a good literature review should

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list if you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can use boolean operators to help narrow down your search:

Read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models and methods? Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible, and make sure you read any landmark studies and major theories in your field of research.

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

You can use our free APA Reference Generator for quick, correct, consistent citations.

To begin organising your literature review’s argument and structure, you need to understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly-visual platforms like Instagram and Snapchat – this is a gap that you could address in your own research.

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarising sources in order.

Try to analyse patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organise your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text, your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, discussing the significance of findings in relation to the literature as a whole.
• Critically evaluate: mention the strengths and weaknesses of your sources.
• Write in well-structured paragraphs: use transitions and topic sentences to draw connections, comparisons and contrasts.

In the conclusion, you should summarise the key findings you have taken from the literature and emphasise their significance.

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a dissertation , thesis, research paper , or proposal .

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarise yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

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• 04 December 2020
• Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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doi: https://doi.org/10.1038/d41586-020-03422-x

Interviews have been edited for length and clarity.

Updates & Corrections

Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

Article   Google Scholar  

Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

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Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . https://doi.org/10.1038/s41570-020-00221-w (2020).

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Literature review

How to write a literature review in 6 steps

How do you write a good literature review? This step-by-step guide on how to write an excellent literature review covers all aspects of planning and writing literature reviews for academic papers and theses.

How to write a systematic literature review [9 steps]

How do you write a systematic literature review? What types of systematic literature reviews exist and where do you use them? Learn everything you need to know about a systematic literature review in this guide

What is a literature review? [with examples]

Not sure what a literature review is? This guide covers the definition, purpose, and format of a literature review.

Get science-backed answers as you write with Paperpal's Research feature

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

Find academic papers related to your research topic faster. Try Research on Paperpal  

3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

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Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• By publication: Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of your organizational strategy. In other words, a chronological review would have subsections for each vital time period. A thematic review would have subtopics based upon factors that relate to the theme or issue.

Sometimes, though, you might need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

Questions for Further Research: What questions about the field has the review sparked? How will you further your research as a result of the review?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author’s information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

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Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . Fourth edition. Thousand Oaks, CA: SAGE, 2014.

Importance of a Good Literature Review

A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations,
• Trace the intellectual progression of the field, including major debates,
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
• Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

Given this, the purpose of a literature review is to:

• Place each work in the context of its contribution to understanding the research problem being studied.
• Describe the relationship of each work to the others under consideration.
• Identify new ways to interpret prior research.
• Reveal any gaps that exist in the literature.
• Resolve conflicts amongst seemingly contradictory previous studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way in fulfilling a need for additional research.
• Locate your own research within the context of existing literature [very important].

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper. 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . Los Angeles, CA: SAGE, 2011; Knopf, Jeffrey W. "Doing a Literature Review." PS: Political Science and Politics 39 (January 2006): 127-132; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012.

Types of Literature Reviews

It is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the primary studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally among scholars that become part of the body of epistemological traditions within the field.

In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews. Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are a number of approaches you could adopt depending upon the type of analysis underpinning your study.

Argumentative Review This form examines literature selectively in order to support or refute an argument, deeply embedded assumption, or philosophical problem already established in the literature. The purpose is to develop a body of literature that establishes a contrarian viewpoint. Given the value-laden nature of some social science research [e.g., educational reform; immigration control], argumentative approaches to analyzing the literature can be a legitimate and important form of discourse. However, note that they can also introduce problems of bias when they are used to make summary claims of the sort found in systematic reviews [see below].

Integrative Review Considered a form of research that reviews, critiques, and synthesizes representative literature on a topic in an integrated way such that new frameworks and perspectives on the topic are generated. The body of literature includes all studies that address related or identical hypotheses or research problems. A well-done integrative review meets the same standards as primary research in regard to clarity, rigor, and replication. This is the most common form of review in the social sciences.

Historical Review Few things rest in isolation from historical precedent. Historical literature reviews focus on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

Methodological Review A review does not always focus on what someone said [findings], but how they came about saying what they say [method of analysis]. Reviewing methods of analysis provides a framework of understanding at different levels [i.e. those of theory, substantive fields, research approaches, and data collection and analysis techniques], how researchers draw upon a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection, and data analysis. This approach helps highlight ethical issues which you should be aware of and consider as you go through your own study.

Systematic Review This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem . Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?" This type of literature review is primarily applied to examining prior research studies in clinical medicine and allied health fields, but it is increasingly being used in the social sciences.

Theoretical Review The purpose of this form is to examine the corpus of theory that has accumulated in regard to an issue, concept, theory, phenomena. The theoretical literature review helps to establish what theories already exist, the relationships between them, to what degree the existing theories have been investigated, and to develop new hypotheses to be tested. Often this form is used to help establish a lack of appropriate theories or reveal that current theories are inadequate for explaining new or emerging research problems. The unit of analysis can focus on a theoretical concept or a whole theory or framework.

NOTE : Most often the literature review will incorporate some combination of types. For example, a review that examines literature supporting or refuting an argument, assumption, or philosophical problem related to the research problem will also need to include writing supported by sources that establish the history of these arguments in the literature.

Baumeister, Roy F. and Mark R. Leary. "Writing Narrative Literature Reviews."  Review of General Psychology 1 (September 1997): 311-320; Mark R. Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Kennedy, Mary M. "Defining a Literature." Educational Researcher 36 (April 2007): 139-147; Petticrew, Mark and Helen Roberts. Systematic Reviews in the Social Sciences: A Practical Guide . Malden, MA: Blackwell Publishers, 2006; Torracro, Richard. "Writing Integrative Literature Reviews: Guidelines and Examples." Human Resource Development Review 4 (September 2005): 356-367; Rocco, Tonette S. and Maria S. Plakhotnik. "Literature Reviews, Conceptual Frameworks, and Theoretical Frameworks: Terms, Functions, and Distinctions." Human Ressource Development Review 8 (March 2008): 120-130; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

Structure and Writing Style

I.  Thinking About Your Literature Review

The structure of a literature review should include the following in support of understanding the research problem :

• An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
• Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
• An explanation of how each work is similar to and how it varies from the others,
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.

The critical evaluation of each work should consider :

• Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
• Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
• Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness -- which of the author's theses are most convincing or least convincing?
• Validity -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

II.  Development of the Literature Review

Four Basic Stages of Writing 1.  Problem formulation -- which topic or field is being examined and what are its component issues? 2.  Literature search -- finding materials relevant to the subject being explored. 3.  Data evaluation -- determining which literature makes a significant contribution to the understanding of the topic. 4.  Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review: Clarify If your assignment is not specific about what form your literature review should take, seek clarification from your professor by asking these questions: 1.  Roughly how many sources would be appropriate to include? 2.  What types of sources should I review (books, journal articles, websites; scholarly versus popular sources)? 3.  Should I summarize, synthesize, or critique sources by discussing a common theme or issue? 4.  Should I evaluate the sources in any way beyond evaluating how they relate to understanding the research problem? 5.  Should I provide subheadings and other background information, such as definitions and/or a history? Find Models Use the exercise of reviewing the literature to examine how authors in your discipline or area of interest have composed their literature review sections. Read them to get a sense of the types of themes you might want to look for in your own research or to identify ways to organize your final review. The bibliography or reference section of sources you've already read, such as required readings in the course syllabus, are also excellent entry points into your own research. Narrow the Topic The narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources. Your professor will probably not expect you to read everything that's available about the topic, but you'll make the act of reviewing easier if you first limit scope of the research problem. A good strategy is to begin by searching the USC Libraries Catalog for recent books about the topic and review the table of contents for chapters that focuses on specific issues. You can also review the indexes of books to find references to specific issues that can serve as the focus of your research. For example, a book surveying the history of the Israeli-Palestinian conflict may include a chapter on the role Egypt has played in mediating the conflict, or look in the index for the pages where Egypt is mentioned in the text. Consider Whether Your Sources are Current Some disciplines require that you use information that is as current as possible. This is particularly true in disciplines in medicine and the sciences where research conducted becomes obsolete very quickly as new discoveries are made. However, when writing a review in the social sciences, a survey of the history of the literature may be required. In other words, a complete understanding the research problem requires you to deliberately examine how knowledge and perspectives have changed over time. Sort through other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to explore what is considered by scholars to be a "hot topic" and what is not.

III.  Ways to Organize Your Literature Review

Chronology of Events If your review follows the chronological method, you could write about the materials according to when they were published. This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union. By Publication Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies. Thematic [“conceptual categories”] A thematic literature review is the most common approach to summarizing prior research in the social and behavioral sciences. Thematic reviews are organized around a topic or issue, rather than the progression of time, although the progression of time may still be incorporated into a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it would still be organized chronologically reflecting technological developments in media. The difference in this example between a "chronological" and a "thematic" approach is what is emphasized the most: themes related to the role of the Internet in presidential politics. Note that more authentic thematic reviews tend to break away from chronological order. A review organized in this manner would shift between time periods within each section according to the point being made. Methodological A methodological approach focuses on the methods utilized by the researcher. For the Internet in American presidential politics project, one methodological approach would be to look at cultural differences between the portrayal of American presidents on American, British, and French websites. Or the review might focus on the fundraising impact of the Internet on a particular political party. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Other Sections of Your Literature Review Once you've decided on the organizational method for your literature review, the sections you need to include in the paper should be easy to figure out because they arise from your organizational strategy. In other words, a chronological review would have subsections for each vital time period; a thematic review would have subtopics based upon factors that relate to the theme or issue. However, sometimes you may need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. However, only include what is necessary for the reader to locate your study within the larger scholarship about the research problem.

Here are examples of other sections, usually in the form of a single paragraph, you may need to include depending on the type of review you write:

• Current Situation : Information necessary to understand the current topic or focus of the literature review.
• Sources Used : Describes the methods and resources [e.g., databases] you used to identify the literature you reviewed.
• History : The chronological progression of the field, the research literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Selection Methods : Criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed [i.e., scholarly] sources.
• Standards : Description of the way in which you present your information.
• Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

IV.  Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence A literature review section is, in this sense, just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence [citations] that demonstrates that what you are saying is valid. Be Selective Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological. Related items that provide additional information, but that are not key to understanding the research problem, can be included in a list of further readings . Use Quotes Sparingly Some short quotes are appropriate if you want to emphasize a point, or if what an author stated cannot be easily paraphrased. Sometimes you may need to quote certain terminology that was coined by the author, is not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute for using your own words in reviewing the literature. Summarize and Synthesize Remember to summarize and synthesize your sources within each thematic paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to your own work and the work of others. Keep Your Own Voice While the literature review presents others' ideas, your voice [the writer's] should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording. Use Caution When Paraphrasing When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

V.  Common Mistakes to Avoid

These are the most common mistakes made in reviewing social science research literature.

• Sources in your literature review do not clearly relate to the research problem;
• You do not take sufficient time to define and identify the most relevant sources to use in the literature review related to the research problem;
• Relies exclusively on secondary analytical sources rather than including relevant primary research studies or data;
• Uncritically accepts another researcher's findings and interpretations as valid, rather than examining critically all aspects of the research design and analysis;
• Does not describe the search procedures that were used in identifying the literature to review;
• Reports isolated statistical results rather than synthesizing them in chi-squared or meta-analytic methods; and,
• Only includes research that validates assumptions and does not consider contrary findings and alternative interpretations found in the literature.

Cook, Kathleen E. and Elise Murowchick. “Do Literature Review Skills Transfer from One Course to Another?” Psychology Learning and Teaching 13 (March 2014): 3-11; Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . London: SAGE, 2011; Literature Review Handout. Online Writing Center. Liberty University; Literature Reviews. The Writing Center. University of North Carolina; Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: SAGE, 2016; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012; Randolph, Justus J. “A Guide to Writing the Dissertation Literature Review." Practical Assessment, Research, and Evaluation. vol. 14, June 2009; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016; Taylor, Dena. The Literature Review: A Few Tips On Conducting It. University College Writing Centre. University of Toronto; Writing a Literature Review. Academic Skills Centre. University of Canberra.

Writing Tip

Break Out of Your Disciplinary Box!

Thinking interdisciplinarily about a research problem can be a rewarding exercise in applying new ideas, theories, or concepts to an old problem. For example, what might cultural anthropologists say about the continuing conflict in the Middle East? In what ways might geographers view the need for better distribution of social service agencies in large cities than how social workers might study the issue? You don’t want to substitute a thorough review of core research literature in your discipline for studies conducted in other fields of study. However, particularly in the social sciences, thinking about research problems from multiple vectors is a key strategy for finding new solutions to a problem or gaining a new perspective. Consult with a librarian about identifying research databases in other disciplines; almost every field of study has at least one comprehensive database devoted to indexing its research literature.

Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Just Review for Content!

While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what scholars are saying, but how are they saying it. Some questions to ask:

• How are they organizing their ideas?
• What methods have they used to study the problem?
• What theories have been used to explain, predict, or understand their research problem?
• What sources have they cited to support their conclusions?
• How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?

When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.

Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1 998.

Yet Another Writing Tip

When Do I Know I Can Stop Looking and Move On?

Here are several strategies you can utilize to assess whether you've thoroughly reviewed the literature:

• Look for repeating patterns in the research findings . If the same thing is being said, just by different people, then this likely demonstrates that the research problem has hit a conceptual dead end. At this point consider: Does your study extend current research?  Does it forge a new path? Or, does is merely add more of the same thing being said?
• Look at sources the authors cite to in their work . If you begin to see the same researchers cited again and again, then this is often an indication that no new ideas have been generated to address the research problem.
• Search Google Scholar to identify who has subsequently cited leading scholars already identified in your literature review [see next sub-tab]. This is called citation tracking and there are a number of sources that can help you identify who has cited whom, particularly scholars from outside of your discipline. Here again, if the same authors are being cited again and again, this may indicate no new literature has been written on the topic.

Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: Sage, 2016; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

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What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

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1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Literature Reviews: 5. Write the Review

• Library Basics
• 1. Choose Your Topic
• How to Find Books
• Types of Clinical Study Designs
• Types of Literature
• 3. Search the Literature
• 4. Read & Analyze the Literature
• 5. Write the Review
• Keeping Track of Information
• Style Guides
• Books, Tutorials & Examples

Qualities of A Good Lit Review

Create an outline, then summarize & synthesize.

Draft an outline for your review.   Read more about developing an outline here at the Purdue OWL site.

Summarize & Synthesize

• Place each work in the context of its contribution to the understanding of the topic.
• Describe the relationship of each work to the others under consideration, noting contradictory studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way forward for further research.

Choose How to Organize Your Paper

Before writing, you should consider a few different ways of organizing or categorizing the literature you've looked at and consider prioritizing the readings, or grouping them by methodology or theme.

1.  Chronologically – Organizing your sources by the date of publication can show how scholarly perspective on a topic has changed over time.

2.  Thematically – Organizing by theme puts all of the sources with a similar focus together, making it very easy to see where differences in perspective emerge.

3.  Methodologically – Organizing by method, much like organizing by theme, puts similar sources together and illustrates what effect method has on final product.  

At a loss for words?

• Academic Phrasebank Check out this phrasebank of terms and phrases to use in your research papers.

Elements of the Literature Review

There are many different ways to organize your references in a literature review, but most reviews contain certain basic elements.

Objectives - Clearly describe the purpose of the paper and state your objectives in completing the literature review.

Background/Introduction – Give an overview of your research topic and what prompted it.

Methods - Describe step by step how your performed your evaluation of the materials.

Discussion/Body - The body contains the evaluation or synthesis of the materials.  Discuss and compare common themes and gaps in the literature. You may also want to include a section on "questions for further research" and discuss what issues the review has sparked about the topic/field or offer suggestions for future studies that build on your current findings.

Conclusion – A summary of your analysis and evaluation of the reviewed works and how it is related to its parent discipline, scientific endeavor, or profession.

Bibliography - A list of the papers you discussed, aka References.  To learn more about different citation styles, visit the "Manage References and Citations" tab.

Writing Tips

Once you actually begin to write the review, stick to your outline and keep these tips in mind:

• Consider your audience.  Are you engaging with specialists in one discipline? Or generalists in more than one discipline?
• When writing for a more general audience, avoid jargon and strive for "plain English."
• When writing for a very specialized audience, consider using "plain English" anyway.
• Short paragraphs are easier to read than long paragraphs.
• Subheadings and subsections can help to underscore the structure of your review.
• Do more than just summarize the readings.  A lit review is not an annotated bibliography.
• Resist the temptation to refer to *all* the readings you've evaluated.  To begin with, focus on readings you've identified as essential or representative.
• Tell the reader how the literature intersects with your project -- how your project complements the existing literature.
• Be objective.  
• << Previous: 4. Read & Analyze the Literature
• Next: Keeping Track of Information >>
• Last Updated: Dec 29, 2023 11:41 AM
• URL: https://research.library.gsu.edu/litrev

Writing a Research Literature Review? — Here are tips to guide you through!

