PDF(Pubmed)
Abstract：
Prospective longitudinal studies mainly conclude on a causal role of e-cigarettes in the initiation of cigarettes in flagrant contradiction with conclusions drawn from epidemiology and other studies showing a sharp decline in cigarette use in parallel with the spread of e-cigarette use. This systematic review explores the reasons for this discrepancy.
Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts.
A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors\' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products.
While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.
Among 84 publications on e-cigarette/cigarette association in adolescents identified in the Medline database from 2011 to 2022, 23 concern 22 never-smoker longitudinal sub-cohorts.
A link between e-cigarette experimentation at T1 and cigarette initiation at T2 is reported in sub-cohort analyses of never-smokers (AOR: 1.41 to 8.30). However, studies exclude 64.3% of T1 e-cigarette experimenters (because of dual-use) and 74.1% of T2 cigarette experimenters. With this study design, e-cigarettes contribute only to 5.3% of T2 cigarette experimentation, casting major doubt on the external validity of results and authors\' conclusions that e-cigarettes have a significant effect on the initiation of cigarettes (Gateway effect) at the population level. This sub-cohort design prohibits highlighting any Diversion effect, which is the most likely mechanism accounting for the competition between these two products.
While nicotine abstinence remains the best medical option, over-regulation of e-cigarettes because of misinterpretation of longitudinal study results may be detrimental to public health and tobacco control.
摘要：
前瞻性纵向研究主要得出以下结论：电子烟在卷烟启动过程中的因果作用与流行病学和其他研究得出的结论明显矛盾，表明卷烟使用量急剧下降与电子烟使用的传播并行。本系统综述探讨了这种差异的原因。
方法：在2011年至2022年Medline数据库中确定的84篇有关青少年电子烟/香烟协会的出版物中，有23篇涉及22个从不吸烟者纵向子队列。
结果：在不吸烟者（AOR：1.41至8.30）的子队列分析中报告了T1时电子烟实验与T2时香烟开始之间的联系。然而,研究排除了64.3%的T1电子烟实验者（由于双重用途）和74.1%的T2电子烟实验者。通过这项研究设计，电子烟仅占T2卷烟实验的5.3%，对结果和作者的结论的外部有效性提出了重大怀疑，即电子烟在人群水平上对卷烟的启动（Gateway效应）有重大影响。此子队列设计禁止突出任何分流效应，这是解释这两种产品之间竞争的最有可能的机制。
结论：虽然戒烟仍然是最好的医疗选择，由于对纵向研究结果的误解而导致的电子烟的过度监管可能不利于公共卫生和烟草控制。
方法：在2011年至2022年Medline数据库中确定的84篇有关青少年电子烟/香烟协会的出版物中，有23篇涉及22个从不吸烟者纵向子队列。
结果：在不吸烟者（AOR：1.41至8.30）的子队列分析中报告了T1时电子烟实验与T2时香烟开始之间的联系。然而,研究排除了64.3%的T1电子烟实验者（由于双重用途）和74.1%的T2电子烟实验者。通过这项研究设计，电子烟仅占T2卷烟实验的5.3%，对结果和作者的结论的外部有效性提出了重大怀疑，即电子烟在人群水平上对卷烟的启动（Gateway效应）有重大影响。此子队列设计禁止突出任何分流效应，这是解释这两种产品之间竞争的最有可能的机制。
结论：虽然戒烟仍然是最好的医疗选择，由于对纵向研究结果的误解而导致的电子烟的过度监管可能不利于公共卫生和烟草控制。
