Electronic Cigarettes (ENDS OR ENNDS) Smoking in Asian Countries After Complete Vaping Ban: A Systematic Review and Meta-Analysis

The harmful health effects of e-cigarettes have led to the imposition of ban on the manufacturing, import, export, advertisement, transport, and sale of such products to varying extents. The primary objective of the study was to estimate the prevalence of e-cigarette consumption in Asian countries where a ban has been imposed. The relevant studies published after the ban were obtained from PubMed, Web of Science, Embase and Scopus (Date of search: 08 May 2024). Cross-sectional and analytical research on the prevalence of vaping from the eligible countries were obtained irrespective of age or gender. Qualitative studies, trials, case reports, case series & reviews, and people who are not vaping e-cigarettes but other form of cigarettes, and studies with ambiguous study/data collection period were excluded. The review protocol was prospectively registered with PROSPERO (CRD42024542959) A total of 22 articles from five Southern Asian countries, mostly from Thailand, were eligible. The pooled prevalence of vaping post ban of e-cigarettes was 16% with high heterogeneity (I²=99.7%). The pooled prevalence of the same in India and Palestine were 14% and 19.7%%, respectively. Meta-regressions showed no significant effect of the duration of e-cigarette ban, year of publication, and mean age of the study population on the prevalence of e-cigarette use. Despite bans presenting an impression of elimination, vaping remains prevalent, albeit at lower levels. This persistence may be attributed to enforcement gaps, illicit market access, and limited public awareness, underscoring the need for effective strategies.