global Burden of Disease Study 2021.The Lancet. Public health · 2025Article
- Article
- A systematic review investigating the impact of dual use of e-cigarettes and conventional cigarettes on smoking cessation.ERJ open research · 2025Article
- "I Don't Really Understand It All!": A Qualitative Study of Parental Perceptions of Australian Vaping Laws.Health promotion journal of Australia : official journal of Australian Association of Health Promotion Professionals · 2025Article
- Trends in smoking prevalence among 14-15-year-old adolescents before and after the emergence of vaping in New Zealand; an interrupted time series analysis of repeated cross-sectional data, 1999-2023.The Lancet regional health. Western Pacific · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThis systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged <20 years with subsequent tobacco use.
methodsWe searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged < 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use.
findingsA total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82; p<0·001, I2: 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07; p<0·001, I2: 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57; p<0·001, I2: 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30; p = 0·47, I2: 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035).
conclusionThere is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.
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What OpenQuestion holds
Registered trials
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.