Access-related factors and e-cigarette use among 11–17-year-olds: a thematic synthesis of European studies using the five dimensions of access

Background

The rapid increase in e-cigarette use among young people is a public health concern that has led to new policies being discussed. This systematic review aimed to synthesise evidence on how access-related factors influence e-cigarette use among 11–17-year-olds in Europe, framing these factors using five dimensions of access (availability, affordability, accommodation, accessibility, acceptability) to inform thinking about policy approaches in the United Kingdom.

Methods

A systematic literature search up to 31 March 2025 of studies published since 2016 was undertaken following PRISMA guidelines (PROSPERO: CRD42024614302). Studies focusing on e-cigarette access among 11–17-year-olds in European countries were eligible for inclusion. We searched EMBASE, PsycINFO, and Web of Science. Findings were narratively synthesised using a Joanna Briggs Institute (JBI) convergent integrated approach; study quality was assessed using JBI checklists. Findings were synthesised thematically using the five dimensions of access as an organising framework.

Results

Twenty-one studies met the inclusion criteria, with some relevant to more than one dimension of access. Nine studies referred to accommodation, with a focus on how key spaces such as schools could limit the ease of e-cigarette use, a challenge complicated by the inherent concealability of e-cigarettes. Ten studies referred to acceptability, as influenced by restrictions on industry promotion of e-cigarettes to young people. Six studies referred to accessibility, which highlighted a particular challenge of age verification at the point of purchase. Five studies referred to affordability, emphasising the importance of relatively low prices as a key marketing tool to young people. Three studies referred to availability, highlighting access via social networks as a key way of circumventing other restrictions. However, there was a lack of evidence on how changes to the different dimensions of access might interact to modify the effects of new regulation.

Conclusion

The five dimensions of access are a potentially useful way to structure thinking about how new regulation might affect young people’s e-cigarette use. The synthesis highlights that young people’s vaping behaviour operates in a complex system of interacting factors; and that evidence gaps remain in developing a clearer picture of this system, including interactions.