Literature review is both a process and a product. It involves searching within a defined source of information related to your research topic and then creating a comprehensive summary of the pertinent research on your topic. It is most certainly over a topic that has further scope for developing a research question .

Often, early career researchers find writing a literature review difficult and are unsure about the best way to structure their review and produce an effective research literature review. To make this process simpler, it is important that researchers understand the concept of literature review and the purpose behind it.

This article explains what a literature review is and how one can write an effective research literature review with the help of literature review examples.

Table of Contents

Research Literature Review in Academia

If you are proposing a research topic that has a substantial amount of previously published work already, the prospect of delivering a good literature review can be a daunting task because a researcher will not only have to refer to journals, books, and articles, but also cite them!

In simpler words, a literature review is a critical collation of data from different sources relevant to your topic of research.

What Are the Four Major Types of Literature Reviews?

Based on their structure and formulation, literature reviews are broadly classified as-

1. Narrative or Traditional Literature Reviews

A narrative or traditional literature review is a comprehensive, critical, and objective analysis of existing knowledge of the topic. Literature review is an essential part of the research process because it helps establish theoretical framework and context for research study.

2. Scoping Reviews

A scoping review aims to identify the nature and extent of research evidence. As its name suggests, a scoping review is an ideal tool to determine the scope of literature on a given research topic.

3. Systematic Literature Reviews

A systematic literature review identifies and helps select research in order to answer a clearly formulated research question. Furthermore, a systematic review follows a defined protocol or plan where the criteria is clearly stated before the review is conducted.

4. Cochrane Reviews

Cochrane reviews are gold standard reviews; which are clearly reported and methodically better than systematic reviews. Moreover, this review systematically compares the risk of bias (RoB) in Cochrane and non-Cochrane systematic reviews using the dataset compiled in their database.

Outline of a Research Literature Review

Irrespective of the type of literature review, the three main components remain constant. A good research literature review consists of:

• Introduction
• The body of the literature review

Keeping these components in mind, the length of a literature review is not restricted to a word limit. It differs with respect to its purpose, audience, and discipline. Ideally, a research literature review written for a dissertation or thesis can be constructed into a full-length chapter of 20 pages.

What Is the Purpose of a Literature Review?

You may be tempted to save time by restricting your review to the last moment, but this can be a critical failure point. The purpose of writing a literature review is to establish your authority in your research. Without that established authority, your research findings are dismissed as nothing but your opinions founded on some basic methodologies.

What Should Not Be Included in a Literature Review?

A poorly executed scientific literature review can destroy a research thesis in four ways:

• If you can’t demonstrate that you have done the background work, you have no credibility as a researcher to recommend future research.
• If you haven’t mapped out the depth and breadth of the currently available material, you have no way to develop a cogent structure for the material you want to present as the foundation for your work.
• In the absence of a comprehensive summary of the material, you have no way to justify the position of your proposed research. Are you filling an identified gap, addressing identified weaknesses in someone else’s work, or perhaps extending an existing study to a broader or new population sample?
• If your research literature review isn’t comprehensive, you lose context when attempting to critique any of the previously published material.

Tips to Write a Good Literature Review

To write a good scientific literature review , you have to begin with a clear understanding of the role it plays in executing a thorough review for academic research:

• Context – where does your research project fit into the overall body of knowledge?
• Make a list of keywords to search your sources relevant to your research question
• Identify the key concepts/variables that apply in this area of research
• Identify the relationships between those concepts/variables
• Establish the need for further research – inconsistencies, lacking evidence, opportunities for further development, or alternative methodologies.

Refer to the literature review example for a better understanding.

Points To Remember

Demonstrate command of the material.

It’s not about maximizing the quantity of material reviewed , nor should the objective be to read “everything” about your proposed topic – for some topics that would be a physical impossibility.

Focus on the relevance of the material to your proposed topic , and map out a logical framework for analyzing that material. Develop relationships that make sense within that framework and organize your review around ideas not tenuous links by researcher or subject or chronology.

Don’t Ever Try to Fake It

Only include the material that you actually read – cutting and pasting someone else’s bibliography will come back to bite you later – especially if you have to do an oral defense and someone asks for your thoughts on a specific article or study.

Remember that just having read a dissertation or conference paper doesn’t count – you must critique it – what worked, what didn’t, and what would you do differently?

It’s All About Making Sense

Your reader should reach the end of your research literature review with a sense of full comprehension as to how your proposed study fits together with the current body of published work:

• You’re attempting to fill an identified gap
• You’re proposing to address an identified shortcoming
• You’re revisiting an inconclusive research summary
• You’re challenging an established theory
• You’re developing a limited study in more detail.

Have you ever faced any challenges in writing a research literature review? Write to us or email us at [email protected] and tell us how you overcame those challenges!

QUITE INFORMATIVE TIPS TO CONSIDER THROUGHOUT MY LITERATURE REVIEW. THANK YOU FOR COMING OUT HANDY

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5 Reasons the Literature Review Is Crucial to Your Paper

3-minute read

• 8th November 2016

People often treat writing the literature review in an academic paper as a formality. Usually, this means simply listing various studies vaguely related to their work and leaving it at that.

But this overlooks how important the literature review is to a well-written experimental report or research paper. As such, we thought we’d take a moment to go over what a literature review should do and why you should give it the attention it deserves.

What Is a Literature Review?

Common in the social and physical sciences, but also sometimes required in the humanities, a literature review is a summary of past research in your subject area.

Sometimes this is a standalone investigation of how an idea or field of inquiry has developed over time. However, more usually it’s the part of an academic paper, thesis or dissertation that sets out the background against which a study takes place.

There are several reasons why we do this.

Reason #1: To Demonstrate Understanding

In a college paper, you can use a literature review to demonstrate your understanding of the subject matter. This means identifying, summarizing and critically assessing past research that is relevant to your own work.

Reason #2: To Justify Your Research

The literature review also plays a big role in justifying your study and setting your research question . This is because examining past research allows you to identify gaps in the literature, which you can then attempt to fill or address with your own work.

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Reason #3: Setting a Theoretical Framework

It can help to think of the literature review as the foundations for your study, since the rest of your work will build upon the ideas and existing research you discuss therein.

A crucial part of this is formulating a theoretical framework , which comprises the concepts and theories that your work is based upon and against which its success will be judged.

Reason #4: Developing a Methodology

Conducting a literature review before beginning research also lets you see how similar studies have been conducted in the past. By examining the strengths and weaknesses of existing research, you can thus make sure you adopt the most appropriate methods, data sources and analytical techniques for your own work.

Reason #5: To Support Your Own Findings

The significance of any results you achieve will depend to some extent on how they compare to those reported in the existing literature. When you come to write up your findings, your literature review will therefore provide a crucial point of reference.

If your results replicate past research, for instance, you can say that your work supports existing theories. If your results are different, though, you’ll need to discuss why and whether the difference is important.

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Characteristics of a Good Literature Review in Health & Medicine

Clear Objectives and Research Questions : The review should start with clearly defined objectives and research questions that guide the scope and focus of the review.

Comprehensive Coverage : Include a wide range of relevant sources, such as research articles, review papers, clinical guidelines, and books. Aim for a broad understanding of the topic, covering historical developments and current advancements. To do this, an intentional and minimally biased search strategy.

• Link to relevant databases to consider for a comprehensive search (search 2+ databases)
• Link to the video "Searching your Topic: Strategies and Efficiencies" by Hanna Schmillen
• Link to the worksheet "From topic, to PICO, to search strategy" to help researchers work through their topic into an intentional search strategy by Hanna Schmillen

Transparency and Replicability : The review process, search strategy, should be transparent, with detailed documentation of all steps taken. This allows others to replicate the review or update it in the future.

Appraisal of Studies Included : Each included study should be critically appraised for methodological quality and relevance. Use standardized appraisal tools to assess the risk of bias and the quality of evidence.

• Link to the video " Evaluating Health Research" by Hanna Schmillen
• Link to evaluating and appraising studies tab, which includes a rubric and checklists

Clear Synthesis and Discussion of Findings : The review should provide a thorough discussion of the findings, including any patterns, relationships, or trends identified in the literature. Address the strengths and limitations of the reviewed studies and the review itself. Present findings in a balanced and unbiased manner, avoiding over interpretation or selective reporting of results.

Implications for Practice and Research : The review should highlight the practical implications of the findings for medical practice and policy. It should also identify gaps in the current literature and suggest areas for future research.

Referencing and Citation : Use proper citation practices to credit original sources. Provide a comprehensive reference list to guide readers to the original studies.

• Link to Citation Style Guide, includes tab about Zotero

Note: A literature review is not a systematic review. For more information about systematic reviews and different types of evidence synthesis projects, see the Evidence Synthesis guide .

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How to write a literature review introduction (+ examples)

The introduction to a literature review serves as your reader’s guide through your academic work and thought process. Explore the significance of literature review introductions in review papers, academic papers, essays, theses, and dissertations. We delve into the purpose and necessity of these introductions, explore the essential components of literature review introductions, and provide step-by-step guidance on how to craft your own, along with examples.

Why you need an introduction for a literature review

When you need an introduction for a literature review, what to include in a literature review introduction, examples of literature review introductions, steps to write your own literature review introduction.

A literature review is a comprehensive examination of the international academic literature concerning a particular topic. It involves summarizing published works, theories, and concepts while also highlighting gaps and offering critical reflections.

In academic writing , the introduction for a literature review is an indispensable component. Effective academic writing requires proper paragraph structuring to guide your reader through your argumentation. This includes providing an introduction to your literature review.

It is imperative to remember that you should never start sharing your findings abruptly. Even if there isn’t a dedicated introduction section .

Instead, you should always offer some form of introduction to orient the reader and clarify what they can expect.

There are three main scenarios in which you need an introduction for a literature review:

• Academic literature review papers: When your literature review constitutes the entirety of an academic review paper, a more substantial introduction is necessary. This introduction should resemble the standard introduction found in regular academic papers.
• Literature review section in an academic paper or essay: While this section tends to be brief, it’s important to precede the detailed literature review with a few introductory sentences. This helps orient the reader before delving into the literature itself.
• Literature review chapter or section in your thesis/dissertation: Every thesis and dissertation includes a literature review component, which also requires a concise introduction to set the stage for the subsequent review.

You may also like: How to write a fantastic thesis introduction (+15 examples)

It is crucial to customize the content and depth of your literature review introduction according to the specific format of your academic work.

In practical terms, this implies, for instance, that the introduction in an academic literature review paper, especially one derived from a systematic literature review , is quite comprehensive. Particularly compared to the rather brief one or two introductory sentences that are often found at the beginning of a literature review section in a standard academic paper. The introduction to the literature review chapter in a thesis or dissertation again adheres to different standards.

Here’s a structured breakdown based on length and the necessary information:

Academic literature review paper

The introduction of an academic literature review paper, which does not rely on empirical data, often necessitates a more extensive introduction than the brief literature review introductions typically found in empirical papers. It should encompass:

• The research problem: Clearly articulate the problem or question that your literature review aims to address.
• The research gap: Highlight the existing gaps, limitations, or unresolved aspects within the current body of literature related to the research problem.
• The research relevance: Explain why the chosen research problem and its subsequent investigation through a literature review are significant and relevant in your academic field.
• The literature review method: If applicable, describe the methodology employed in your literature review, especially if it is a systematic review or follows a specific research framework.
• The main findings or insights of the literature review: Summarize the key discoveries, insights, or trends that have emerged from your comprehensive review of the literature.
• The main argument of the literature review: Conclude the introduction by outlining the primary argument or statement that your literature review will substantiate, linking it to the research problem and relevance you’ve established.
• Preview of the literature review’s structure: Offer a glimpse into the organization of the literature review paper, acting as a guide for the reader. This overview outlines the subsequent sections of the paper and provides an understanding of what to anticipate.

By addressing these elements, your introduction will provide a clear and structured overview of what readers can expect in your literature review paper.

Regular literature review section in an academic article or essay

Most academic articles or essays incorporate regular literature review sections, often placed after the introduction. These sections serve to establish a scholarly basis for the research or discussion within the paper.

In a standard 8000-word journal article, the literature review section typically spans between 750 and 1250 words. The first few sentences or the first paragraph within this section often serve as an introduction. It should encompass:

• An introduction to the topic: When delving into the academic literature on a specific topic, it’s important to provide a smooth transition that aids the reader in comprehending why certain aspects will be discussed within your literature review.
• The core argument: While literature review sections primarily synthesize the work of other scholars, they should consistently connect to your central argument. This central argument serves as the crux of your message or the key takeaway you want your readers to retain. By positioning it at the outset of the literature review section and systematically substantiating it with evidence, you not only enhance reader comprehension but also elevate overall readability. This primary argument can typically be distilled into 1-2 succinct sentences.

In some cases, you might include:

• Methodology: Details about the methodology used, but only if your literature review employed a specialized method. If your approach involved a broader overview without a systematic methodology, you can omit this section, thereby conserving word count.

By addressing these elements, your introduction will effectively integrate your literature review into the broader context of your academic paper or essay. This will, in turn, assist your reader in seamlessly following your overarching line of argumentation.

Introduction to a literature review chapter in thesis or dissertation

The literature review typically constitutes a distinct chapter within a thesis or dissertation. Often, it is Chapter 2 of a thesis or dissertation.

Some students choose to incorporate a brief introductory section at the beginning of each chapter, including the literature review chapter. Alternatively, others opt to seamlessly integrate the introduction into the initial sentences of the literature review itself. Both approaches are acceptable, provided that you incorporate the following elements:

• Purpose of the literature review and its relevance to the thesis/dissertation research: Explain the broader objectives of the literature review within the context of your research and how it contributes to your thesis or dissertation. Essentially, you’re telling the reader why this literature review is important and how it fits into the larger scope of your academic work.
• Primary argument: Succinctly communicate what you aim to prove, explain, or explore through the review of existing literature. This statement helps guide the reader’s understanding of the review’s purpose and what to expect from it.
• Preview of the literature review’s content: Provide a brief overview of the topics or themes that your literature review will cover. It’s like a roadmap for the reader, outlining the main areas of focus within the review. This preview can help the reader anticipate the structure and organization of your literature review.
• Methodology: If your literature review involved a specific research method, such as a systematic review or meta-analysis, you should briefly describe that methodology. However, this is not always necessary, especially if your literature review is more of a narrative synthesis without a distinct research method.

By addressing these elements, your introduction will empower your literature review to play a pivotal role in your thesis or dissertation research. It will accomplish this by integrating your research into the broader academic literature and providing a solid theoretical foundation for your work.

Comprehending the art of crafting your own literature review introduction becomes significantly more accessible when you have concrete examples to examine. Here, you will find several examples that meet, or in most cases, adhere to the criteria described earlier.

Example 1: An effective introduction for an academic literature review paper

To begin, let’s delve into the introduction of an academic literature review paper. We will examine the paper “How does culture influence innovation? A systematic literature review”, which was published in 2018 in the journal Management Decision.

The entire introduction spans 611 words and is divided into five paragraphs. In this introduction, the authors accomplish the following:

• In the first paragraph, the authors introduce the broader topic of the literature review, which focuses on innovation and its significance in the context of economic competition. They underscore the importance of this topic, highlighting its relevance for both researchers and policymakers.
• In the second paragraph, the authors narrow down their focus to emphasize the specific role of culture in relation to innovation.
• In the third paragraph, the authors identify research gaps, noting that existing studies are often fragmented and disconnected. They then emphasize the value of conducting a systematic literature review to enhance our understanding of the topic.
• In the fourth paragraph, the authors introduce their specific objectives and explain how their insights can benefit other researchers and business practitioners.
• In the fifth and final paragraph, the authors provide an overview of the paper’s organization and structure.

In summary, this introduction stands as a solid example. While the authors deviate from previewing their key findings (which is a common practice at least in the social sciences), they do effectively cover all the other previously mentioned points.

Example 2: An effective introduction to a literature review section in an academic paper

The second example represents a typical academic paper, encompassing not only a literature review section but also empirical data, a case study, and other elements. We will closely examine the introduction to the literature review section in the paper “The environmentalism of the subalterns: a case study of environmental activism in Eastern Kurdistan/Rojhelat”, which was published in 2021 in the journal Local Environment.

