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The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review

Author

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  • Charlotta Pisinger

    (Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
    Danish Heart Foundation, 1120 Copenhagen, Denmark
    Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark)

  • Sofie K. Bergman Rasmussen

    (Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark)

Abstract

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”.

Suggested Citation

  • Charlotta Pisinger & Sofie K. Bergman Rasmussen, 2022. "The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review," IJERPH, MDPI, vol. 19(20), pages 1-23, October.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:20:p:13687-:d:949510
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    References listed on IDEAS

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    1. Monique Williams & Prue Talbot, 2019. "Design Features in Multiple Generations of Electronic Cigarette Atomizers," IJERPH, MDPI, vol. 16(16), pages 1-15, August.
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    4. Adam Prokopowicz & Andrzej Sobczak & Jerzy Szdzuj & Katarzyna Grygoyć & Leon Kośmider, 2020. "Metal Concentration Assessment in the Urine of Cigarette Smokers Who Switched to Electronic Cigarettes: A Pilot Study," IJERPH, MDPI, vol. 17(6), pages 1-12, March.
    5. Dong-Woo Choi & Jooeun Jeon & Sang Ah Lee & Kyu-Tae Han & Eun-Cheol Park & Sung-In Jang, 2018. "Association between Smoking Behavior Patterns and Glycated Hemoglobin Levels in a General Population," IJERPH, MDPI, vol. 15(10), pages 1-10, October.
    6. Daniel Tzu-Hsuan Chen & Christina N. Kyriakos, 2021. "Cigarette and E-Cigarettes Dual Users, Exclusive Users and COVID-19: Findings from Four UK Birth Cohort Studies," IJERPH, MDPI, vol. 18(8), pages 1-12, April.
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    1. Stephen L. Hamann & Nipapun Kungskulniti & Naowarut Charoenca & Vijj Kasemsup & Suwanna Ruangkanchanasetr & Passara Jongkhajornpong, 2023. "Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems," IJERPH, MDPI, vol. 20(19), pages 1-19, September.

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