Abstract
BACKGROUND: The use of electronic nicotine delivery systems (ENDS), including e-cigarettes, vape pens, hookah pens, e-cigars, and e-pipes, has grown in popularity worldwide, particularly among young individuals. However, these products are not without risks, as their emissions may contain harmful substances such as diacetyl (a flavoring agent linked to specific pulmonary problems in high concentrations), tobacco-specific nitrosamines, and volatile organic compounds with unknown long-term effects on lung health. OBJECTIVE: This systematic review and meta-analysis aimed to assess the prevalence of ENDS use among school and college students on a global scale. METHODS: A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science databases. Two researchers independently selected and extracted data from the identified studies. The pooled prevalence of ENDS use among school or college students was calculated using a random-effect meta-analysis. RESULTS: The systematic review encompassed 146 studies with 4,189,145 subjects from 53 countries and six continents. The overall current prevalence of ENDS use was 10.2%, indicating a significant presence of this behavior among students. Moreover, ENDS current use was higher among males (10.2%) than females (7.5%). In comparison, the lifetime prevalence was 22.0%, indicating that a substantial portion of students have tried these products but do not continue to use them regularly. CONCLUSION: Our meta-analysis reveals a significant prevalence of ENDS use among school and college students globally, with higher rates observed among males than females. The lifetime prevalence of ENDS indicates that many students have tried or are currently using these products. The current prevalence of ENDS use was 10.2%, with notable variations across different continents.