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      Prevalence of dual use of combustible tobacco and E-cigarettes among pregnant smokers: a systematic review and meta-analysis

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          Abstract

          Background

          As e-cigarettes gain popularity as potential tobacco cessation aids, concerns arise about their dual use with traditional cigarettes, especially among pregnant women, potentially subjecting both women and fetuses to heightened risks. This systematic review and meta-analysis aimed to determine the overall prevalence of dual use of tobacco smoking and e-cigarette use in pregnant women.

          Methods

          A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane on October 20, 2023. The included studies reported the number of pregnant women and the count of those who were dual users. Quality assessment was undertaken using the JBI tool. The pooled prevalence of dual use was determined via a random-effects model. All statistical analyses were executed using R software, version 4.3. PROSPERO: CRD42023486020.

          Results

          Eighteen studies were analyzed, encompassing 5,983,363 pregnant women. The meta-analysis indicated an overall prevalence of 4.6% (95% CI: 2.0-10.3) for dual users with significant heterogeneity (I 2 = 100%). Subgroup analysis based on the country showed a prevalence of 4.9% (95% CI: 2.0 to 11.6) for USA and 8.1% (95% CI: 0.00 to 1.00) for UK. Meta-regression revealed reduction of prevalence of dual use from 2019 to 2023. A potential publication bias was indicated by the LFK index and the Doi plot.

          Conclusion

          The dual consumption of e-cigarettes and traditional tobacco in pregnant women is a significant health concern, with a notable prevalence. Given the established risks of tobacco smoking during pregnancy and the uncertainties surrounding e-cigarettes, more comprehensive research and public health interventions are urgently needed to address this issue.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-024-20746-9.

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          Most cited references60

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          The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Plea for routinely presenting prediction intervals in meta-analysis

            Objectives Evaluating the variation in the strength of the effect across studies is a key feature of meta-analyses. This variability is reflected by measures like τ2 or I2, but their clinical interpretation is not straightforward. A prediction interval is less complicated: it presents the expected range of true effects in similar studies. We aimed to show the advantages of having the prediction interval routinely reported in meta-analyses. Design We show how the prediction interval can help understand the uncertainty about whether an intervention works or not. To evaluate the implications of using this interval to interpret the results, we selected the first meta-analysis per intervention review of the Cochrane Database of Systematic Reviews Issues 2009–2013 with a dichotomous (n=2009) or continuous (n=1254) outcome, and generated 95% prediction intervals for them. Results In 72.4% of 479 statistically significant (random-effects p 0), the 95% prediction interval suggested that the intervention effect could be null or even be in the opposite direction. In 20.3% of those 479 meta-analyses, the prediction interval showed that the effect could be completely opposite to the point estimate of the meta-analysis. We demonstrate also how the prediction interval can be used to calculate the probability that a new trial will show a negative effect and to improve the calculations of the power of a new trial. Conclusions The prediction interval reflects the variation in treatment effects over different settings, including what effect is to be expected in future patients, such as the patients that a clinician is interested to treat. Prediction intervals should be routinely reported to allow more informative inferences in meta-analyses.
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              The development of a critical appraisal tool for use in systematic reviews addressing questions of prevalence.

              Recently there has been a significant increase in the number of systematic reviews addressing questions of prevalence. Key features of a systematic review include the creation of an a priori protocol, clear inclusion criteria, a structured and systematic search process, critical appraisal of studies, and a formal process of data extraction followed by methods to synthesize, or combine, this data. Currently there exists no standard method for conducting critical appraisal of studies in systematic reviews of prevalence data.
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                Author and article information

                Contributors
                abhay.psm@dmiher.edu.in
                sanjitsahnepal561@gmail.com
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                18 November 2024
                18 November 2024
                2024
                : 24
                : 3200
                Affiliations
                [1 ]School of Pharmaceutical Sciences, Lovely Professional University, ( https://ror.org/00et6q107) Phagwara, India
                [2 ]Research and Enterprise, University of Cyberjaya, ( https://ror.org/04f1eek20) Persiaran Bestari, Cyber 11, Cyberjaya, Selangor 63000 Malaysia
                [3 ]Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
                [4 ]Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), ( https://ror.org/02k949197) Bangalore, Karnataka India
                [5 ]Department of Allied Healthcare and Sciences, Vivekananda Global University, ( https://ror.org/038mz4r36) Jaipur, Rajasthan 303012 India
                [6 ]Institute of Pediatric Gastroenterology and Hepatology, NIMS University, ( https://ror.org/05tw0x522) Jaipur, India
                [7 ]Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, Punjab 140307 India
                [8 ]Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh 531162 India
                [9 ]School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, ( https://ror.org/00ba6pg24) Dehradun, India
                [10 ]Department of Biotechnology, Graphic Era (Deemed to be University), ( https://ror.org/03tjsyq23) Clement Town, Dehradun, 248002 India
                [11 ]GRID grid.414704.2, ISNI 0000 0004 1799 8647, Jawaharlal Nehru Medical College and Global Health Academy, School of Epidemiology and Public Health, , Datta Meghe Institute of Higher Education, ; Wardha, India
                [12 ]SR Sanjeevani Hospital, Kalyanpur, Siraha 56517 Nepal
                [13 ]GRID grid.464654.1, ISNI 0000 0004 1764 8110, Department of Paediatrics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, , Dr. D. Y. Patil Vidyapeeth, ; Pune, Maharashtra 411018 India
                [14 ]GRID grid.440681.f, ISNI 0000 0004 1764 9922, Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, , Dr. D.Y. Patil Vidyapeeth, ; Pune, Maharashtra 411018 India
                [15 ]IES Institute of Pharmacy, IES University, Bhopal, Madhya Pradesh 462044 India
                [16 ]New Delhi Institute of Management, Delhi, India
                [17 ]Clinical Microbiology, RDC, Manav Rachna International Institute of Research and Studies, ( https://ror.org/02kf4r633) Faridabad, Haryana 121004 India
                [18 ]Dr Lal PathLabs - Nepal, Chandol-4, Maharajgunj, Kathmandu 44600 Nepal
                [19 ]GRID grid.412431.1, ISNI 0000 0004 0444 045X, Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, , Saveetha University, ; Chennai, India
                [20 ]GRID grid.418403.a, ISNI 0000 0001 0733 9339, Noida Institute of Engineering and Technology (Pharmacy Institute), ; Greater Noida, India
                [21 ]Centre of Research Impact and Outcome, Chitkara University, ( https://ror.org/057d6z539) Rajpura, Punjab 140417 India
                [22 ]Chitkara Centre for Research and Development, Chitkara University, ( https://ror.org/057d6z539) Himachal Pradesh, 174103 India
                [23 ]University Center for Research and Development, Chandigarh University, ( https://ror.org/05t4pvx35) Mohali, Punjab India
                [24 ]Medical Laboratories Techniques Department, AL-Mustaqbal University, ( https://ror.org/023a3xe97) Hillah, Babil, 51001 Iraq
                Article
                20746
                10.1186/s12889-024-20746-9
                11572542
                39558300
                c3a058ad-1726-48b4-b152-e63c2a194ce9
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

                History
                : 5 August 2024
                : 14 November 2024
                Categories
                Systematic Review
                Custom metadata
                © BioMed Central Ltd., part of Springer Nature 2024

                Public health
                e-cigarette,tobacco,pregnancy,meta-analysis,dual-use,systematic review
                Public health
                e-cigarette, tobacco, pregnancy, meta-analysis, dual-use, systematic review

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