The paper begins with a general introduction and then proceeds to the literature review, designated by the authors as their conceptual framework. Of particular interest is the first paragraph of this conceptual framework, comprising 142 words across five sentences:

“ A peripheral and marginalised nationality within a multinational though-Persian dominated Iranian society, the Kurdish people of Iranian Kurdistan (a region referred by the Kurds as Rojhelat/Eastern Kurdi-stan) have since the early twentieth century been subject to multifaceted and systematic discriminatory and exclusionary state policy in Iran. This condition has left a population of 12–15 million Kurds in Iran suffering from structural inequalities, disenfranchisement and deprivation. Mismanagement of Kurdistan’s natural resources and the degradation of its natural environmental are among examples of this disenfranchisement. As asserted by Julian Agyeman (2005), structural inequalities that sustain the domination of political and economic elites often simultaneously result in environmental degradation, injustice and discrimination against subaltern communities. This study argues that the environmental struggle in Eastern Kurdistan can be asserted as a (sub)element of the Kurdish liberation movement in Iran. Conceptually this research is inspired by and has been conducted through the lens of ‘subalternity’ ” ( Hassaniyan, 2021, p. 931 ).

In this first paragraph, the author is doing the following:

• The author contextualises the research
• The author links the research focus to the international literature on structural inequalities
• The author clearly presents the argument of the research
• The author clarifies how the research is inspired by and uses the concept of ‘subalternity’.

Thus, the author successfully introduces the literature review, from which point onward it dives into the main concept (‘subalternity’) of the research, and reviews the literature on socio-economic justice and environmental degradation.

While introductions to a literature review section aren’t always required to offer the same level of study context detail as demonstrated here, this introduction serves as a commendable model for orienting the reader within the literature review. It effectively underscores the literature review’s significance within the context of the study being conducted.

Examples 3-5: Effective introductions to literature review chapters

The introduction to a literature review chapter can vary in length, depending largely on the overall length of the literature review chapter itself. For example, a master’s thesis typically features a more concise literature review, thus necessitating a shorter introduction. In contrast, a Ph.D. thesis, with its more extensive literature review, often includes a more detailed introduction.

Numerous universities offer online repositories where you can access theses and dissertations from previous years, serving as valuable sources of reference. Many of these repositories, however, may require you to log in through your university account. Nevertheless, a few open-access repositories are accessible to anyone, such as the one by the University of Manchester . It’s important to note though that copyright restrictions apply to these resources, just as they would with published papers.

Master’s thesis literature review introduction

The first example is “Benchmarking Asymmetrical Heating Models of Spider Pulsar Companions” by P. Sun, a master’s thesis completed at the University of Manchester on January 9, 2024. The author, P. Sun, introduces the literature review chapter very briefly but effectively:

PhD thesis literature review chapter introduction

The second example is Deep Learning on Semi-Structured Data and its Applications to Video-Game AI, Woof, W. (Author). 31 Dec 2020, a PhD thesis completed at the University of Manchester . In Chapter 2, the author offers a comprehensive introduction to the topic in four paragraphs, with the final paragraph serving as an overview of the chapter’s structure:

PhD thesis literature review introduction

The last example is the doctoral thesis Metacognitive strategies and beliefs: Child correlates and early experiences Chan, K. Y. M. (Author). 31 Dec 2020 . The author clearly conducted a systematic literature review, commencing the review section with a discussion of the methodology and approach employed in locating and analyzing the selected records.

Having absorbed all of this information, let’s recap the essential steps and offer a succinct guide on how to proceed with creating your literature review introduction:

• Contextualize your review : Begin by clearly identifying the academic context in which your literature review resides and determining the necessary information to include.
• Outline your structure : Develop a structured outline for your literature review, highlighting the essential information you plan to incorporate in your introduction.
• Literature review process : Conduct a rigorous literature review, reviewing and analyzing relevant sources.
• Summarize and abstract : After completing the review, synthesize the findings and abstract key insights, trends, and knowledge gaps from the literature.
• Craft the introduction : Write your literature review introduction with meticulous attention to the seamless integration of your review into the larger context of your work. Ensure that your introduction effectively elucidates your rationale for the chosen review topics and the underlying reasons guiding your selection.

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Literature Reviews

• 1. Define your research question
• Getting started
• Types of reviews

Define topic

Brainstorming, limit scope, how ai can help, helpful resources.

• 2. Plan your search
• 3. Search the literature
• 4. Organize your results
• 5. Synthesize your findings
• 6. Write the review
• Artificial intelligence (AI) tools
• Thompson Writing Studio This link opens in a new window
• Need to write a systematic review? This link opens in a new window

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For example, the following research question is too broad.

Does social media affect mental health in college students?

A more focused research question could be:

Does social media play a role in the number of eating disorder diagnoses in college-aged women?

Need some guidance? Contact your subject librarian for a research consultation or reach out to [email protected] .

Start the brainstorming process:

• Begin by identifying a broad topic of research interest (the more you're personally interested in it, the better!). Write it down to clarify your focus.
• Narrow down your scope  by considering specific areas within this topic that you want to explore.
• Identify key themes and elements  related to these specific areas. These will be the building blocks of your investigation.
• Finally,  integrate these key areas and elements  into a well-crafted research question.

One way to brainstorm is to use a flowchart.

The scope of a topic  encompasses the boundaries and constraints you set for your research. The more precise your research question, the smoother the research process becomes.

Feeling stuck? Here are some ways you can narrow down your topic:

• geographic location
• time period
• discipline/field of study
• age group, etc.

You:  I need to conduct a literature review about social media, mental health, and college students. What are some example research questions within this topic?

ChatGPT: 

• How does the frequency and nature of social media use impact the mental health of college students?
• What role do specific social media platforms play in influencing the mental well-being of college students?
• How do online social interactions on platforms like Facebook, Instagram, or Twitter relate to the mental health outcomes of college students?
• Are there differences in the association between social media use and mental health outcomes based on demographic factors such as gender, age, or academic major among college students?
• What strategies do college students employ to cope with negative mental health effects associated with social media use?
• How does the perception of social support through online platforms affect the mental health of college students?
• To what extent does the comparison of oneself to others on social media contribute to mental health challenges among college students?
• What interventions or educational programs are effective in promoting positive mental health behaviors in the context of social media use for college students?
• How do social media literacy and awareness programs impact the mental health attitudes and behaviors of college students?
• What is the relationship between the use of social media for academic and social purposes and the mental health outcomes of college students?

Generative AI tools : ChatGPT , Google Gemini (formerly Bard) , Claude , Microsoft Copilot

For more information on how to incorporate AI tools into your research, check out the section on AI Tools .

• Developing Your Research Question
• Developing a Researchable Question
• Brainstorming tips from UNC Writing Center
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• Next: 2. Plan your search >>
• Last Updated: May 17, 2024 8:42 AM
• URL: https://guides.library.duke.edu/litreviews

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Rapid literature review: definition and methodology

Beata smela.

a Assignity, Cracow, Poland

Mondher Toumi

b Public Health Department, Aix-Marseille University, Marseille, France

Karolina Świerk

Clement francois, małgorzata biernikiewicz.

c Studio Slowa, Wroclaw, Poland

Emilie Clay

d Clever-Access, Paris, France

Laurent Boyer

Introduction: A rapid literature review (RLR) is an alternative to systematic literature review (SLR) that can speed up the analysis of newly published data. The objective was to identify and summarize available information regarding different approaches to defining RLR and the methodology applied to the conduct of such reviews.

Methods: The Medline and EMBASE databases, as well as the grey literature, were searched using the set of keywords and their combination related to the targeted and rapid review, as well as design, approach, and methodology. Of the 3,898 records retrieved, 12 articles were included.

Results: Specific definition of RLRs has only been developed in 2021. In terms of methodology, the RLR should be completed within shorter timeframes using simplified procedures in comparison to SLRs, while maintaining a similar level of transparency and minimizing bias. Inherent components of the RLR process should be a clear research question, search protocol, simplified process of study selection, data extraction, and quality assurance.

Conclusions: There is a lack of consensus on the formal definition of the RLR and the best approaches to perform it. The evidence-based supporting methods are evolving, and more work is needed to define the most robust approaches.

Introduction

A systematic literature review (SLR) summarizes the results of all available studies on a specific topic and provides a high level of evidence. Authors of the SLR have to follow an advanced plan that covers defining a priori information regarding the research question, sources they are going to search, inclusion criteria applied to choose studies answering the research question, and information regarding how they are going to summarize findings [ 1 ].

The rigor and transparency of SLRs make them the most reliable form of literature review [ 2 ], providing a comprehensive, objective summary of the evidence for a given topic [ 3 , 4 ]. On the other hand, the SLR process is usually very time-consuming and requires a lot of human resources. Taking into account a high increase of newly published data and a growing need to analyze information in the fastest possible way, rapid literature reviews (RLRs) often replace standard SLRs.

There are several guidelines on the methodology of RLRs [ 5–11 ]; however, only recently, one publication from 2021 attempted to construct a unified definition [ 11 ]. Generally, by RLRs, researchers understand evidence synthesis during which some of the components of the systematic approach are being used to facilitate answering a focused research question; however, scope restrictions and a narrower search strategy help to make the project manageable in a shorter time and to get the key conclusions faster [ 4 ].

The objective of this research was to collect and summarize available information on different approaches to the definition and methodology of RLRs. An RLR has been run to capture publications providing data that fit the project objective.

To find publications reporting information on the methodology of RLRs, searches were run in the Medline and EMBASE databases in November 2022. The following keywords were searched for in titles and abstracts: ‘targeted adj2 review’ OR ‘focused adj2 review’ OR ‘rapid adj2 review’, and ‘methodology’ OR ‘design’ OR ‘scheme’ OR ‘approach’. The grey literature was identified using Google Scholar with keywords including ‘targeted review methodology’ OR ‘focused review methodology’ OR ‘rapid review methodology’. Only publications in English were included, and the date of publication was restricted to year 2016 onward in order to identify the most up-to-date literature. The reference lists of each included article were searched manually to obtain the potentially eligible articles. Titles and abstracts of the retrieved records were first screened to exclude articles that were evidently irrelevant. The full texts of potentially relevant papers were further reviewed to examine their eligibility.

A pre-defined Excel grid was developed to extract the following information related to the methodology of RLR from guidelines:

• Definition,
• Research question and searches,
• Studies selection,
• Data extraction and quality assessment,
• Additional information.

There was no restriction on the study types to be analyzed; any study reporting on the methodology of RLRs could be included: reviews, practice guidelines, commentaries, and expert opinions on RLR relevant to healthcare policymakers or practitioners. The data extraction and evidence summary were conducted by one analyst and further examined by a senior analyst to ensure that relevant information was not omitted. Disagreements were resolved by discussion and consensus.

Studies selection

A total of 3,898 records (3,864 articles from a database search and 34 grey literature from Google Scholar) were retrieved. After removing duplicates, titles and abstracts of 3,813 articles were uploaded and screened. The full texts of 43 articles were analyzed resulting in 12 articles selected for this review, including 7 guidelines [ 5–11 ] on the methodology of RLRs, together with 2 papers summarizing the results of the Delphi consensus on the topic [ 12 , 13 ], and 3 publications analyzing and assessing different approaches to RLRs [ 4 , 14 , 15 ].

Overall, seven guidelines were identified: from the World Health Organization (WHO) [ 5 ], National Collaborating Centre for Methods and Tools (NCCMT) [ 7 ], the UK government [ 8 ], the Oxford Centre for Evidence Based Medicine [ 9 ], the Cochrane group [ 6 , 11 ], and one multi-national review [ 10 ]. Among the papers that did not describe the guidelines, Gordon et al. [ 4 ] proposed 12 tips for conducting a rapid review in the right settings and discussed why these reviews may be more beneficial in some circumstances. The objective of work conducted by Tricco et al. [ 13 ] and Pandor et al. [ 12 ] was to collect and compare perceptions of rapid reviews from stakeholders, including researchers, policymakers, industry, journal editors, and healthcare providers, and to reach a consensus outlining the domains to consider when deciding on approaches for RLRs. Haby et al. [ 14 ] run a rapid review of systematic reviews and primary studies to find out the best way to conduct an RLR in health policy and practice. In Tricco et al. (2022) [ 15 ], JBI position statement for RLRs is presented.

From all the seven identified guidelines information regarding definitions the authors used for RLRs, approach to the PICOS criteria and search strategy development, studies selection, data extractions, quality assessment, and reporting were extracted.

Cochrane Rapid Reviews Methods Group developed methods guidance based on scoping review of the underlying evidence, primary methods studies conducted, as well as surveys sent to Cochrane representative and discussion among those with expertise [ 11 ]. They analyzed over 300 RLRs or RLR method papers and based on the methodology of those studies, constructed a broad definition RLR, one that meets a minimum set of requirements identified in the thematic analysis: ‘ A rapid review is a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting a variety of methods to produce evidence in a resource-efficient manner .’ This interpretation aligns with more than 50% of RLRs identified in this study. The authors additionally provided several other definitions, depending on specific situations or requirements (e.g., when RLR is produced on stakeholder’s request). It was additionally underlined that RLRs should be driven by the need of timely evidence for decision-making purposes [ 11 ].

Rapid reviews vary in their objective, format, and methods used for evidence synthesis. This is a quite new area, and still no agreement on optimal methods can be found [ 5 ]. All of the definitions are highlighting that RLRs are completed within shorter timeframes than SLRs, and also lack of time is one of the main reasons they are conducted. It has been suggested that most rapid reviews are conducted within 12 weeks; however, some of the resources suggest time between a few weeks to no more than 6 months [ 5 , 6 ]. Some of the definitions are highlighting that RLRs follow the SLR process, but certain phases of the process are simplified or omitted to retrieve information in a time-saving way [ 6 , 7 ]. Different mechanisms are used to enhance the timeliness of reviews. They can be used independently or concurrently: increasing the intensity of work by intensifying the efforts of multiple analysts by parallelization of tasks, using review shortcuts whereby one or more systematic review steps may be reduced, automatizing review steps by using new technologies [ 5 ]. The UK government report [ 8 ] referred to two different RLRs: in the form of quick scoping reviews (QSR) or rapid evidence assessments (REA). While being less resource and time-consuming compared to standard SLRs, QSRs and REAs are designed to be similarly transparent and to minimize bias. QSRs can be applied to rather open-ended questions, e.g., ‘what do we know about something’ but both, QSRs and REAs, provide an understanding of the volume and characteristics of evidence on a specific topic, allowing answering questions by maximizing the use of existing data, and providing a clear picture of the adequacy of existing evidence [ 8 ].

Research questions and searches

The guidelines suggest creating a clear research question and search protocol at the beginning of the project. Additionally, to not duplicate RLRs, the Cochrane Rapid Reviews Methods Group encourages all people working on RLRs to consider registering their search protocol with PROSPERO, the international prospective register of reviews; however, so far they are not formally registered in most cases [ 5 , 6 ]. They also recommend involving key stakeholders (review users) to set and refine the review question, criteria, and outcomes, as well as consulting them through the entire process [ 11 ].

Regarding research questions, it is better to structure them in a neutral way rather than focus on a specific direction for the outcome. By doing so, the researcher is in a better position to identify all the relevant evidence [ 7 ]. Authors can add a second, supportive research question when needed [ 8 ]. It is encouraged to limit the number of interventions, comparators and outcomes, to focus on the ones that are most important for decision-making [ 11 ]. Useful could be also reviewing additional materials, e.g., SLRs on the topic, as well as conducting a quick literature search to better understand the topic before starting with RLRs [ 7 ]. In SLRs researchers usually do not need to care a lot about time spent on creating PICOS, they need to make sure that the scope is broad enough, and they cannot use many restrictions. When working on RLRs, a reviewer may spend more or less time defining each of the components of the study question, and the main step is making sure that PICOS addresses the needs of those who requested the rapid review, and at the same time, it is feasible within the required time frame [ 7 ]. Search protocol should contain an outline of how the following review steps are to be carried out, including selected search keywords and a full strategy, a list of data sources, precise inclusion and exclusion criteria, a strategy for data extraction and critical appraisal, and a plan of how the information will be synthesized [ 8 ].

