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Screening, data extraction and critical appraisal followed Cochrane methods. Our primary outcome was the association between e\u2010cigarette use, availability or both, and change in population rate of smoking in young people. The secondary outcomes were initiation, progression and cessation of smoking at individual level. We assessed certainty using Grading of Recommendations, Assessment, Development and Evaluations (GRADE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 126 studies. For our primary outcome, there was very low certainty evidence (limited by risk of bias and inconsistency) suggesting that e\u2010cigarette use and availability were inversely associated with smoking in young people (i.e. as e\u2010cigarettes became more available and\/or used more widely, youth smoking rates went down or, conversely, as e\u2010cigarettes were restricted, youth smoking rates went up). All secondary outcomes were judged to be very low certainty due to very serious risk of bias. Data consistently showed direct associations between vaping at baseline and smoking initiation (28 studies) and smoking progression (5 studies). The four studies contributing data on smoking cessation had mixed results, precluding drawing any conclusion on the direction of association. There was limited information to determine whether relationships varied by sociodemographic characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>At an individual level, people who vape appear to be more likely to go on to smoke than people who do not vape; however, it is unclear if these behaviours are causally linked. Very low certainty evidence suggests that youth vaping and smoking could be inversely related.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.16773","type":"journal-article","created":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T06:20:22Z","timestamp":1738218022000},"page":"1090-1111","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Electronic cigarettes and subsequent cigarette smoking in young people: A systematic review"],"prefix":"10.1111","volume":"120","author":[{"given":"Rachna","family":"Begh","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9669-9180","authenticated-orcid":false,"given":"Monserrat","family":"Conde","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences 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