Evidence update on e-cigarette dependence: A systematic review and meta-analysis

Area of Science:

• Public Health
• Addiction Science
• Tobacco Control

Background:

• E-cigarette use has rapidly increased across various populations.
• Understanding the risk of e-cigarette dependence is crucial for public health interventions.
• Previous reviews, including one by the National Academies of Science, Engineering, and Medicine, highlighted the need for updated evidence.

Purpose of the Study:

• To systematically review and update the evidence on e-cigarette dependence risk.
• To examine dependence in different populations, including never-smokers and dual users.
• To synthesize findings on factors influencing e-cigarette dependence.

Main Methods:

• A comprehensive literature search was conducted across six academic databases (September 2017–December 2023).
• Included peer-reviewed human, animal, and in vitro studies examining e-cigarette use and dependence; excluded qualitative studies.
• Meta-analyses were performed where possible, with quality assessment using appropriate risk of bias tools.

Main Results:

• Meta-analyses indicated no significant difference in dependence between non-smoker vapers and current smokers/dual users.
• Never-smoker vapers exhibited lower dependence levels compared to dual users (SMD -0.723, p < 0.01).
• Nicotine vapers showed higher dependence than non-nicotine vapers; dependence correlated positively with nicotine concentration, frequency, and duration of use.

Conclusions:

• E-cigarette dependence is comparable in level and prevalence to cigarette dependence.
• Significant variability exists in population definitions and dependence assessment methods.
• Further research and ongoing monitoring are essential for effective public health strategies.