In terms of searches running, in most cases, an exhaustive process will not be feasible. Researchers should make sure that the search is effective and efficient to produce results in a timely manner. Cochrane Rapid Reviews Methods Group recommends involving an information specialist and conducting peer review of at least one search strategy [ 11 ]. According to the rapid review guidebook by McMaster University [ 7 ], it is important that RLRs, especially those that support policy and program decisions, are being fed by the results of a body of literature, rather than single studies, when possible. It would result in more generalizable findings applied at the level of a population and serve more realistic findings for program decisions [ 7 ]. It is important to document the search strategy, together with a record of the date and any date limits of the search, so that it can easily be run again, modified, or updated. Furthermore, the information on the individual databases included in platform services should always be reported, as this depends on organizations’ subscriptions and must be included for transparency and repeatability [ 7 , 8 ]. Good solution for RLRs is narrowing the scope or searching a limited number of databases and other sources [ 7 ]. Often, the authors use the PubMed/MEDLINE, Cochrane Library, and Embase databases. In most reviews, two or more databases are searched, and common limits are language (usually restricted to English), date, study design, and geographical area. Some RLRs include searching of grey literature; however, contact with authors is rather uncommon [ 5 , 8 ]. According to the flexible framework for restricted systematic review published by the University of Oxford, the search should be run in at least one major scientific database such as PubMed, and one other source, e.g., Google Scholar [ 9 ]. Grey literature and unpublished evidence may be particularly needed and important for intervention questions. It is related to the fact that studies that do not report the effects of interventions are less likely to be published [ 8 ]. If there is any type of evidence that will not be considered by the RLRs, e.g., reviews or theoretical and conceptual studies, it should also be stated in the protocol together with justification [ 8 ]. Additionally, authors of a practical guide published by WHO suggest using a staged search to identify existing SLRs at the beginning, and then focusing on studies with other designs [ 5 ]. If a low number of citations have been retrieved, it is acceptable to expand searches, remove some of the limits, and add additional databases and sources [ 7 ].

Searching for RLRs is an iterative process, and revising the approach is usually needed [ 7 ]. Changes should be confirmed with stakeholders and should be tracked and reflected in the final report [ 5 ].

The next step in the rapid review is the selection of studies consisting of two phases: screening of titles and abstracts, and analysis of full texts. Prior to screening initiation, it is recommended to conduct a pilot exercise using the same 30–50 abstracts and 5–10 full-texts for the entire screening team in order to calibrate and test the review form [ 11 ]. In contrast to SLRs, it can be done by one reviewer with or without verification by a second one. If verification is performed, usually the second reviewer checks only a subset of records and compares them. Cochrane Group, in contrast, recommends a stricter approach: at least 20% of references should be double-screened at titles and abstracts stage, and while the rest of the references may be screened by one reviewer, the excluded items need to be re-examined by second reviewer; similar approach is used in full-text screening [ 11 ]. This helps to ensure that bias was reduced and that the PICOS criteria are applied in a relevant way [ 5 , 8 , 9 , 11 ]. During the analysis of titles and abstracts, there is no need to report reasons for exclusion; however, they should be tracked for all excluded full texts [ 7 ].

Data extraction and quality assessment

According to the WHO guide, the most common method for data extraction in RLRs is extraction done by a single reviewer with or without partial verification. The authors point out that a reasonable approach is to use a second reviewer to check a random sample of at least 10% of the extractions for accuracy. Dual performance is more necessary for the extraction of quantitative results than for descriptive study information. In contrast, Cochrane group recommends that second reviewer should check the correctness and completeness of all data [ 11 ]. When possible, extractions should be limited to key characteristics and outcomes of the study. The same approach to data extraction is also suggested for a quality assessment process within rapid reviews [ 5 , 9 , 11 ]. Authors of the guidebook from McMaster University highlight that data extraction should be done ideally by two reviewers independently and consensus on the discrepancies should always be reached [ 7 ]. The final decision on the approach to this important step of review should depend on the available time and should also reflect the complexity of the research question [ 9 ].

For screening, analysis of full texts, extractions, and quality assessments, researchers can use information technologies to support them by making these review steps more efficient [ 5 ].

Before data reporting, a reviewer should prepare a document with key message headings, executive summary, background related to the topic and status of the current knowledge, project question, synthesis of findings, conclusions, and recommendations. According to the McMaster University guidebook, a report should be structured in a 1:2:20 format, that is, one page for key messages, two pages for an executive summary, and a full report of up to 20 pages [ 7 ]. All the limitations of the RLRs should be analyzed, and conclusions should be drawn with caution [ 5 ]. The quality of the accumulated evidence and the strength of recommendations can be assessed using, e.g., the GRADE system [ 5 ]. When working on references quoting, researchers should remember to use a primary source, not secondary references [ 7 ]. It would be worth considering the support of some software tools to automate reporting steps. Additionally, any standardization of the process and the usage of templates can support report development and enhance the transparency of the review [ 5 ].

Ideally, all the review steps should be completed during RLRs; however, often some steps may need skipping or will not be completed as thoroughly as should because of time constraints. It is always crucial to decide which steps may be skipped, and which are the key ones, depending on the project [ 7 ]. Guidelines suggest that it may be helpful to invite researchers with experience in the operations of SLRs to participate in the rapid review development [ 5 , 9 ]. As some of the steps will be completed by one reviewer only, it is important to provide them with relevant training at the beginning of the process, as well as during the review, to minimize the risk of mistakes [ 5 ].

Additional information

Depending on the policy goal and available resources and deadlines, methodology of the RLRs may be modified. Wilson et al. [ 10 ] provided extensive guidelines for performing RLR within days (e.g., to inform urgent internal policy discussions and/or management decisions), weeks (e.g., to inform public debates), or months (e.g., to inform policy development cycles that have a longer timeline, but that cannot wait for a traditional full systematic review). These approaches vary in terms of data synthesis, types of considered evidence and project management considerations.

In shortest timeframes, focused questions and subquestions should be formulated, typically to conduct a policy analysis; the report should consist of tables along with a brief narrative summary. Evidence from SLRs is often considered, as well as key informant interviews may be conducted to identify additional literature and insights about the topic, while primary studies and other types of evidence are not typically feasible due to time restrictions. The review would be best conducted with 1–2 reviewers sharing the work, enabling rapid iterations of the review. As for RLRs with longer timeline (weeks), these may use a mix of policy, systems and political analysis. Structure of the review would be similar to shorter RLRs – tabular with short narrative summary, as the timeline does not allow for comprehensive synthesis of data. Besides SLRs, primary studies and other evidence may be feasible in this timeframe, if obtained using the targeted searches in the most relevant databases. The review team should be larger, and standardized procedures for reviewing of the results and data extraction should be applied. In contrast to previous timeframe, merit review process may be feasible. For both timeframes, brief consultations with small transdisciplinary team should be conducted at the beginning and in the final stage of the review to discuss important matters.

For RLRs spanning several months, more comprehensive methodology may be adapted in terms of data synthesis and types of evidence. However, authors advise that review may be best conducted with a small review team in order to allow for more in-depth interpretation and iteration.

Studies analyzing methodology

There have been two interesting publications summarizing the results of Delphi consensus on the RLR methodology identified and included in this review [ 12 , 13 ].

Tricco et al. [ 13 ] first conducted an international survey and scoping review to collect information on the possible approaches to the running of rapid reviews, based on which, they employed a modified Delphi method that included inputs from 113 stakeholders to explore the most optimized approach. Among the six most frequent rapid review approaches (not all detailed here) being evaluated, the approach that combines inclusion of published literature only, a search of more than one database and limitations by date and language, study selection by one analyst, data extraction, and quality assessment by one analyst and one verifier, was perceived as the most feasible approach (72%, 81/113 responses) with the potentially lowest risk of bias (12%, 12/103). The approach ranked as the first one when considering timelines assumes updating of the search from a previously published review, no additional limits on search, studies selection and data extraction done by one reviewer, and no quality assessment. Finally, based on the publication, the most comprehensive RLRs can be made by moving on with the following rules: searching more than one database and grey literature and using date restriction, and assigning one reviewer working on screening, data extraction, and risk of bias assessment ( Table 1 ). Pandor et al. [ 12 ] introduced a decision tool for SelecTing Approaches for Rapid Reviews (STARR) that were produced through the Delphi consensus of international experts through an iterative and rigorous process. Participants were asked to assess the importance of predefined items in four domains related to the rapid review process: interaction with commissioners, understanding the evidence base, data extraction and synthesis methods, and reporting of rapid review methods. All items assigned to four domains achieved > 70% of consensus, and in that way, the first consensus-driven tool has been created that supports authors of RLRs in planning and deciding on approaches.

Six most frequent approaches to RLRs (adapted from Tricco et al. [ 13 ]).

Haby et al. [ 14 ] run searches of 11 databases and two websites and developed a comprehensive overview of the methodology of RLRs. With five SLRs and one RCT being finally included, they identified the following approaches used in RLRs to make them faster than full SLRs: limiting the number and scope of questions, searching fewer databases, limited searching of grey literature, restrictions on language and date (e.g., English only, most recent publications), updating the existing SLRs, eliminating or limiting hand searches of reference lists, noniterative search strategies, eliminating consultation with experts, limiting dual study selection, data extraction and quality assessment, minimal data synthesis with short concise conclusions or recommendations. All the SLRs included in this review were consistent in stating that no agreed definition of rapid reviews is available, and there is still no final agreement on the best methodological rules to be followed.

Gordon et al. [ 4 ] explained the advantages of performing a focused review and provided 12 tips for its conduction. They define focused reviews as ‘a form of knowledge synthesis in which the components of the systematic process are applied to facilitate the analysis of a focused research question’. The first tip presented by the authors is related to deciding if a focused review is a right solution for the considered project. RLRs will suit emerging topics, approaches, or assessments where early synthesis can support doctors, policymakers, etc., but also can direct future research. The second, third, and fourth tips highlight the importance of running preliminary searches and considering narrowing the results by using reasonable constraints taking into account the local context, problems, efficiency perspectives, and available time. Further tips include creating a team of experienced reviewers working on the RLRs, thinking about the target journal from the beginning of work on the rapid review, registering the search protocol on the PROSPERO registry, and the need for contacting authors of papers when data available in publications are missing or incongruent. The last three tips are related to the choice of evidence synthesis method, using the visual presentation of data, and considering and describing all the limitations of the focused review.

Finally, a new publication by Tricco et al. from 2022, describing JBI position statement [ 15 ] underlined that for the time being, there is no specific tool for critical appraisal of the RLR’s methodological quality. Instead, reviewers may use available tools to assess the risk of bias or quality of SLRs, like ROBIS, the JBI critical appraisal tools, or the assessment of multiple systematic reviews (AMSTAR).

Inconsistency in the definitions and methodologies of RLR

Although RLR was broadly perceived as an approach to quicken the conduct of conventional SLR, there is a lack of consensus on the formal definition of the RLR, so as to the best approaches to perform it. Only in 2021, a study proposing unified definition was published; however, it is important to note that the most accurate definition was only matching slightly over 50% of papers analysed by the authors, which underlines the lack of homogeneity in the field [ 11 ]. The evidence-based supporting methods are evolving, and more evidence is needed to define the most robust approaches [ 5 ].

Diverse terms are used to describe the RLR, including ‘rapid review’, focused systematic review’, ‘quick scoping reviews’, and ‘rapid evidence assessments’. Although the general principles of conducting RLR are to accelerate the whole process, complexity was seen in the methodologies used for RLRs, as reflected in this study. Also, inconsistencies related to the scope of the questions, search strategies, inclusion criteria, study screening, full-text review, quality assessment, and evidence presentation were implied. All these factors may hamper decision-making about optimal methodologies for conducting rapid reviews, and as a result, the efficiency of RLR might be decreased. Additionally, researchers may tend to report the methodology of their reviews without a sufficient level of detail, making it difficult to appraise the quality and robustness of their work.

Advantages and weaknesses of RLR

Although RLR used simplified approaches for evidence synthesis compared with SLR, the methodologies for RLR should be replicable, rigorous, and transparent to the greatest extent [ 16 ]. When time and resources are limited, RLR could be a practical and efficient tool to provide the summary of evidence that is critical for making rapid clinical or policy-related decisions [ 5 ]. Focusing on specific questions that are of controversy or special interest could be powerful in reaffirming whether the existing recommendation statements are still appropriate [ 17 ].

The weakness of RLR should also be borne in mind, and the trade-off of using RLR should be carefully considered regarding the thoroughness of the search, breadth of a research question, and depth of analysis [ 18 ]. If allowed, SLR is preferred over RLR considering that some relevant studies might be omitted with narrowed search strategies and simplified screening process [ 14 ]. Additionally, omitting the quality assessment of included studies could result in an increased risk of bias, making the comprehensiveness of RLR compromised [ 13 ]. Furthermore, in situations that require high accuracy, for example, where a small relative difference in an intervention has great impacts, for the purpose of drafting clinical guidelines, or making licensing decisions, a comprehensive SLR may remain the priority [ 19 ]. Therefore, clear communications with policymakers are recommended to reach an agreement on whether an RLR is justified and whether the methodologies of RLR are acceptable to address the unanswered questions [ 18 ].

Disclosure statement

No potential conflict of interest was reported by the author(s).

• Open access
• Published: 22 May 2024

Long-term outcome and fertility results of intraplacental choriocarcinoma: a retrospective study of 14 patients and literature review

• Yang Liu 1   na1 ,
• Xiaochen Song 1   na1 ,
• Hui Zhang 2 ,
• Fengzhi Feng 1 ,
• Jun Zhao 1 ,
• Junjun Yang 1 ,
• Tong Ren 1 ,
• Xirun Wan 1 ,
• Fang Jiang 1 ,
• Yuan Li 1 &
• Yang Xiang   ORCID: orcid.org/0000-0002-9112-1021 1  

Orphanet Journal of Rare Diseases volume  19 , Article number:  214 ( 2024 ) Cite this article

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Backgrounds

Intraplacental choriocarcinoma (IC) is an extremely rare subtype of gestational choriocarcinoma. The long-term follow-up and reproductive outcomes of IC patients remain unclear. Here, we report a series of 14 cases and conduct a literature review to assess the fertility and recurrence results of this rare disease.

Fourteen patients with pathologically confirmed IC treated in Peking Union Medical College Hospital between January 2002 and July 2022 were included in this study. Half of them had metastatic IC and were treated by chemotherapy with or without surgery. Only 1 patient had chemoresistant disease, but she achieved complete remission after immunotherapy. The median follow-up time was 45.5 months (range 4-192), and no recurrence occurred. One metastatic IC patient who achieved remission after chemotherapy had a full-term delivery. Among the 5 patients with fertility demands, 3 abandoned their pursuit of pregnancy because of “fear and worry about choriocarcinoma recurrence”. We reviewed a total of 89 cases of IC in English and Chinese literature from 1963 to 2022, and only 5 cases with subsequent pregnancy were reported, all of them were nonmetastatic IC cases.

Conclusions

IC is sensitive to chemotherapy and has good long-term remission and a low recurrence rate. Patients with metastatic or nonmetastatic IC can have good pregnancy results after treatment. Doctors should pay more attention to the psychology of these patients.

Clinical trial registration

Intraplacental choriocarcinoma (IC), first reported by Driscoll [ 1 ] in 1963, is a rare subtype of gestational choriocarcinoma in which choriocarcinoma is found within the placenta. The clinical manifestations are atypical and can be asymptomatic lesions confined to the placenta [ 2 ] or metastatic choriocarcinoma with both maternal and infantile involvement [ 3 ]. It may cause fetal complications such as fetomaternal hemorrhage, stillbirth and intrauterine growth restriction in the perinatal period [ 4 ]. The reported incidence of gestational choriocarcinoma is 1 per 50,000 normal pregnancies [ 5 ]. And pathologically diagnosed IC has been reported to account for only 2.3% of gestational choriocarcinoma cases [ 6 ], making it extremely rare. Due to the rarity of IC, sometimes it’s difficult to histologically differentiate it from another equally rare disease, chorangiocarcinoma [ 7 ].

Literature review indicates that there are fewer than 100 reported IC cases until now, and the long-term follow-up and reproductive outcomes of it remain unclear. Peking Union Medical College Hospital (PUMCH) is a center for the diagnosis and treatment of gestational trophoblastic neoplasia in China. This retrospective study systematically analyzed the medical records of all IC patients treated in our center over the past 20 years (2002–2022), aiming to explore the long-term outcome and fertility results of this rare disease.

The medical records and long-term follow-up data of all patients with a pathologically confirmed diagnosis of IC at PUMCH were reviewed. Demographic data and information on the presenting symptoms, gestational week and fetal outcomes were obtained from the clinical records. In this study, IC was staged according to the revised International Federation of Gynecology and Obstetrics (FIGO) criteria for GTN and assigned FIGO scores [ 8 ]. Written informed consent was obtained from each patient, and the study was approved by the Institutional Review Board of PUMCH (K3862).

