In 2013 the group published the tobacco policy review Tobacco Free Ireland, a report that set Ireland’s goal to reduce smoking prevalence to less than 5% by 2025. The report identified tobacco damage reduction as an important issue to consider. Since the introduction of e-cigarettes in the European Union (EU) in 2006 and the United States of America (USA) in 2007, research has been conducted into their potential benefits in terms of reducing tobacco and public health harm of e-cigarettes -cigarettes has grown. The systematic evidence analysis reported in this article outlines what is known so far about the consumption of e-cigarettes and the onset of smoking from tobacco cigarettes in adolescents. There are two sister reviews: the first shows the harms and benefits of e-cigarettes [McCarthy 2020] and the second presents a systematic overview of the role of e-cigarettes in smoking cessation [Quigley 2020] . These reviews are one of the contributions to the Irish Government’s policy and clinical guidance on e-cigarettes.

Our systematic review published in BMC Public Healthfound that e-cigarette use among teenagers in Europe and North America is linked to the onset of tobacco smoking. Based on the adjusted odds ratios of nine primary studies, our meta-analysis calculated that teenagers who had ever used e-cigarettes at the start of the study were three to six times more likely to start smoking. These results identify an important health-related harm and are supported by four additional systematic reviews. [Soneji 2017; Glasser 2019; Khouja 2019; Aladeokin and Haighton 2019] Three of these ratings were from young adults [Soneji 2017; Glasser 2019; Khouja 2019] and one was with teenagers living in the UK [Aladeokin and Haighton 2019] . These results are important as the prevalence of e-cigarette use increases in Europe and North America. For example, the prevalence of e-cigarette use among teenagers in the United States rose from 1.5% in 2011 to 20.8% in 2018 [Cullen 2018] and in Ireland usage is 22% [Költő 2020] . In addition, there is a danger that society will not be able to protect the advances in tobacco smoking reduction among teenagers.

The study provides additional support for urgent responses from policy makers to cease teenage use in order to reduce direct harm in this vulnerable population group.

Given the availability and use of e-cigarettes, this study provides additional support for urgent policymaker responses to cease their use by teenagers in order to reduce direct harm in this vulnerable population. The study presented in this paper was conducted as part of a wider evidence review program to inform and support public health policy in Ireland that included mapping the harms and benefits of e-cigarettes (and their e-liquids) [McCarthy 2020] and a systematic review of the role of e-cigarettes in smoking cessation [Quigley 2020] . We found that e-cigarettes (and their e-liquids) lead to acute harm such as poisoning, lung injuries, burns, and blast injuries, a finding that is consistent with six other aligned systematic reviews [Peruga 2020; National Academies of Sciences, Engineering, Medicine2018, Pisinger 2014; CADTH 2017; Byrne 2018; Bals 2019] and stressed the need for further studies with robust methods to measure the long-term health effects of their use, as these are not yet known.

Children and adolescents need the same protection from e-cigarettes as conventional tobacco cigarettes

Children and adolescents need the same protection from e-cigarettes as traditional tobacco cigarettes through a well-enforced regulatory system of measures, including age restrictions on purchases, control of availability through licensors, restrictions on product visibility and attractiveness, and reasonable pricing through taxation.


Cullen KA, Ambrose BK, Gentzke AS, Apelberg BJ, Jamal A, King BA. Practical Tips: Electronic Cigarette Use and All Tobacco Products in Middle and High School Students – USA, 2011–2018. MMWR Morb Mortal Wkly Rep 2018, 67: 1276-1277; doi: 10.15585 / mmwr.mm6745a5.

Költő A, Gavin A, Molcho M, Kelly C, Walker L, Nic Gabhainn S. Irish Health Behavior among School Age Children (HBSC) 2018 Dublin, Ireland: Department of Health and Health Promotion Research Center in Galway, National University of Ireland, Galway; 2020. Available from:

Soneji S, Barrington-Trimis JL, Wills TA, Leventhal AM, Unger JB, Gibson LA, Yang J, Primack BA, Andrews JA, Miech RA et al. Relationship between first-time e-cigarette consumption and subsequent cigarette smoking in adolescents and young adults: A systematic review and meta-analysis. JAMA Pediatrics 2017, 171(8): 788-797; doi: 10.1001 / jamapediatrics.2017.1488.

Glasser A, Abudayyeh H, Cantrell J, Niaura R. E-cigarette use patterns among adolescents and young adults: Reviewing the effects of e-cigarettes on cigarette smoking. Nicotine Tob Res 2019, 21(10): 1320-1330; doi: 10.1093 / ntr / nty103.

Khouja JN, Suddell SF, Peters SE, Taylor AE, Munafò MR. Is the consumption of e-cigarettes among young non-smokers associated with later smoking? A systematic review and meta-analysis. Tob control 2020: Tobacco Control-2019-055433; doi: 10.1136 / tobaccocontrol-2019-055433.

Aladeokin A, Haighton C. Is e-cigarette use associated with smoking among teenagers in the UK? A systematic review with meta-analysis. Tob Back Cessat 2019, 5(April 15; doi: 10.18332 / tpc / 108553.

Quigley JM, Woods B, Thompson J, Bryden PA, Scott DA. PRM209 – Confrontation with heterogeneity: Using systematic reviews effectively for meta-analyzes. Worth health 2013, 16(7): A612; doi: 10.1016 / j.jval.2013.08.1763.

McCarthy A, Lee C, O’Brien D, Long J. Harm and Benefits of E-Cigarettes and Heat Resistant Tobacco Products: A Literature Map. Dublin, Ireland: Health Research Committee; 2020; 461 S. Available at: returnPage / 1 /

Peruga A, World Health Organization Regional Office for Europe. Electronic Nicotine and Non-nicotine Delivery Systems: A Brief Summary. Copenhagen: WHO Regional Office for Europe. ; 2020; 20 p. Available at: letter-2020

National Academies of Sciences, Engineering, Medicine. Public health consequences of e-cigarettes. Washington DC, USA: The National Academies Press; 2018; 774 S. Available from:

Scientific Committee on Health, Environment and Emerging Risks (SCHEER). Request for a scientific opinion on electronic cigarettes. European Commission ,; 2020: 2 p. Available at:

Pisinger C, Døssing M. A systematic review of the health effects of e-cigarettes. Back Med 2014, 69: 248-260; doi: 10.1016 / j.ypmed.2014.10.009.

Canadian Agency for Drugs and Technologies in Health (CADTH). Electronic Cigarettes for Reduction or Quitting Smoking: Clinical Benefits, Safety, and Guidelines. Ottawa, Canada: Canadian Agency for Drugs and Technologies in Health (CADTH); 2017. Available at:

Byrne S, Brindal E, Williams G, Anastasiou K, Tonkin A, Battams S, Riley MD. E-Cigarettes, Smoking, and Health: An Update on the Literature Research. Australia: Commonwealth Scientific and Industrial Research Organization (CSIRO) 2018; 394 p. Available at:

Bals R, Boyd J, Esposito S, Foronjy R, Hiemstra PS, Jimenez-Ruiz CA, Katsaounou P, Lindberg A, Metz C, Schober W. et al. Electronic Cigarettes: A Task Force Report from the European Respiratory Society. Eur or J 2019, 53(2): 1801151; doi: 10.1183 / 13993003.01151-2018.


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