Prevalence and determinants of e-cigarette use in South Asia: a systematic review

E-cigarette use has become a significant global public health concern. Recently, several systematic reviews have synthesised evidence on e-cigarette use in Europe, America and Southeast Asia. However, there is no known systematic review of such on South Asia (SA). This systematic review aimed to systematically synthesise empirical evidence on the prevalence and determinants of e-cigarette use in SA.

This systematic review adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and Cochrane Handbook for Systematic Reviews of Interventions. Nine databases, as well as additional sources, were searched to retrieve relevant articles on the prevalence and determinants of e-cigarette use in SA. Only those peer-reviewed articles which met the eligibility criteria were included in this systematic review. Data were extracted from the included articles and synthesised using a narrative synthesis approach.

Seventeen articles were included in this systematic review and all were graded as above average after quality appraisal. Lifetime prevalence of e-cigarette use was reported in three SA countries only: India (0.1-23.8%), Bangladesh (0.4-0.5%) and Nepal (21.2%). The prevalence of current e-cigarette use was reported in four SA countries only: Pakistan (6.20-10.1%), India (0.01-5.39%), Nepal (5.9%) and Bangladesh (0.5%). The following factors were the reported determinants of e-cigarette use that were significant (p<0.05) among SA populations: self-perception of e-cigarette use as addictive, less harmful, an alternative to tobacco smoking and as a safe product; leisure use; individual appeal to the flavours of e-cigarette; individual stress; presence of mental depression; peer influence; social acceptance of e-cigarette use and prices of e-cigarettes.

Empirical evidence on e-cigarette use is limited to specific sociodemographic, socioeconomic and geographical regions in SA. Additional empirical investigations are required to outline the prevalence and determinants of e-cigarette use in SA countries lacking adequate data. Also, there is a need for tailored interventions targeting e-cigarette use in SA.