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E-Cigarette Awareness, Use, and Harm Perception among Adults: A Meta-Analysis of Observational Studies

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  • Ying Xu
  • Yanfang Guo
  • Kaiqian Liu
  • Zheng Liu
  • Xiaobo Wang

Abstract

Objective: The aim of this study is to systematically review the published literature on the awareness, previous and current use, and harm perceptions of electronic cigarettes (e-cigarettes) among adults. Methods: A search of the most current literature using the PubMed and Scopus database to identify articles published since 2003 yielded a total of 28 relevant articles. Results: The pooled prevalence of awareness, previous use, current use of e-cigarettes and perceived healthier of e-cigarettes than regular cigarettes (healthier perception) among adults were 61.2% (95% confidence interval (CI): 51.5–70.8%), 16.8% (95% CI: 14.0–19.6%), 11.1% (95% CI: 9.2–13.1%), and 52.6% (95% CI: 42.5–62.6%), respectively, using a random effects model. The subgroup analysis showed that pooled estimates were highest in the group of current smokers of regular cigarettes, except that the highest pooled rate of current use was seen in the group of former smokers of regular cigarettes (the corresponding rates were 71.9% (95% CI: 57.5–86.3%), 27.2% (95% CI: 18.8–35.6%), 16.8% (95% CI: 7.2–26.3%), and 63.1% (95% CI: 52.1–74.1%)), and the lowest pooled rates were in the group of non-smokers, except for the rate of healthier perception in the users of e-cigarettes (and the corresponding rates were 46.8% (95% CI: 26.8–66.8%), 2.5% (95% CI: 1.1–5.6%), 1.2% (95% CI: 0.4–2.1%), and 37.9% (95% CI: -0.5–76.3%)). The cumulative meta-analysis found that awareness increased over time, while the prevalence of previous use, current use, and healthier perception first experienced an increase followed by a decrease and remained stable thereafter. Conclusions: E-cigarette awareness has been increasing, and e-cigarette use and perceived health risks are nearly invariable between 2009 and 2014. Given the substantial heterogeneity in the prevalence rate estimates, there is a need for more accurate and comparable prevalence estimates for e-cigarettes across the world.

Suggested Citation

  • Ying Xu & Yanfang Guo & Kaiqian Liu & Zheng Liu & Xiaobo Wang, 2016. "E-Cigarette Awareness, Use, and Harm Perception among Adults: A Meta-Analysis of Observational Studies," PLOS ONE, Public Library of Science, vol. 11(11), pages 1-18, November.
    • Handle: RePEc:plo:pone00:0165938
    DOI: 10.1371/journal.pone.0165938
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    References listed on IDEAS

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    1. Choi, K. & Forster, J., 2013. "Characteristics associated with awareness, perceptions, and use of electronic nicotine delivery systems among young US Midwestern adults," American Journal of Public Health, American Public Health Association, vol. 103(3), pages 556-561.
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    4. Popova, L. & Ling, P.M., 2013. "Alternative tobacco product use and smoking cessation: A national study," American Journal of Public Health, American Public Health Association, vol. 103(5), pages 923-930.
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    2. Elise M. Stevens & Emily T. Hébert & Alayna P. Tackett & Eleanor L. S. Leavens & Theodore L. Wagener, 2020. "Harm Perceptions of the JUUL E-Cigarette in a Sample of Ever Users," IJERPH, MDPI, vol. 17(13), pages 1-9, July.
    3. David T. Levy & Luz María Sánchez-Romero & Nargiz Travis & Zhe Yuan & Yameng Li & Sarah Skolnick & Jihyoun Jeon & Jamie Tam & Rafael Meza, 2021. "US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths," IJERPH, MDPI, vol. 18(9), pages 1-22, May.
    4. Ce Shang & Scott R. Weaver & Nahleen Zahra & Jidong Huang & Kai-Wen Cheng & Frank J. Chaloupka, 2018. "The Association between Potential Exposure to Magazine Ads with Voluntary Health Warnings and the Perceived Harmfulness of Electronic Nicotine Delivery Systems (ENDS)," IJERPH, MDPI, vol. 15(4), pages 1-12, March.
    5. Kim A.G.J. Romijnders & Liesbeth van Osch & Hein de Vries & Reinskje Talhout, 2019. "A Deliberate Choice? Exploring the Decision to Switch from Cigarettes to E-Cigarettes," IJERPH, MDPI, vol. 16(4), pages 1-11, February.
    6. Ahmed M. Al Rajeh & Ilias Mahmud & Mahmudul Hassan Al Imam & Muhammad Aziz Rahman & Fariss Al Shehri & Salman Alomayrin & Nawaf Alfazae & Yousif Mohammed Elmosaad & Ibrahim Alasqah, 2022. "E-Cigarette Use among Male Smokers in Al-Ahsa, Kingdom of Saudi Arabia: A Cross-Sectional Study," IJERPH, MDPI, vol. 20(1), pages 1-13, December.

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