The statistical analyses were performed with SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Data are presented as the means and standard deviations (SD) or medians (ranges) for continuous variables and as frequencies (corresponding percentages) for categorical variables.

Demographic and clinical characteristics of the 14 patients

A total of 2,150 women were diagnosed with gestational choriocarcinoma at PUMCH between January 2002 and July 2022. Fourteen were pathologically diagnosed with IC, including 2 previously reported cases [ 3 , 9 ]. Therefore, IC accounts for 0.7% of gestational choriocarcinoma diagnoses made at our center.

The demographic and clinical characteristics of all 14 patients are presented below (Table  1 ). Among the 14 patients, 10 were of Han nationality, 2 were of Hui nationality, and 2 were of Manchu nationality. The median age at diagnosis was 33 years (range 26–44), with a median of 3 previous pregnancies (range 1–5). Three (21.4%) patients were diagnosed in the first trimester (pregnancy 8 to 11 + 6 weeks). The 3 patients had abnormally and significantly increased β-human chorionic gonadotropin (β-hCG) levels up to 600,000 mIU/ml, and IC was confirmed by postabortion pathology. One (7.1%) patient was diagnosed in the second trimester (pregnancy 12 to 27 + 6 weeks). The remaining 10 (71.4%) patients were diagnosed in the third trimester (pregnancy 28 to 41 weeks) or postpartum, in terms of delivery methods, 6 of them (60%) underwent cesarean section due to obstetric factors or fetal distress, the other 4 patients (including 2 with intrauterine fetal deaths) underwent vaginal delivery.

The symptoms included vaginal bleeding (6/14, 42.9%), fetomaternal hemorrhage (5/14, 35.7%), and hemoptysis (1/14, 7.1%). Among the 7 cases of nonmetastatic IC, the β-hCG level automatically dropped to normal postpartum levels within 12.9 ± 8.2 weeks. Among the 7 cases of metastatic IC, the common metastatic sites were the lung (7/7, 100%), uterus (3/7, 42.9%), intracranial region (1/7, 14.3%) and vagina (1/7, 14.3%). There was 1 case in which fetal choriocarcinoma was diagnosed first, followed by a diagnosis of maternal metastatic IC [ 3 ].

The treatment of the 7 patients with metastatic IC is shown in Table  2 . All patients were treated with chemotherapy. After chemotherapy, 3 (42.9%) underwent surgical treatment. One patient (14.3%) had chemoresistant disease but achieved complete remission after programmed cell death ligand-1 (PD-L1) immunotherapy.

Perinatal outcome

Four cases were excluded because they were diagnosed in the first or second trimester, and the perinatal outcomes of the remaining 10 patients are summarized below (Table  3 ). There were 2 intrauterine fetal deaths. Among the other 8 patients, each with a live birth, 1 had a premature delivery (35 weeks of gestation), and 7 had full-term deliveries. One newborn baby with a jejunal mass was treated by surgical resection, and pathology confirmed that it was choriocarcinoma. Then, the baby was successfully treated with combined chemotherapy [ 3 ]. Five newborn babies were pale and had anemia, which was confirmed to be associated with FMH.

Long-term outcomes and fertility results

The median follow-up time was 45.5 months (range 4-192), and there was no recurrence among the 14 patients. Of the 5 patients with fertility demands, 2 (40.0%) became pregnant again. One patient had fetal malformation at 11 weeks of gestation and underwent therapeutically induced labor. The other patient who had metastatic IC and received actinomycin D for 4 cycles, received FAV for 1 cycle, then changed to EMA/CO for 2 cycles and underwent 3 additional cycles for consolidation after achieving remission. She had a spontaneous intrauterine pregnancy that reached term at 37 months after treatment. No abnormality was found in the placental pathology examination, and the baby was healthy. The remaining 3 (60.0%) patients abandoned their pursuit of pregnancy because of “fear and worry about choriocarcinoma recurrence”.

Literature review

We reviewed and summarized the reported cases of IC in English and Chinese Literature from 1963 to 2022, and a total of 89 cases have been reported [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ]. Of the 101 IC patients (plus the 14 cases in our center, excluding the duplicate cases), 51 (50.5%) had non-metastatic IC. Among them, 7 patients (13.7%) received prophylactic chemotherapy, 1 was lost to follow-up, and 1 (2.0%) patient relapsed with lung metastasis and was cured by multiagent chemotherapy. In particular, 1 patient had a second diagnosis of IC confirmed by histological examination of the placenta after a second pregnancy. Further investigations revealed no evidence of metastasis, and her β-hCG level spontaneously returned to normal after delivery.

Among the 50 (49.5%) patients with metastatic IC, 2 patients were lost to follow-up, 13 (26.0%) patients died during the follow-up period, and 35 (70.0%) patients achieved complete remission by chemotherapy with or without surgery/radiotherapy. We further analyzed the 13 patients who died and found that only 3 patients had received chemotherapy. The remaining 10 patients were from an era when chemotherapy was not developed, 5 patients received only surgery, 4 died prior to initiation of therapy, and there was 1 treatment-related death.

At present, only 5 cases with subsequent pregnancy have been reported, [ 6 , 9 , 15 , 16 ] all of them were nonmetastatic IC cases, with good maternal and infant outcomes.

The fertility and recurrence results of IC at long-term follow-up were assessed in this study. We found that IC is sensitive to chemotherapy and has good long-term remission with a low recurrence rate, and patients with metastatic or nonmetastatic IC can have good pregnancy results after treatment.

The application of chemotherapy has greatly improved the prognosis of gestational choriocarcinoma patients. As a rare subtype, the main treatment for IC is also chemotherapy. Duleba et al. [ 17 ] recommended surveillance alone in nonmetastatic IC cases and chemotherapy for metastatic IC cases. A review published in 2013 mentioned that before chemotherapy was available, the survival rate at 5 years with hysterectomy alone was 41% in nonmetastatic IC and 19% in cases of metastasis [ 18 ]. However, almost all metastatic IC patients have achieved long-term remission since the application of effective multiagent chemotherapy [ 6 ]. In our study, there was one patient with chemotherapy resistance who received PD-L1 immunotherapy and achieved long-term remission. Based on our review of the literature and the results of our study, we recommend observation for nonmetastatic IC cases and combination chemotherapy for metastatic IC.

The reproductive outcomes of IC patients have rarely been discussed. All cases with subsequent pregnancy have been reported were nonmetastatic IC patients. For patients with metastatic IC, no subsequent pregnancy has been reported ever. In our study, it is noteworthy that full-term delivery occurred in a metastatic IC patient who achieved remission after chemotherapy. A review showed that after undergoing chemotherapy for GTN, 86.7% of women desired to conceive, the term live birth rate was 75.8%, and multiagent chemotherapy did not increase the risk of adverse obstetric events or the rate of fetal malformation in pregnancy [ 19 ]. Based on the aforementioned research, we believe that both metastatic and nonmetastatic IC patients were able to have good pregnancy outcomes.

It is worth noting that 60.0% of patients in our study with fertility demands abandoned the plan for later pregnancy because of “fear and worry about choriocarcinoma recurrence”, indicating that the psychological burden of IC patients should be an important consideration. Gestational choriocarcinoma is closely related to pregnancy events, including molar pregnancies, normal pregnancies, miscarriages, and ectopic pregnancies. Patients worry about the possibility of recurrence of gestational choriocarcinoma, and psychological morbidity rates exceed community levels even among patients who do not require chemotherapy [ 20 ]. Based on the current literature and the experience of our study, there is no clear evidence that subsequent pregnancy in patients with IC leads to IC recurrence. These can be used to support subsequent pregnancy considerations in patients with IC.

Our study has some unique strengths. This is the first report of patients with metastatic IC who had successful pregnancy after undergoing treatment with chemotherapy. Moreover, this is the first study to analyze the clinical features and prognosis of more than 10 IC cases. The primary limitation of the present study is that it is a retrospective study with a long enrollment period (20 years). However, because IC is an extremely rare disease, it is difficult to report more cases in a short time span.

IC is a rare subtype of gestational choriocarcinoma that is sensitive to chemotherapy and has good long-term remission with a low recurrence rate. Patients with metastatic or nonmetastatic IC can have good pregnancy results after treatment. Doctors should pay more attention to the psychology of these patients.

Data availability

The datasets generated and analysed during the current study are not publicly available due the need to protect study participant privacy but are available from the corresponding author on reasonable request.

Abbreviations

• Intraplacental choriocarcinoma

Peking Union Medical College Hospital

International Federation of Gynecology and Obstetrics

β-human chorionic gonadotropin

gestational trophoblastic neoplasia

gestational diabetes mellitus

fetomaternal hemorrhage

no evidence of disease

total abdominal hysterectomy

laparoscopic total hysterectomy

video-assisted thoracic surgery

floxuridine, actinomycin-D, etoposide and vincristine

floxuridine, actinomycin-D and vincristine

etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine

paclitaxel, cisplatin/paclitaxel and etoposide

floxuridine, etoposide and vincristine

actinomycin-D and etoposide

methotrexate

5-fluorouracil

programmed cell death ligand 1

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Acknowledgements

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This work was funded by National Key R&D Program of China (2023YFC2705800), the National High Level Hospital Clinical Research Funding (2022-PUMCH-A-115).

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Yang Liu and Xiaochen Song contributed equally to this work.

Authors and Affiliations

Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, No. 1 Shuaifu Road, Dongcheng District, Beijing, 100730, China

Yang Liu, Xiaochen Song, Fengzhi Feng, Jun Zhao, Junjun Yang, Tong Ren, Xirun Wan, Fang Jiang, Yuan Li & Yang Xiang

Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China

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Yang Liu participated in data collection, data interpretation, and statistical analyses and wrote the original draft. XCS and Yuan Li conceived the study and participated in the data interpretation and manuscript revision. HZ reviewed and confirmed the pathology slices. FZF, JZ, JJY, TR, XRW and FJ participated in patient enrollment, diagnosis and treatment, investigation, and data provision. YX provided the most cases and participated in data interpretation and manuscript revision. All authors read and approved the final manuscript.

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Correspondence to Yang Xiang .

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Liu, Y., Song, X., Zhang, H. et al. Long-term outcome and fertility results of intraplacental choriocarcinoma: a retrospective study of 14 patients and literature review. Orphanet J Rare Dis 19 , 214 (2024). https://doi.org/10.1186/s13023-024-03199-6

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What is the 'best' children's book? Kids, parents and authors on why some rise to the top

What was your favorite book as a kid?

That question makes for a surprisingly effective icebreaker. You can tell a lot about someone from the books they read as a child. Case in point: I’m a journalist, a talker, a storyteller. Many of my childhood favorites had equally yappy and imaginative characters – “Junie B. Jones” by Barbara Park, “Olivia” by Ian Falconer, “Lilly’s Purple Plastic Purse” by Kevin Henkes.

The stories we read at bedtime seldom stay there . Here’s what parents, booksellers, authors and – most importantly – kids told me about what makes the best children’s book.

What makes the best children’s book?

Reading is subjective, of course. But in the quest for the “best” children’s books, parents should look out for a story that’s as entertaining to them as it is to their kids. 

Check out: USA TODAY's weekly Best-selling Booklist

“The secret to a really successful picture book is a picture book that both the parent and child can each enjoy on their own level,” says Peter Glassman, the owner of children’s bookstore “Books of Wonder” in New York City.

At a minimum, you have to make sure it’s a book you’re willing to read over and over.

“Sometimes I view children’s book authors as parenting partners where they’re like ‘This book is for the kid, but I’m going to make sure there’s a joke in here for you,'" said Tocarra Mallard , a TV writer from New York and a mother of two who makes TikToks about children’s books.

A good children’s book may teach kids about colors or numbers, but the best children's books can give them a voice to process and experience emotions.

In “The Pout-Pout Fish” by Deborah Diesen, a favorite in Mallard’s house, an act of acceptance helps turn a frown upside down. It has a silly, catchy rhyme that makes her 2-year-old laugh , but also a lesson for her 5-year-old that it's OK to feel blue sometimes. Kids aren't just kids – they're small people who live in a world that can foster anxiety, depression and other complicated feelings," Mallard says.

“For us to pretend that children (exist in) light and love and goodness at all times is denying them their humanity,” she says.

In their words: Kids tell us what makes a good book

Sometimes, finding the “best” book for your kid is just about knowing your kid. Some children want a picture-heavy book while others, like Mallard's son, who is autistic and hyperlexic, need a strong story with lots of words.

I spent the day at “Books of Wonder” earlier this spring to ask kids what makes the best children’s book.

Iago and Nico Akerman, both 11, told me the books they liked reading in school were about human history, how money works and agriculture in Latin America. Reading is a tool for the brothers to help decode the world around them.

Eight-year-old Valerie Song also loves to learn through reading. It “helps your brain grow,” she told me. 

She’s drawn to series because she’s a speed reader – and they help her feel connected to characters. Valerie was reading the last "Harry Potter" book when we spoke. Fantasy books can help you “go anywhere you want,” she said. As for everyday adventures, “I get enough of that in real life,” she reported. 

Frog and Toad are everywhere: How 50-year-old children's characters became Gen Z icons

What makes an award-winning children’s book?

A captivating story is the foundation for an award-winning book, says Shannon DeVito, the senior director of books at Barnes & Noble, which hosts an annual “Children’s and YA Book Awards.” Witty characters and dynamic illustrations aren’t powerful if there isn’t a story that inspires young readers to keep reading, she says.

But beyond that, a book should have characters or lessons that young readers can identify with. Last year’s overall winner was “ The Swifts: A Dictionary of Scoundrels ” by Beth Lincoln, a chapter book with a vibrant cast of characters. This year’s winner, “ A Royal Conundrum (The Misfits ) ” by Lisa Yee, is described by Barnes & Noble as a book for anyone who has ever felt like an outsider.

One pair of young sisters I spoke to at Books of Wonder, 3-year-old Azadeh and 5-year-old Arya Hashemi-Sohi, love “Saffron Ice Cream” by Rashin Kheiriyeh because one of the characters is named Azadeh. The sisters are half Persian, so their mom, Jeunelle Cunningham, told me they keep an eye out for books with Persian characters.

Glassman has been a bookseller for decades and says it excites him to see different childhood experiences represented in books.

“ Max and The House of Spies” by Adam Gidwitz , for example, is a story he wished he had growing up. It follows a Jewish boy living in London after leaving Germany during World War II. Max has red hair and freckles, just as Glassman did when he was growing up. 

Children’s books have gotten more diverse, both in the authors and the characters they write. A 2022 breakdown from the Cooperative Children’s Book Center noted 40% of books published in 2022 and received by the CCBC were by authors of color. On the other hand, an analysis of award-winning children’s books showed white characters are overrepresented .

“A good book that talks about modern culture, (and has a) diverse cast of characters is better than something that doesn’t,” DeVito says.

How to write a children’s book

Author Dan Gutman knows a thing or two about writing successful children’s books. His “My Weird School” books have sold over 35 million copies and he published the series’ 100th book earlier this year.

His secret sauce? Target the kids who don’t like to read. He focuses on short chapters and paragraphs, a linear, easy-to-follow storyline and, his personal favorite, “grown-ups doing dumb things.”

“I wasn’t a big reader myself, I relate really well to kids, especially boys, who don’t like to read,” Gutman says. “My goal is that that kid will open up one of my books and an hour later look up and think ‘Wow, that didn’t even feel like I was reading. I felt like I was watching a movie in my head.’”

That feeling is what Glassman looks for in a book as well. “I go to a book not to be impressed with someone’s writing – which sometimes I am – but I go to a book for the story. I love story, that is my great love,” he says.

• Open access
• Published: 22 May 2024

A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes

• Mimi M. Kim 1 ,
• Isabella Steffensen 1 ,
• Red Thaddeus D. Miguel 1 ,
• Tanja Babic 1 &
• Julien Carlone 1  

Harm Reduction Journal volume  21 , Article number:  99 ( 2024 ) Cite this article

Metrics details

Introduction

The rapid increase in e-cigarette use over the past decade has triggered an important public health question on the potential association between e-cigarette use and combustible cigarette smoking. Following AMSTAR 2 and PRISMA guidelines, this evidence synthesis sought to identify and characterize any associations between e-cigarette use among individuals not smoking cigarettes and initiation of cigarette smoking.

The protocol was registered on September 24, 2018 (PROSPERO 2018 CRD42018108540). Three databases were queried from January 01, 2007 to April 26, 2023. Search results were screened using the PICOS review method.

