Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis.

Introduction:
This text presents a systematic review and meta-analysis of the association between perceptions of e-cigarettes (harmfulness and addictiveness) and e-cigarette use among adolescents and youth. The review aimed to provide conclusive evidence to aid in the effective planning and implementation of tobacco policy, preventive, and health promotion measures.

Key Points:

* The review included 20 articles, with 887,182 adolescents and 10,304 youth participants.
* Most studies had a moderate risk of bias, and two cohort studies had a moderate and low risk of bias.
* The meta-analysis found that young people who were ever e-cigarette users were two times more likely to disagree that e-cigarettes are harmful and perceived e-cigarettes as less harmful than tobacco cigarettes.
* Young people who were ever e-cigarette users were also 2.3 and 1.8 times more likely to perceive e-cigarettes as less addictive or more addictive than tobacco cigarettes, respectively.
* Subgroup analysis showed that adolescents were more likely to believe that e-cigarettes are less harmful than tobacco cigarettes, while youth users perceived otherwise.
* The Grades of Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence, which ranged from very low to low.
* A sensitivity analysis was performed, and no publication bias was assessed due to the limited number of included studies.

Main Message:
The review and meta-analysis provide evidence that perceptions of e-cigarettes are associated with e-cigarette use among adolescents and youth. The findings suggest that health promotion strategies could focus on changing the risk perceptions of e-cigarettes to prevent and curb the uptake of e-cigarettes among young people. However, the quality of evidence was rated as very low to low, indicating a need for further research to strengthen the evidence base.

Aly AS, Mamikutty R, Marhazlinda J. Association between Harmful and Addictive Perceptions of E-Cigarettes and E-Cigarette Use among Adolescents and Youth-A Systematic Review and Meta-Analysis. Children (Basel, Switzerland). 2022;9(11). doi:10.3390/children9111678