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E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups
  1. Greg Hartwell1,
  2. Sian Thomas1,
  3. Matt Egan1,
  4. Anna Gilmore2,
  5. Mark Petticrew1
  1. 1 Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London, UK
  2. 2 Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
  1. Correspondence to Greg Hartwell, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, NIHR School for Public Health Research, London WC1H 9SH, UK; gregory.hartwell{at}


Objective To assess whether electronic cigarette (e-cigarette) awareness, ‘ever use’ and current use vary significantly between different sociodemographic groups.

Design Systematic review.

Data sources Published and unpublished reports identified by searching seven electronic databases (PubMed, MEDLINE, Web of Science, EMBASE, Global Health, PsycINFO, CINAHL Plus) and grey literature sources.

Study selection Systematic search for and appraisal of cross-sectional or longitudinal studies that assessed e-cigarette awareness, ‘ever use’ or current use, and included subgroup analysis of 1 or more PROGRESS Plus sociodemographic groups. No geographical or time restrictions imposed. Assessment by multiple reviewers, with 17% of full articles screened meeting the selection criteria.

Data extraction Data extracted and checked by multiple reviewers, with quality assessed using an adapted tool developed by the Joanna Briggs Institute.

Data synthesis Results of narrative synthesis suggest broadly that awareness, ‘ever use’ and current use of e-cigarettes may be particularly prevalent among older adolescents and younger adults, males, people of white ethnicity and—particularly in the case of awareness and ‘ever use’—those of intermediate or high levels of education. In some cases, results also varied within and between countries.

Conclusions E-cigarette awareness, ‘ever use’ and current use appear to be patterned by a number of sociodemographic factors which vary between different countries and subnational localities. Care will therefore be required to ensure neither the potential benefits nor the potential risks of e-cigarettes exacerbate existing health inequalities.

  • Disparities
  • Electronic nicotine delivery devices
  • Socioeconomic status
  • Priority/special populations

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors GH conceived the study, which all authors then helped refine. GH and ST executed the search strategy and screened the initial results of the literature searches, selecting the studies for inclusion, appraising and extracting data from the included studies, and analysing and interpreting the findings. At each of these stages, ME and MP provided further guidance and input as required. GH, ST and ME drafted the manuscript, which all authors then contributed to critically revising. GH is the guarantor. All authors have full access to all of the data (including tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding GH is supported by a Health Education England (HEE) and National Institute for Health Research (NIHR) ICA Programme Clinical Doctoral Research Fellowship (ICA-CDRF-2015–01–017). MP, ME and ST's research was funded by the NIHR School for Public Health Research (SPHR). This paper presents independent research funded by the National Institute for Health Research (NIHR) and NIHR School for Public Health Research (SPHR).

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Full supplementary appendices covering data extraction and critical appraisal are available from the authors.

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