Among 55 included studies (40 “good” and 15 “fair”; evidence grade: “high”) that adjusted for gender, age, and race/ethnicity between groups, generally, there was a significant association between non-regular e-cigarette use and initiation of cigarette smoking, further supported by the meta-analytic results (AOR 3.71; 95% CI 2.86–4.81). However, smoking initiation was most often measured as ever/current cigarette smoking. Two studies (quality: 2 “good”) evaluated progression to regular cigarette smoking among individuals with regular use of e-cigarettes, and generally found no significant associations. One study (“good”) evaluated smoking initiation among individuals with regular use of e-cigarettes, finding an increasing probability of ever smoking cigarettes with increased e-cigarette use. Twelve studies (10 “good” and two “fair”) examining progression to regular smoking among individuals with non-regular use of e-cigarettes reported inconsistent findings.

Conclusions

Numerous methodological flaws in the body of literature limit the generalizability of these results to all individuals who are not smoking cigarettes with few studies measuring established/regular use/smoking of e-cigarettes and cigarettes. Further, studies did not control adequately for specific confounding variables representing common liabilities between e-cigarette use and cigarette smoking, nor did they account for sufficient follow-up durations. Collectively, these flaws limit the generalizability of findings to the question of an association between e-cigarette use and cigarette smoking initiation.

Implications

In order to support robust determinations regarding e-cigarette use and the initiation of—or progression to—cigarette smoking, future research should apply measures of e-cigarette and cigarette use in a manner consistent with examining true initiation (i.e., established and/or regular use, as opposed to ever or current use), increase follow-up durations to adequately evaluate progression to regular smoking, and sufficiently account for known or suspected confounding variables that would represent common liabilities between e-cigarette use and cigarette smoking.

Empirical evidence suggests e-cigarette aerosol does not contain most of the approximately 7000 chemicals present in cigarette smoke [ 1 , 2 ]. However, with the decline in cigarette smoking prevalence, there has been a parallel increasing prevalence in electronic cigarette (e-cigarette) use [ 3 , 4 , 5 , 6 ].

The potential association between e-cigarette use and cigarette smoking is an important public health issue [ 7 , 8 , 9 ]. Understanding the individual and population level impact of e-cigarettes requires an objective synthesis of the empirical evidence that informs on the potential association between e-cigarette use and subsequent cigarette smoking and the inherent risks to health presented by e-cigarettes themselves [ 2 ]. Among the public health concerns of the use of e-cigarettes is the question of youth who may transition from e-cigarettes to cigarette smoking [ 2 ]. Hence, an assessment of causality is central to understanding the public health effect of e-cigarettes.

The Common Liability model is an important consideration when assessing causality between e-cigarette and cigarette smoking, particularly among tobacco non-users [ 10 , 11 ]. Specifically, the common liability model posits that risks associated with using different substances can be explained by identifying common predisposing factors that also influence use behaviors [ 10 , 11 ]. According to this model, where risk-taking propensities and psychosocial processes can be factors that link patterns of multiple addictions, common liability can provide a parsimonious explanation of substance use and addiction co-occurrence [ 11 ]. Thus, narrowly focusing on the association between e-cigarette use and subsequent cigarette smoking without consideration of potential common liability factors limits an inference of causality [ 12 ].

The current systematic review and meta-analysis evaluated potential associations between e-cigarette use among tobacco non-users and cigarette smoking initiation, applying a level of methodological rigor not previously reported in other reviews. Based on a general understanding of the available published literature on e-cigarette use and cigarette smoking, a priori outcome measures included: age at initiation of smoking combustible cigarettes; percent who initiated smoking combustible cigarettes; and initiation and progression to regular smoking of combustible cigarettes. Study design was not limited in the inclusion criteria. While previous systematic reviews have examined the relationship between e-cigarette use and the onset of cigarette smoking in youth and young adults [ 3 , 13 , 14 , 15 , 16 , 17 ], as well as in the general population [ 18 , 19 ], this review specifically focused on initiation of and progression to regular cigarette smoking—an outcome measure unique to this systematic review. Furthermore, given the rapid rate of emerging evidence on e-cigarette use, this review provides an important timely evidence synthesis to previous reviews.

The methods and results reported here correspond to a larger systematic review addressing the key research question, “Are there any potential associations between e-cigarette use among non-tobacco users and intention to smoke combustible cigarettes or initiating smoking of combustible cigarettes?” The focus of the findings reported here is the identification and characterization of any potential associations between e-cigarette use among non-tobacco users and the initiation of cigarette smoking.

The review protocol was registered with PROSPERO (The International Prospective Register of Systematic Reviews) on September 24, 2018 (PROSPERO 2018 CRD42018108540; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108540 ).

This review strictly followed standards of systematic review methodology (“high” overall rating by A MeaSurement Tool to Assess systematic Reviews [AMSTAR] 2) [ 20 ] and reporting (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]) [ 21 ].

Terminology

Specific terminology in this review are fully reported in Supplemental Section 1 : Terminology.

Literature search methods

MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), and PsycINFO were the database sources for the literature search. Applying search terms developed using medical subject headings (MeSH) and text words related to the associations between e-cigarette use and cigarette smoking intention and initiation, a full literature search was executed by an information specialist. Search dates were restricted to 2007 onwards due to the mass market introduction of e-cigarettes in the US [ 1 , 2 ] (Supplemental Section 2 : Literature Search Strategy).

The screening process was executed according to the PICOS (Population or participants and conditions of interest, Interventions or exposures, Comparisons or control groups, Outcomes of interest, and Study designs) review method (Supplemental Section 3 : Inclusion/Exclusion Criteria) [ 22 ]. The population of interest—tobacco non-users—without restriction by age. The interventions and controls were individuals using e-cigarettes and non-users, respectively. Outcome measures identified a priori included: age of initiation for cigarette smoking, initiation of cigarette smoking, and initiation and progression to regular cigarette smoking (not included in previously published systematic reviews [ 3 , 13 ]). Given the limited available evidence from randomized controlled trials (RCTs), this review was not limited by study design. The search strategy included: published peer-reviewed literature; theses and dissertations; government and industry documents; clinical trial registries (clinicaltrials.gov); gray literature in Google Scholar; consideration of reference lists across included studies; and content expert consultation. Studies were restricted to English-only publications.

Although the established/regular e-cigarette use provides the strongest evidence measure of sustained use behaviors, this review did not restrict use criteria. Additionally, studies were not restricted to those controlling for specific confounding variables that would represent common liabilities between e-cigarette use and cigarette smoking. The current review focused on studies that adjusted for at least the confounders of age, gender, and race/ethnicity.

Evidence synthesis

Two reviewers independently screened articles based on the inclusion/exclusion criteria at the title/abstract level and then, full-text for studies not excluded based on the title/abstract alone. Data extraction was first conducted by one reviewer and then checked by a second reviewer. Across all levels of review and data extraction, discrepancies were resolved through discussion between the two reviewers and included a third team member when adjudication was necessary. All data were extracted and recorded in the DistillerSR platform (Evidence Partners, Ottawa, Canada) [ 23 ].

Estimates of the difference between individuals using e-cigarettes and individuals who are not using e-cigarettes are presented with the best measures of precision (i.e., 95% confidence intervals [CIs]) and/or statistical significance (i.e., p value) reported in the included studies. Reporting references to “significant” and/or “significantly” are only used to indicate statistical significance (i.e., p  < 0.05 and/or CI excludes 1.0). The DerSimonian–Laird method was used to conduct random-effects meta-analyses where included studies were weighted by the inverse of the sum of within-study variance plus between-study variance [ 24 ]. The Cochran’s Q statistic assessed heterogeneity across pooled studies which was then quantified using the inconsistency index (I 2 ).

Study authors were contacted to obtain missing data. All meta-analytic data were analyzed through Review Manager version 5.3 [ 25 ], in Windows 10 Pro version 22H2.

Sensitivity analyses

Data permitting, sensitivity analyses were planned to include stratification of results (or removal of data inputs) from: studies that did not adjust for meso- and macro-level variables in addition to age, race/ethnicity, and gender; studies that did not define e-cigarette use or regular cigarette smoking; and studies with a questionable definition of e-cigarette use and/or regular cigarette smoking. Additionally, data permitting, stratification by age group, and a sensitivity analysis of age, was planned. A sub-group analysis for the meta-analysis based on the country where the study was implemented, and a sensitivity analysis excluding studies graded as “Fair,” was likewise planned.

Assessment of confounding

This review applied the Socio-Ecological Model as defined by McLeroy et al. [ 26 ] to guide consideration of the interrelationships between individuals and their social (micro-), physical (meso-), and policy (macro-) environments (further detail reported in Supplemental Section 4 : Conceptual Framework).

Evaluation of confounding factors was followed according to Cochrane guidelines for systematic reviews [ 27 ]; specifically, during protocol writing, a list of potential confounding factors was identified a priori based on evidence and expert opinion from members of the research team and external advisors; and during the systematic review process, the variables that individual study authors considered were recorded for additional post hoc consideration.

Outcomes and related psychometrics

Recognizing that not all the outcome measures are equally valid and reliable, this review examined the Contextual Question (CQ): “Have measures used to examine initiation and progression to regular cigarette smoking been psychometrically assessed as reliable and valid?” Specific criteria were applied to assess reliability and validity across the outcome measures [ 28 ] (full reporting in Supplemental Section 5 : Contextual Questions).

Study quality assessment

Two reviewers independently appraised study quality using the Downs and Black checklist. Individual studies were graded as either “excellent,” “good,” “fair,” or “poor” [ 29 ] (Full reporting in Supplemental Section 6 : Study Quality Assessment). A funnel plot was planned to test for the risk of publication bias if 10 or more studies provided estimates pooled in the meta-analysis.

Strength of evidence evaluation

Strength of evidence (SOE) was assessed for studies that controlled for age, gender, and race/ethnicity and those that did not control for key confounders. The overall SOE was graded as “high,” “moderate,” “low,” or “insufficient” using the Agency for Healthcare Research and Quality (AHRQ) Evidence Based Practice (EPC) grading system [ 30 ] (full reporting in Supplemental Section 7 : Strength of Evidence).

Consideration of industry funding bias

The potential impact of funding bias on results and conclusions has been a topic addressed in the evidence base [ 31 , 32 , 33 ]. As indicated in the conflict-of-interest disclosure for this review, and given the recent increase of peer-reviewed systematic reviews and meta-analyses, this topic with potential industry and public health impact may have a heightened importance as a methodological issue. To specifically address any potential concerns of funding bias in this reported evidence synthesis, this review was executed with the highest standards of the systematic review methodology including: a priori protocol registration (PROSPERO 2018 CRD42018108540; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018108540 ); strict adherence to the PICOS throughout the execution of this review; a transparent and replicable search strategy executed by an information specialist with corresponding literature research results (Supplemental Section 8 : Literature Search Output, Studies Reviewed at the Full-Text Level); full reporting of excluded studies including reason for exclusion (Supplemental Section 9 : List of Excluded Studies); full reporting details on quantitative methods; and the expected details, per AMSTAR-2 and PRISMA guidelines, to disseminate a fully transparent and replicable evidence synthesis. Overall, the methodological rigor of this review with fully transparent and replicable reporting can also serve as a measure to minimize publication bias with systematic reviews.

The initial database search (January 1, 2007 to August 31, 2018) yielded 2526 articles, with four additional articles identified through other sources [ 3 , 34 , 35 , 36 ], resulting in 2530 articles. The first updated literature search (January 1, 2018 to August 30, 2019) yielded 1525 articles with 307 duplicate articles due to applied overlapping timeframes between the two searches. This overlapping timeframe conducted searches from the first of the year; therefore, overlapping search timeframes were unavoidable. Additionally, two articles were identified through other sources [ 37 , 38 ], resulting in 1220 unique articled retrieved. A second updated literature search for the timeframe of January 1, 2019 to October 7, 2020 yielded 2211 articles, of which 595 were duplicate articles with the previous database search, resulting in 1616 unique articles retrieved. A third updated search for the January 1, 2020 to November 24, 2021 timeframe yielded 3245 articles, of which 935 were duplicate articles with the previous database search, resulting in 2310 unique articles retrieved. Finally, a fourth updated search for the January 1, 2021 to April 26, 2023 period yielded 3925 articles, of which 1420 were duplicate articles with the previous database search, resulting in 2505 unique articles retrieved.

A cumulative total of 10,175 articles were retrieved from the specified databases, with an additional six additional articles identified from other sources (total: 10,181). Of the 10,181 potentially relevant articles, 9186 were excluded at the title/abstract level, resulting in 995 articles eligible for review at full-text level (Supplemental Section 8 : Literature Search Output, Studies Reviewed at the Full-Text Level). Subsequently, a further 873 articles were excluded (Supplemental Section 9 : List of Excluded Studies), resulting in 122 studies eligible for inclusion in the larger systematic review (Supplemental Section 10 : List of Included Studies). Inter-rater reliability at Level 2 screening was considered substantial or near perfect agreement [ 39 ] across all literature searches with a weighted overall kappa ranging from 0.72 to 0.95 (refer to Fig.  1 for each level of screening).

PRISMA flowchart

Of the 122 studies identified in the systematic review, 99 studies reported on cigarette smoking initiation or progression and were eligible for the qualitative and quantitative evidence. Of these 99 studies, 55 reported results that were adjusted for gender, age, and race/ethnicity between groups. For each included study, data were extracted on: study characteristics (Supplemental Section 11 : Study and Sample Characteristics, Adjusted Studies), demographic and baseline characteristics (Supplemental Section 12 : Demographic and Baseline Characteristics, Adjusted Studies), and study outcomes (Supplemental Section 13 : Evidence Tables, Adjusted Studies). Studies reporting unadjusted results are presented in Supplemental Section 14 (Study and Sample Characteristics, Unadjusted Studies), Supplemental Section 15 (Study and Sample Characteristics, Unadjusted Studies), and Supplemental Section 16 (Evidence Tables, Unadjusted Studies), but are not included in the qualitative or quantitative synthesis of evidence.

The highest number of studies (10 studies) were published in both 2020 [ 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ] and 2018 [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ]; followed by 7 studies in each of 2021 [ 60 , 61 , 62 , 63 , 64 , 65 , 66 ], 2019 [ 37 , 67 , 68 , 69 , 70 , 71 , 72 ], and 2017 [ 34 , 36 , 73 , 74 , 75 , 76 , 77 ]; six studies in 2022 [ 78 , 79 , 80 , 81 , 82 , 83 ]; three studies in each of 2023 [ 84 , 85 , 86 ] and 2015 [ 87 , 88 , 89 ]; and two studies in 2016 [ 90 , 91 ]. Studies were predominantly longitudinal in design and were from registered surveys. Of the 55 included studies, 41 were conducted in the US [ 36 , 40 , 41 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 56 , 58 , 59 , 62 , 63 , 64 , 65 , 67 , 68 , 69 , 70 , 71 , 72 , 75 , 76 , 77 , 78 , 79 , 81 , 82 , 83 , 86 , 87 , 88 , 89 , 90 , 91 ], five in the UK [ 34 , 37 , 61 , 66 , 85 ], two in Canada [ 60 , 73 ], one study in each of Mexico [ 74 ], Netherlands [ 57 ], Netherlands and Belgium [ 84 ], Romania [ 55 ], South Korea [ 42 ], Switzerland [ 50 ], and Thailand [ 80 ]. In terms of the study population, four studies defined their study population as “adults” [ 40 , 48 , 69 , 72 ], one study stratified their results by youth and adult populations [ 43 ]; three studies defined their participants as 12 years or older [ 59 , 81 , 86 ]. For the remaining 47 studies that defined participants, respondents were categorized as “youth,” “adolescents,” or “young adults” (participants defined as “students” were between grade 6 and college level) [ 34 , 36 , 37 , 41 , 42 , 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 70 , 71 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 82 , 83 , 84 , 85 , 87 , 88 , 89 , 90 , 91 ].

In addition to age, sex, and race/ethnicity, most studies included further adjustments with varying combinations of other micro, meso, and macro covariates. However, none of the studies sufficiently adjusted for potential confounding variables that would represent common liabilities between e-cigarette use and cigarette smoking [ 92 ]—meaning that a bias for those predisposing elements would exist among individuals using e-cigarettes that would likely be unadjusted for in the included studies.

