This sample was restricted to high school students

The gap

Evidence profile

Stated in the limitations section of the source papers, classified as general, spanning 2 journals.

Supporting evidence — 3 representative gaps

• Association between the use of e-cigarettes and heated tobacco products and asthma prevalence in adolescents: A secondary dataset analysis of the Korea Youth Risk Behavior Survey 2022–2024 (2026) · Tobacco Induced Diseases · doi

  Several limitations of this study should be acknowledged. First, the cross-sectional design precludes causal inference regarding the observed associations between tobacco product use and asthma. Second, both asthma status and tobacco use were assessed using self-reported measures, which may be subject to misclassification bias due to recall error or social desirability, potentially leading to non-differential misclassification. Third, although we adjusted for a wide range of sociodemographic, behavioral, and environmental factors, residual confounding by unmeasured variables – such as intensity and duration of tobacco use, nicotine dependence, or prior combustible cigarette use – cannot be excluded. In addition, the findings may not be fully generalizable to adolescents who are not enrolled in school or to settings with different cultural and regulatory contexts. Finally, reverse causality cannot be ruled out with this cross-sectional design. Despite these limitations, the present study provides large-scale, nationally representative evidence of an association between emerging tobacco product use and asthma prevalence among adolescents, underscoring Tob. Induc. Dis. 2026;24(May):70 https://doi.org/10.18332/tid/217962 7 Tobacco Induced Diseases Research Paperthe importance of continued surveillance and youthfocused tobacco control and prevention efforts.

  generalstated in limitationsevidence 5/5
  Keywords: tobacco product health asthma adolescents youth cross sectional design cannot among limitations causal observed associations
• Predictors of e‑cigarette use among Indonesian youth: Evidence from the 2019 Global Youth Tobacco Survey (2026) · Türkiye Halk Sağlığı Dergisi · doi

  be Nevertheless, acknowledged. First, the cross-sectional nature of the study prevents causal interpretation and does not allow for establishing the temporal order between predictors and e-cigarette use. Second, the use of self-reported measures may have introduced recall and social desirability biases, especially in light of the stigma associated with smoking behaviors among youth. Third, while the study included key determinants, other important influences such as exposure to e‑cigarette advertising, parental smoking, and peer network characteristics were not assessed. Finally, the analysis did not capture longitudinal trajectories of use, which would be essential for understanding progression from experimentation to regular use. Future investigations would benefit from employing longitudinal study designs and integrating contextual variables such as policy landscapes and exposure to digital marketing to generate a more comprehensive understanding of e-cigarette use among youth in Indonesia.

  generalstated in limitationsevidence 5/5
  Keywords: cigarette youth smoking indonesia among exposure longitudinal cross sectional predictors self reported measures determinants peer
• Reductions in smoking progression from 10th to 12th grade across 5 cohorts in Southern California 1995–2014 (2026) · Tobacco Induced Diseases · doi

  This sample was restricted to high school students; data on progression in smoking frequency beyond high school could not be evaluated. No data were available on other potential confounders (e. if youth under-reported the number of cigarettes smoked due to perceived social norms, particularly in more recent years when smoking had become less socially acceptable). Given recent evidence of a later age of transition to regular smoking in more recent years, additional studies examining whether these patterns extend into early adulthood are warranted.

  generalstated in limitationsevidence 5/5
  Keywords: smoking recent high school years sample restricted students progression frequency beyond evaluated available potential confounders

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