Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis,The Lancet Public Health

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Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis
The Lancet Public Health ( IF 25.4 ) Pub Date : 2021-07-16 , DOI: 10.1016/s2468-2667(21)00106-7
Sze Lin Yoong ₁ , Alix Hall ₂ , Alecia Leonard ₃ , Sam McCrabb ₄ , John Wiggers ₂ , Edouard Tursan d'Espaignet ₅ , Emily Stockings ₆ , Hebe Gouda ₇ , Ranti Fayokun ₇ , Alison Commar ₇ , Vinayak M Prasad ₇ , Christine Paul ₄ , Christopher Oldmeadow ₈ , Li Kheng Chai ₉ , Bruce Thompson ₁₀ , Luke Wolfenden ₂

Affiliation

School 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.
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; Hunter New England Population Health, Wallsend, NSW, 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.
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.
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 New England Population Health, Wallsend, NSW, Australia; School of Rural Medicine, University of New England, Armidale, NSW, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.
Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland.
Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Health 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.
School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.

Background

There 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.

Methods

In 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.

Findings

The 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, I²=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6–9, I²=99·8%). The pooled estimate for occasional use was 0·8% (0·5–1·2, I²=99·4%) for daily use and 7·5% (6·1–9·1, I²=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS.

Interpretation

There 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.

Funding

World Health Organization and the Bill & Melinda Gates Foundation.

中文翻译：

儿童和青少年中电子尼古丁传送系统和电子非尼古丁传送系统的流行率：系统评价和荟萃分析

背景

有人担心，儿童和青少年使用电子尼古丁传送系统（ENDS）和电子非尼古丁传送系统（ENNDS）可能对健康有害。了解这些设备的使用范围对于为公共卫生政策提供信息至关重要。我们的目的是综合 20 岁以下儿童和青少年中 ENDS 或 ENNDS 使用的流行率。

方法

在这项系统回顾和荟萃分析中，我们从2016年1月1日到8月31日在五个数据库（MEDLINE、Web of Science、Cumulative Index to Nursing and Allied Health Documentation、Embase 和 Wiley Cochrane Library）中进行了电子检索， 2020年，还有灰色文献检索。纳入的研究报告了 20 岁以下人群的全国代表性样本中 ENDS 或 ENNDS 使用流行率，并收集了 2016 年至 2020 年之间的数据。如果研究是在 20 岁或以上的人群中进行，使用的数据来自专家，则排除研究小组没有采用适当的权重，或者没有使用确保招募具有全国代表性的样本的方法。我们包含了每个国家/地区的最新数据。我们将一个国家的多个国家估计值合并起来（如果这些估计值是在同一年完成的）。我们使用乔安娜·布里格斯研究所批判性评估清单（由作者名单中的两名评审员）对评审中包含的所有调查进行了偏差风险评估。使用随机效应荟萃分析来汇总曾经、当前、偶尔和日常使用的总体流行率估计值。本研究已在 PROSPERO 前瞻性注册，CRD42020199485。

发现

包括来自代表 69 个国家和地区的 26 项国家调查的最新患病率数据，样本量中位数为 3925 名（IQR 1=2266，IQR 3=10 593）儿童和青少年。在 8 岁至 20 岁以下的儿童和青少年中，永远（定义为任何终生使用）ENDS 或 ENNDS 使用的汇总患病率为 17·2%（95% CI 15–20，I ² =99·9%）），而对于当前使用（定义为过去 30 天内的使用），汇总流行率估计为 7·8% (6–9, I ² =99·8%)。偶尔使用的汇总估计值为 0·8% (0·5–1·2, I ² =99·4%) 日常使用为 7·5% (6·1–9·1, I ² =99·4%) 4%）偶尔使用。高收入地理区域的 ENDS 或 ENNDS 使用流行率最高。在研究质量方面，由于研究具有全国代表性，所有评分的调查对于所使用的抽样框架的偏倚风险较低。纳入研究中实施最差的方法学特征是对受试者和环境的详细描述。很少有调查报告 ENDS 或 ENNDS 的口味或类型的使用情况。