Relationship Between Electronic Cigarettes and Alcohol Use Behaviors: A Systematic Review and Meta-Analysis

Nicotine and alcohol are among the most commonly co-used substances. The rise in e-cigarette use, particularly among younger populations, has introduced new dynamics in substance use behaviors, potentially altering traditional consumption patterns and raising concerns about the relationship between e-cigarette use and alcohol consumption. This systematic review and meta-analysis aimed to synthesize existing data to elucidate the relationship between e-cigarette use and alcohol consumption behaviors. A literature search was conducted across PubMed, Embase, and Web of Science up to July 15, 2024. Studies reporting measures of association between alcohol behaviors and e-cigarette use were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models, with heterogeneity assessed via the I2 statistic and prediction intervals. The Newcastle-Ottawa Scale was used for quality assessment. All statistical analyses were performed in R software version 4.4. Among the 4,771 records screened, 34 studies were included. The meta-analysis revealed a significant association between alcohol use and e-cigarette use (pooled OR = 1.796, 95% CI: 1.412 to 2.285). Additionally, binge drinking was strongly associated with e-cigarette use (pooled OR = 3.078, 95% CI: 2.364 to 4.007). E-cigarette users were also more likely to engage in alcohol consumption (pooled OR = 3.731, 95% CI: 2.137 to 6.514) and binge drinking (pooled OR = 4.071, 95% CI: 3.209 to 5.166). The findings indicate a possible relationship between e-cigarette use and alcohol consumption and binge drinking. Integrated prevention strategies addressing the co-use of these substances, particularly among youth and young adults, are needed.