Initiation of cigarette smoking was evaluated by the largest number of included studies (49 adjusted studies) [ 34 , 36 , 37 , 41 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ], followed by initiation and progression to regular cigarette smoking (12 adjusted studies) [ 37 , 40 , 45 , 48 , 54 , 61 , 65 , 66 , 69 , 72 , 73 , 86 ]. One adjusted study examined the potential relationship between e-cigarette use and age of initiation for cigarette smoking [ 75 ].

The reliability and validity of each outcome measure were evaluated according to the CQ with a comprehensive but not systematic review of the literature. The objective in doing so was to provide fuller context for the interpretation of findings from the evidence synthesis. All measures were single-item measures related to the initiation and/or progression of cigarette smoking. All three measures of initiation were supported by empirical data regarding their reliability and/or validity, and therefore qualified as “acceptable”—including initiation of cigarette smoking, age of initiation for cigarette smoking, and initiation and progression to regular cigarette smoking (full reporting in Supplemental Section 5 : Contextual Questions).

Quality appraisal for each included study was conducted by two reviewers according to the Downs and Black checklist [ 29 ]. Forty (73%) were rated “good” quality [ 34 , 37 , 40 , 41 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 64 , 65 , 66 , 67 , 68 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 84 , 86 , 87 , 88 , 90 , 91 ], 15 (27%) were rated “fair,” [ 36 , 42 , 43 , 50 , 63 , 69 , 70 , 71 , 79 , 80 , 81 , 82 , 83 , 85 , 89 ] and no studies were rated “excellent” or “poor” (Supplemental Section 6 : Study Quality Assessment). Publication bias was assessed using funnel plots, and no publication bias was detected.

The overall SOE among the adjusted data regarding the association between e-cigarette use and age of initiation of cigarette smoking was graded “moderate”; the body of evidence specific to e-cigarette use and initiation of cigarette smoking was graded “high”; and the body of evidence specific to initiation and progression to regular cigarette smoking was graded “moderate.” The SOE domain score table and the SOE and CQ ratings summary table for both the adjusted and unadjusted data are presented in Supplemental Section 7 : Strength of Evidence.

Definitions of e-cigarette use by outcome measure

Among the 55 included studies, one evaluated age of cigarette smoking initiation [ 75 ], 42 evaluated initiation of cigarette smoking [ 34 , 36 , 41 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 59 , 60 , 62 , 63 , 64 , 67 , 68 , 70 , 71 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 87 , 88 , 89 , 90 , 91 ], five evaluated progression to regular smoking [ 40 , 45 , 48 , 65 , 69 ], and seven studies evaluated both initiation of cigarette smoking and progression to regular smoking [ 37 , 54 , 61 , 66 , 72 , 73 , 86 ].

Among the 49 studies that examined initiation of cigarette smoking, only one evaluated the association between regular e-cigarette use and initiation of cigarette smoking. Wills et al. [ 77 ] defined e-cigarette use on a frequency scale (1–2 times ever use, 3–4 times ever use, yearly/monthly, and weekly/daily), with the initiation of cigarette smoking defined as having “ever smoked a whole cigarette”. For the remaining studies that examined initiation of cigarette smoking among individuals with non-regular use of e-cigarettes, ever use was the most common measure of both e-cigarette use (39 studies) [ 34 , 37 , 42 , 43 , 44 , 46 , 47 , 49 , 52 , 54 , 55 , 56 , 57 , 59 , 61 , 63 , 64 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 93 ] and cigarette use (33 studies) [ 34 , 37 , 42 , 43 , 44 , 46 , 47 , 49 , 52 , 55 , 56 , 57 , 58 , 61 , 63 , 64 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 80 , 84 , 87 , 89 , 91 ], with current or past 30-day use being the second most common measure (16 studies for e-cigarette use [ 36 , 41 , 52 , 53 , 54 , 58 , 60 , 62 , 67 , 72 , 73 , 78 , 79 , 80 , 86 , 91 ] and 23 studies for cigarette use [ 36 , 41 , 43 , 47 , 52 , 53 , 54 , 58 , 59 , 60 , 62 , 63 , 64 , 68 , 74 , 76 , 78 , 79 , 80 , 81 , 85 , 90 , 93 ]). The most commonly evaluated relationship for these two tobacco use behaviors was between ever use of e-cigarettes and ever use of cigarettes (30 studies) [ 34 , 37 , 42 , 43 , 44 , 46 , 47 , 49 , 52 , 55 , 56 , 57 , 61 , 63 , 64 , 66 , 67 , 68 , 70 , 71 , 72 , 74 , 76 , 77 , 78 , 79 , 80 , 84 , 87 , 88 ]. Ever use of e-cigarettes and current use of cigarettes was the second most commonly evaluated relationship (17 studies) [ 43 , 47 , 52 , 54 , 59 , 63 , 64 , 68 , 74 , 76 , 78 , 79 , 80 , 81 , 85 , 90 , 93 ], followed by current use of e-cigarettes and current use of cigarettes (11 studies) [ 36 , 41 , 52 , 53 , 54 , 58 , 60 , 62 , 78 , 79 , 80 ].

Twelve studies examined the association between e-cigarette use and initiation of and progression to regular cigarette smoking [ 37 , 45 , 48 , 54 , 61 , 65 , 66 , 69 , 72 , 73 , 86 , 94 ]. All of these 12 studies evaluated the association between non-regular e-cigarette use and progression to regular cigarette smoking. Additionally, two of the 12 studies also evaluated the association between regular e-cigarette use and progression to regular cigarette smoking [ 40 , 48 ]. Azagba et al. [ 94 ] defined e-cigarette use as either every day (current daily use and having ever used fairly regularly), some day (current use and having ever used fairly regularly), or experimental (current use and never having used fairly regularly), with progression to regular cigarette smoking defined as transitioning from either current non-established to current-established cigarette smoking, current non-established to current daily-established cigarette smoking, or current-established to current daily-established cigarette smoking [ 40 ]. Among individuals with established (having ever used fairly regularly) e-cigarette use, Wei et al. [ 48 ] evaluated transitions from non-current, non-established cigarette smoking to either exclusive current-established cigarette smoking or current-established dual use of cigarettes and e-cigarettes.

For the 12 studies that used definitions of non-regular e-cigarette use, e-cigarette use was defined as follows: current or past-30-day use in two studies [ 45 , 73 ]; e-cigarette experimentation, defined as non-established use (less than 100 times during lifetime) in one study [ 69 ]; and ever use of e-cigarettes in four studies [ 37 , 61 , 65 , 66 ]. Three studies applied multiple definitions of non-regular e-cigarette use: Chaffee et al. [ 54 ] included ever, past 30-day, and former e-cigarette use; Sun et al. [ 86 ] included ever and past 30-day use, while McMillen et al. [ 72 ] included ever and past 30-day e-cigarette use. Two studies that evaluated regular e-cigarette use also evaluated non-regular use defined as experimental use [ 40 , 48 ].

In the one study that evaluated age of initiation of cigarette smoking, e-cigarette use was defined as current use [ 75 ].

Qualitative synthesis of best available evidence

Fifty-five studies adjusted for three main confounders (gender, age, and race/ethnicity) between groups, and were analyzed in the qualitative review and quantitative syntheses reported below. Results for each outcome measure in the qualitative analysis were stratified by regular versus non-regular e-cigarette use.

Adjusted data for age of initiation, initiation of cigarette smoking, and progression to regular smoking are provided in Supplemental Section 13 : Evidence Tables, Adjusted Studies. Unadjusted data for age of initiation of cigarette smoking, initiation of cigarette smoking, and initiation and progression to regular cigarette smoking are provided in Supplemental Section 16 : Evidence Tables, Unadjusted Studies; however, unadjusted data are not included in qualitative analysis.

Age of initiation of cigarette smoking (regular e-cigarette use)

No studies provided adjusted analyses of age of initiation of cigarette smoking among individuals with regular use of e-cigarettes.

Age of initiation of cigarette smoking (non-regular e-cigarette use: 1 study)

One adjusted study was identified that investigated the association between non-regular e-cigarette use and age of initiation of cigarette smoking [ 75 ] (Summary characteristics of this study are provided in Table  1 ). In a cross-sectional analysis, McCabe et al. [ 75 ] reported that the adjusted odds of smoking the first cigarette at an earlier age (Grade 8 or below) were significantly higher among individuals using e-cigarettes (current [past-30-day]) versus individuals who are not using e-cigarettes (adjusted odds ratio [AOR] 4.12, 95% CI 2.56–6.62). Further, the odds of an earlier age of onset of daily cigarette smoking (before 8th grade level) were not significantly different between individuals currently using e-cigarettes (past-30-day) and individuals who are not using e-cigarettes (AOR 1.67, 95% CI 0.385–7.25) [ 75 ].

Initiation of cigarette smoking (regular e-cigarette use: 1 study)

One adjusted study was identified that investigated the association between regular e-cigarette use and odds of initiation of cigarette smoking among individuals not smoking cigarettes at baseline[ 77 ] (Summary characteristics of this study are provided in Table  2 ).

In their study of 1070 individuals who never smoked cigarettes at baseline, Wills et al. [ 77 ] examined the association between e-cigarette use and initiation of cigarette smoking by stratifying the probability of smoking onset by frequency of e-cigarette use at baseline, including a measure of regular (weekly/daily) e-cigarette use. Compared with individuals who are not using e-cigarettes, all individuals who have used e-cigarettes had significantly higher adjusted odds of initiating cigarette smoking: individuals who ever used e-cigarettes (1–2 times): AOR 2.88 (95% CI 1.96–4.22); individuals who ever used e-cigarettes (3–4 times): AOR 2.29 (95% CI 1.35–3.87); weekly/daily users: AOR 4.09 (95% CI 2.43–6.88); and yearly/monthly users: AOR 4.17 (95% CI 2.03–8.57).

Initiation of cigarette smoking (non-regular e-cigarette use: 49 studies)

Forty-nine adjusted studies examined the association between non-regular e-cigarette use and initiation of cigarette smoking among individuals not smoking cigarettes at baseline [ 34 , 36 , 37 , 41 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ]. Summary characteristics of these 49 studies are provided in Table  3 .

As discussed in the search results of the meta-analysis, 12 studies met the inclusion criteria of the meta-analysis [ 34 , 43 , 52 , 56 , 59 , 63 , 66 , 76 , 77 , 80 , 81 , 84 ]. These studies are included in Table  3 , but are not discussed in qualitative synthesis. For a variety of reasons, 37 studies did not meet the criteria to be included in the quantitative synthesis (Supplemental Section 17 : Meta-Analytic Results); however, these studies contained information important to the research question and are described below.

Twenty-four studies—15 prospective cohort studies [ 37 , 46 , 49 , 55 , 58 , 61 , 62 , 68 , 70 , 71 , 73 , 83 , 87 , 89 , 90 ], eight longitudinal panel studies [ 41 , 47 , 50 , 53 , 72 , 82 , 86 , 88 ], and one retrospective cohort study [ 67 ]—all reported statistically significant AORs, showing a higher likelihood of individuals who have used e-cigarettes (non-regular use: ever, ever in the past 12 months, and current) initiating smoking compared with individuals who are not using e-cigarettes. Their AORs ranged from 1.75 (95% CI 1.10–2.77) in a prospective cohort of Grade 9 individuals who never smoked cigarettes at baseline reporting any cigarette use at follow-up (either 6 or 12 months) [ 87 ] to 8.3 (95% CI 1.2–58.6) in a prospective cohort of 16–26 year old non-susceptible individuals who never smoked a cigarette reporting ever cigarette use (at least one puff) at 18-month follow-up [ 89 ].

Four studies calculated the adjusted relative risk (ARR) of individuals who have used e-cigarettes (ever and current [past-30-day]) smoking cigarettes compared with individuals who are not using e-cigarettes [ 36 , 64 , 74 , 78 ]. Lozano et al. [ 74 ] found a statistically significantly higher risk for trying smoking (ARR 1.40, 95% CI 1.22–1.60), however, no significant difference was reported for current smoking (≥ 1 cigarette in the past 30 days; ARR 1.43, 95% CI 0.94–2.16). Miech et al. [ 36 ] also found a statistically significantly higher risk for current smoking (ARR 4.78, 95% CI 1.91–11.96).

Keller-Hamilton et al. [ 64 ] reported that individuals who have used e-cigarettes at baseline were more than twice as likely to report ever (ARR 2.71, 95% CI 1.89–3.87) and current (i.e., past 30 day) smoking (ARR 2.20, 95% CI 1.33–3.64) at follow-up compared to individuals who are not using e-cigarettes. Similar results were reported in a propensity score-matched analysis (ever cigarette use ARR 2.22; 95% CI 0.90–5.47; past 30-day cigarette use ARR 1.25; 95% CI 0.41–3.82). Using data from Waves 1–5 of the PATH study, Harlow et al. [ 78 ] showed that, among baseline never-smokers, ever e-cigarette use at Wave 2 was associated with a higher likelihood of ever smoking at Waves 3, 4, and 5 (ARR 2.7, 95% CI 2.4–3.0). This association was present for all sub-categories of e-cigarette ever-use, namely former use (ARR 2.5, 95% CI 2.2–2.9), current (i.e., past 30-day) use (ARR 3.5, 95% CI 2.9–4.1), use of tobacco-flavored (ARR 2.5, 95% CI 1.8–3.5), and nontobacco-flavored (ARR 2.8, 95% CI 2.5–3.1) e-cigarettes. In a marginal structural model that accounted for time-dependent confounding, ever e-cigarette use was similarly associated with a higher likelihood of ever smoking at follow-up waves (ARR 2.4, 95% CI 2.1–2.7), regardless of the sub-category of ever use (former use ARR 2.2, 95% CI 2.0–2.5; current use ARR 3.1, 95% CI 2.6–3.7), or e-cigarette flavor (tobacco flavored ARR 2.4, 95% CI 1.7–3.3; nontobacco flavored ARR 2.4, 95% CI 2.2–2.7) [ 78 ]. The study also reported that the likelihood of being an individual who currently smoked (i.e., past 30-day) at Waves 3–5 was higher among individuals who have ever used e-cigarettes at baseline (ARR 2.9, 95% CI 2.5–3.3), quit e-cigarette use (ARR 2.6, 95% CI 2.2–3.1), currently used (ARR 3.8, 95% CI 3.1–4.6), used tobacco-flavored (ARR 2.6, 95% CI 1.7–3.9), and non-tobacco-flavored (ARR 3.0, 95% CI 2.6–3.4) e-cigarettes [ 78 ]. Similarly, in the marginal structural model, the likelihood of past 30-day cigarette use at Waves 3–5 was associated with ever (ARR 2.5, 95% CI 2.2–2.9), former (ARR 2.3, 95% CI 1.9–2.7), current (ARR 3.4, 95% CI 2.8–4.2), tobacco-flavored (ARR 2.3, 95% CI 1.5–3.5), and nontobacco-flavored (ARR 2.6, 95% CI 2.2–3.0) [ 78 ] e-cigarette use.

A study by Aleyan et al. [ 60 ] calculated regression coefficients to estimate the association between past 30-day e-cigarette use at Wave 1 and initiation of cigarette smoking at Wave 3. Past-30-day e-cigarette use at Wave 1 was significantly associated with past 30-day cigarette smoking (β = 1.06; SE = 0.28; 95% CI 0.52–1.60; p  < 0.001), and dual use at Wave 3 (β = 1.31; SE = 0.24; 95% CI 0.84–1.79; p  < 0.001). Further, the association between past 30-day e-cigarette use at Wave 1 and cigarette smoking at Wave 3 remained significant after adjustment for having one or more friends who smoked at Wave 1.

Kintz et al. [ 44 ] calculated a phi-coefficient for the relationship between ever use of e-cigs at baseline and subsequent cigarette initiation (self-reported first use) at follow-up, and found that baseline ever e-cigarette use was significantly associated with cigarette smoking initiation at follow-up (phi coefficient = 0.141, p  < 0.001).

Two studies applied a multistate Markov model to evaluate the probability of transitioning to cigarette smoking [ 42 , 85 ]. A study by Kang et al. [ 42 ] applied a multistate Markov model to show that individuals who have ever used e-cigarettes at baseline had a 9.52% (95% CI 6.57–13.85) probability of transitioning to dual e-cigarette and cigarette use, whereas individuals who are not using e-cigarettes at baseline had a 1.39% (95% CI 1.29–1.49) probability of transitioning to exclusive cigarette use. Parnham et al. [ 85 ] examined transition probabilities between e-cigarette use and smoking in UK adolescents and young adults. In an analysis that adjusted for age, wave of data collection, sex, ethnicity, and tertiles of household income, adjusted probability of transition from ever e-cigarette use to smoking ranged from 14% (95% CI 13–16) in Year 1 to 27% (95% CI 25–29) in Year 5, while the probability of transitioning from e-cigarette never use to smoking ranged from 2% (95% CI 2–2) to 10% (95% CI 9–10) [ 85 ].

