ArticleJournal of public health (Oxford, England)2026
Addressing challenges in reviewing e-cigarette evidence: proposing a new 'Test for Dominance' in systematic reviews.
Article in Journal of public health (Oxford, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
backgroundCurrent systematic review evidence on e-cigarettes as a smoking cessation tool is contested. Part of the reason for this is the difficulty of objectively assessing the limited and heterogeneous evidence base.The study aim was to develop a novel approach to testing the validity of systematic reviews and assessing the extent of the dominance of included primary studies.
methodsLeave-one-out meta-analysis was used to measure dominance. The systematic review on e-cigarettes as a smoking cessation tool by Hanewinkel et al. was used as a proof of concept.
resultsThe Hajek et al. study dominates the Hanewinkel et al. systematic review, exerting a disproportionate influence on the overall pooled effect.
conclusionsThis research has identified a gap in current approaches to validity testing in systematic reviews. The Test for Dominance could supplement existing testing, including tests for heterogeneity, sensitivity analysis, and subgroup analysis. When a single study dominates a systematic review, the findings of that review should be interpreted with caution and further randomised controlled trials undertaken to reduce such distortion.
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