TY - JOUR

T1 - The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes

T2 - A Systematic Review

AU - Pisinger, Charlotta

AU - Rasmussen, Sofie K. Bergman

PY - 2022

Y1 - 2022

N2 - Background: A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world. Methods: A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC). Results: Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health. Conclusion: Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".

AB - Background: A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world. Methods: A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC). Results: Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health. Conclusion: Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".

KW - e-cigarettes

KW - electronic cigarettes

KW - ENDS

KW - vaping

KW - cigarettes

KW - smoking

KW - dual use

KW - health

KW - public health

KW - biomarker

KW - HARM REDUCTION

KW - ASSOCIATION

KW - ADOLESCENTS

KW - NICOTINE

KW - EXPOSURE

KW - DISEASE

KW - ADULTS

U2 - 10.3390/ijerph192013687

DO - 10.3390/ijerph192013687

M3 - Review

C2 - 36294263

VL - 19

JO - International Journal of Environmental Research and Public Health

JF - International Journal of Environmental Research and Public Health

SN - 1661-7827

IS - 20

M1 - 13687

ER -