Effects of stress and emotional distress on smoking and vaping: a systematic review and meta-analysis
Abstract
Numerous empirical studies have examined relationships between stress, emotional distress, and (e-)cigarette use. However, there are limited meta-analyses of these relationships. This review and meta-analysis were conducted to fill this gap. 29,284 studies were identified through PsycINFO, OVID MEDLINE and Web of Science and 462 studies (combined N = 9,530,232) were included in the meta-analysis after screening. Independent multilevel meta-analysis and moderator analyses were conducted to examine and compare the stress-smoking, distress-smoking, stress-vaping and distress-vaping relationships. All four relationships were statistically significant, positive, but small in magnitude. The stress-vaping relationship (r+ = 0.169) was significantly stronger than the stress-smoking relationship (r+ = 0.097). Similarly, the distress-vaping relationship (r+ = 0.186) was significantly stronger than the distress-smoking relationship (r+ = 0.139). Different significant moderators were observed for smoking and vaping studies, respectively. Gender moderated the stress-smoking and distress-smoking relationships, with stronger effects observed in studies including more female participants. Among stress-vaping and distress-vaping studies, the type of stress and distress scales showed significant associations with effect size variability. Although significant moderators were found, there remained considerable heterogeneity that could not be explained. Future research could further explore the…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 9,530,232 participants or records.
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