The study by Loukas et al. [ 79 ] reported hazard ratios for the association between past 30-day and ever e-cigarette use and transition from never to current cigarette smoking. After adjusting for covariates, both past 30-day (HR 2.69, 95% CI 1.95–3.72) and ever (HR 2.16, 95% CI 1.79–2.62) e-cigarette use were associated with a higher likelihood of transition to smoking.

Conner et al. [ 61 ] evaluated cigarette smoking initiation (ever use) among individuals who have used e-cigarettes “early” and “late”, defined as reporting ever e-cigarette use at either Wave 3 (early) or Wave 4 (late), respectively. The authors found that the adjusted odds of individuals using e-cigarettes early, compared to individuals who never used e-cigarettes, initiating cigarette smoking was statistically significant both at Wave 4 (AOR 1.39, 95% CI 1.29–1.50) and at Wave 5 (AOR 3.55, 95% CI 2.82–4.49). Similarly, individuals using e-cigarettes late were significantly more likely to initiate cigarette smoking at Wave 5 compared to individuals who have never used e-cigarettes (AOR 2.87, 95% CI 2.33–3.53) [ 61 ].

Chaffee et al. [ 54 ] calculated the AORs for initiating smoking in three different groups of individuals who have used e-cigarettes (versus individuals who have not used e-cigarettes) and found the following: a non-significant AOR of 1.57 (95% CI 0.99–2.49) for individuals who have ever used e-cigarettes and have smoked at least 100 + cigarettes; a non-significant AOR of 1.69 (95% CI 0.93–3.05) for individuals who have used e-cigarettes in the past-30-days who have smoked at least 100 cigarettes; a non-significant AOR for individuals who have smoked at least 100 cigarettes but have quit e-cigarette use (AOR 1.55, 95% CI 0.94–2.56); a non-significant AOR for individuals who have ever used e-cigarettes and smoked a cigarette in the past 30 days (AOR 1.32, 95% CI 0.99–1.76); a significant AOR for individuals who have used e-cigarettes in the past 30 days and smoked a cigarette in the past 30 days (AOR 1.64, 95% CI 1.12–2.41); and, a non-significant AOR for individuals who quit e-cigarette use and smoked in the past 30 days (AOR 1.20, 95% CI 0.86–1.68) [ 54 ].

In additional to their overall analysis, Owotomo et al. [ 46 ] reported AORs for cigarette smoking initiation among subgroups of adolescents according to their baseline cigarette smoking intentions. Overall, the authors found ever e-cigarette use to be significantly associated with ever cigarette smoking (AOR 2.58, 95% CI 1.73–3.85). The association remained significant in a subgroup analysis of adolescents with no baseline intention to smoke (AOR 4.62, 95% CI 2.87–7.42); however, among the subgroup of adolescents with baseline cigarette smoking intentions, the association between ever e-cigarette use and cigarette smoking initiation was nonsignificant (AOR 1.57, 95% CI 0.94–2.63). The AOR for the interaction between smoking intention and ever e-cigarette use with regards to smoking initiation was statistically significant (AOR 0.34, 95% CI 0.18–0.64), suggesting the association between e cigarette use and ever cigarette smoking was dependent on previous smoking intention status.

Three of the 37 studies not included in the meta-analysis evaluated initiation of cigarette smoking and either susceptibility or propensity to smoke cigarettes among individuals using e-cigarettes versus individuals who are not using e-cigarettes [ 52 , 57 , 91 ]. Barrington-Trimis et al. [ 52 ] evaluated the association between susceptibility and initiation of cigarette smoking in either individuals who have ever used e-cigarettes or individuals who are not using e-cigarettes and found a statistically significant difference between the two groups. The authors found that among individuals who are not using e-cigarettes, susceptibility to cigarette use was associated with over three times the odds of subsequent initiation of cigarette smoking compared with non-susceptible individuals who are not using e-cigarettes (AOR 3.47, 95% CI 2.38–5.07); however, only a small, non-statistically significant association was observed between susceptible and non-susceptible individuals who have ever used e-cigarettes and initiation of cigarette smoking (AOR 1.57, 95% CI 0.80–3.05) [ 52 ]. Thus, susceptibility only statistically significantly affected the subsequent initiation of cigarette smoking in individuals who are not using e-cigarettes ( p interaction  = 0.04).

Findings from a 2016 study by Wills et al. indicated that the effect of e-cigarette for cigarette smoking onset decreased as propensity increased—the AOR for smoking onset for individuals currently using e-cigarettes (past-30-day) versus individuals who are not using e-cigarettes was 2.23 (95% CI 1.57–3.17) for those in the bottom 10th percentile for propensity to smoke, and 1.32 (95% CI 1.19–1.47) for those in the top 10th percentile for propensity to smoke [ 91 ].

In a 2018 study, Treur et al. provided AORs for low-propensity- and high-propensity-to-smoke groups for ever e-cigarette versus individuals who are not using e-cigarettes, both with and without nicotine [ 57 ]. The investigators found that, for e-cigarettes containing nicotine, the AOR for initiating conventional smoking was 7.80 (95% CI 1.90–32.04) in the low-propensity-to-smoke group, and 2.89 (95% CI 1.47–5.68) in the high-propensity-to-smoke group; for e-cigarettes containing no nicotine, the AOR for initiating conventional smoking was 6.07 (95% CI 2.18–16.90) in the low-propensity-to-smoke group, and 3.30 (95% CI 2.33–4.67) in the high-propensity-to-smoke group.

Treur et al. also compared the effects of e-cigarette use with nicotine and e-cigarette use without nicotine in individuals using e-cigarettes versus individuals who have never used e-cigarettes [ 57 ]. The study reported an AOR for initiation of 5.36 (95% CI 2.73–10.52) for individuals who ever used e-cigarettes without nicotine compared with individuals who are not using e-cigarettes, and an AOR of 11.90 (95% CI 3.36–42.11) for individuals who ever used e-cigarettes with nicotine compared with individuals not using e-cigarettes.

Three studies evaluated initiation in susceptible subgroups [ 34 , 68 , 90 ], two of which were included in the meta-analysis for initiation of cigarette smoking [ 34 , 90 ]. The association between ever e-cigarette use and susceptibility to smoking was evaluated in a 2016 prospective cohort study by Barrington-Trimis et al. [ 90 ]. The study found that ever e-cigarette use had less of an effect in individuals classified as being susceptible to smoking, as demonstrated by a lower odds of initiation of cigarette smoking in that group (AOR 2.12, 95% CI 0.79–5.74), compared with individuals using e-cigarettes initially classified as non-susceptible to smoking (AOR 9.69, 95% CI 4.02–23.4) ( p interaction  = 0.025) [ 90 ]. Interestingly, the effect of e-cigarette use in the susceptible group on initiation of cigarette smoking was not statistically significant.

Berry et al. [ 68 ] reported similar outcomes, both in terms of ever and current cigarette use. In terms of ever cigarette use, the authors demonstrated lower odds of initiation among individuals who had used e-cigarettes in the past versus individuals who are not using e-cigarettes (AOR 3.51, 95% CI 2.52–4.89) among individuals classified as intermediate/high risk for smoking, compared with those classified as low risk (AOR 8.57, 95% CI 3.87–18.97). Similarly, in terms of current cigarette use, odds of initiation were lower among individuals classified as intermediate/high risk (AOR 2.16, 95% CI 1.23–3.79) compared with those classified as low risk (AOR 10.36, 95% CI 3.11–34.54). In both cases, this indicates that e-cigarette use had less of an effect on initiation among those individuals considered intermediate/high risk.

Best et al. [ 34 ], also included in the meta-analysis, found that there was an interaction between susceptibility to smoking and ever e-cigarette use with regards to initiation of cigarette smoking (AOR for e-cigarette use and susceptibility interaction of 0.42, 95% CI 0.19–0.94). In other words, there would be greater interaction between e-cigarette use and non-susceptible populations compared with susceptible populations in terms of initiation of cigarette smoking. It is worth noting that although Best et al. refer in their study to susceptibility and not the intent, the questions that respondents answered, i.e., “Do you think you will smoke cigarettes or hand-rolled cigarettes at any time during the next year” and “If one of your friends offered you a cigarette or hand-rolled cigarettes (roll-ups), would you smoke it?” were questions that measured intent.

Lastly, one study by Barrington-Trimis et al. [ 51 , 52 ] investigating initiation of cigarette smoking, with analyses of switching and dual-use, found that the adjusted odds of reporting dual use (at follow-up) among individuals who had ever used e-cigarettes exclusively at baseline (versus individuals who had never used e-cigarettes at baseline) were higher than the odds of reporting switching from baseline exclusive e-cigarette use to exclusive cigarette smoking at follow-up (AOR 7.16, 95% CI 4.47–11.5 vs. AOR 2.67, 95% CI 1.53–4.65, respectively). In another analysis, the authors also found that the odds of reporting dual use among current (past 30-day) e-cigarette users (versus non-current users) were similarly higher than the odds of reporting switching from exclusive e-cigarette use to exclusive cigarette smoking (AOR 8.86, 95% CI 5.08–15.4 vs. AOR 3.84, 95% CI 1.80–8.19, respectively [ 52 ].

Initiation of and progression to regular cigarette smoking (regular e-cigarette use: 2 studies)

Two adjusted studies were identified that provided adjusted analyses of initiation of and progression to regular cigarette smoking in individuals with regular use of e-cigarettes [ 40 , 48 ]. Summary characteristics of these two studies are provided in Table  4 .

Azagba et al. [ 40 ] defined regular e-cigarette use as either every day or someday use. In terms of the transition from experimental to some-day cigarette smoking, no significant association was found between individuals using e-cigarettes every day and individuals who have never used e-cigarettes (AOR 1.31, 95% CI 0.20–8.58), nor between individuals using e-cigarettes some day and individuals who have never used e-cigarettes (AOR 0.48, 95% CI 0.13–1.78). Similarly, no significant associations were found between individuals using e-cigarettes every day and individuals who have never used e-cigarettes (AOR 0.58, 95% CI 0.09–3.93) and individuals using e-cigarettes some day and individuals who have never used e-cigarettes (AOR 1.14, 95% CI 0.42–3.05) in terms of the transition from experimental to daily cigarette smoking. Likewise, in terms of the transition from some-day to daily cigarette smoking, no significant association was found between individuals using e-cigarettes every day and individuals who have never used e-cigarettes (AOR 1.89, 95% CI 0.98–3.66), nor between individuals using e-cigarettes some day and individuals who have never used e-cigarettes (AOR 1.41, 95% CI 0.84–2.39).

Wei et al. [ 48 ] evaluated transitions from non-current, non-established cigarette smoking to either exclusive current-established cigarette smoking or current-established dual use of cigarettes and e-cigarettes, among baseline individuals using e-cigarettes exclusively. The authors found that individuals who have established e-cigarette use were significantly less likely to transition to exclusive current-established cigarette smoking than individuals who have non-established e-cigarette use (AOR 0.13, 95% CI 0.02–0.87); however, no significant association was found between e-cigarette use (established versus non-established) and transitioning to dual use of cigarettes and e-cigarettes (AOR 0.53, 95% CI 0.05–6.25).

Initiation of and progression to regular cigarette smoking (non-regular e-cigarette use: 11 studies)

Eleven adjusted studies examined the potential association between e-cigarette use and initiation and progression to regular cigarette smoking among individuals with non-regular use of e-cigarettes [ 37 , 40 , 45 , 54 , 61 , 65 , 66 , 69 , 72 , 73 , 86 ]. Study characteristics for the 11 included studies are presented in Table  5 .

Sun et al. [ 86 ] used data from Waves 3–5 of the PATH study to investigate the association between e-cigarette use and the progression into regular cigarette smoking—defined as past 12-month use at Wave 4 with established use and at least 20 days use in the past 30 days at Wave 5. The authors show that the association between ever e-cigarette user and progression into regular smoking is non-significant with baseline e-cigarette ever-users having a lower risk of progressing into established regular smoking 0.13% (95% CI − 0.31 to 0.58) versus 0.17% (95% CI − 0.30 to 0.64) for baseline e-cigarette never-users (ARD − 0.03, 95% CI − 0.33 to 0.27; AOR 0.80, 95% CI 0.10–6.49). Similarly, e-cigarette current use was not associated with progression into established regular smoking as evidenced by the absolute risk of 0.47% (95% CI − 1.46 to 2.39) for individuals currently using e-cigs versus 0.15% (95% CI − 0.27 to 0.58) for e-cig non-users (ARD 0.31, 95% CI − 1.36 to 1.99; AOR 3.14, 95% CI 0.13–74.96) [ 86 ].

In addition to applying measures of regular e-cigarette use described previously, Azagba et al. [ 40 ] also applied a non-regular definition of experimental e-cigarette use. Consistent with their findings from their analyses of regular e-cigarette use, no significant associations were found between experimental and e-cigarette never-users in terms of: transitioning from experimental to someday cigarette smoking (AOR 0.98, 95% CI 0.44–2.20); transitioning from experimental to daily cigarette smoking (AOR 0.59, 95% CI 0.26–1.31); and transitioning from some day to daily cigarette smoking (AOR 1.03, 95% CI 0.61–1.75) [ 40 ].

A longitudinal panel study by McMillen et al. [ 72 ] reported inconsistent findings, depending on the measure of e-cigarette use applied. When evaluating ever e-cigarette use (versus e-cigarette non-use), no significant association with progression to current established cigarette smoking was found (AOR 2.5, 95% CI 0.6–10.9); however, current e-cigarette users were found to be significantly more likely to progress to current established cigarette smoking compared to individuals who are not using e-cigarettes (AOR 8.0, 95% CI 2.8–22.7). Another longitudinal panel study by Pierce et al. [ 65 ] evaluated rate of progression to daily cigarette smoking at Wave 4 among ever (but not daily) tobacco product users at Wave 3 of the PATH survey. The authors found that the adjusted risk difference between individuals who have ever used e-cigarettes versus e-cigarette never-users for progression to daily cigarette smoking was 7% (95% CI 6–9%) higher for individuals using e-cigarettes, although statistical significance was not assessed [ 65 ].

Findings from a prospective cohort study by Chaffee et al. [ 54 ] suggested the AOR of progressing to regular smoking (i.e., smoked ≥ 100 cigarettes and smoked in the past 30 days) was statistically significantly higher in individuals who have ever used e-cigarettes compared with individuals who are not using e-cigarettes (AOR 1.80, 95% CI 1.04–3.12); however, no such association was shown for past-30-day e-cigarette users (AOR 1.76, 95% CI 0.92–3.37). A second prospective cohort study by Hammond et al. [ 73 ] reported that progression to regular cigarette smoking was statistically significantly higher in past-30-day e-cigarette users compared with individuals who are not using e-cigarettes (AOR 1.79, 95% CI 1.41–2.28), while findings from a third prospective cohort study by Conner et al. [ 37 ] suggested statistically significantly higher odds of progressing to regular smoking (≥ 1 cigarette per week) at 2 years among individuals who have ever used e-cigarettes compared with individuals who are not using e-cigarettes (AOR 1.27, 95% CI 1.17–1.39). A fourth prospective cohort study, also by Conner et al. [ 61 ], reported statistically significantly higher odds of regular smoking (defined as smoking at least 1 cigarette per week) at Wave 5 among adolescents who first reported e-cigarette use at 13–14 years old (i.e., early users; AOR 1.25, 95% CI 1.16–1.34), and those who first reported e-cigarette use at 14–15 years (i.e., late users; AOR 1.12, 95% CI 1.08–1.16). The final prospective cohort study by Staff et al. [ 66 ] reported that the adjusted odds of reporting frequent smoking by age 17 were significantly higher for individuals using e-cigarettes compared with individuals who are not using e-cigarettes at baseline (AOR 2.91, 95% CI 1.56–5.4). The odds of frequent smoking remained significantly higher for individuals using e-cigarettes when the samples were matched on risk factors using propensity score matching.

Osibogun et al. [ 45 ] evaluated progression to regular cigarette smoking at both 1 and 2 years from baseline, finding that progression at 1 year was significantly associated with e-cigarette use (AOR 5.0, 95% CI 1.9–12.8). However, progression at 2 years was not significantly associated with e-cigarette use (AOR 3.4, 95% CI 1.0–11.5) [ 45 ].

The one cross-sectional study by Friedman et al. [ 69 ] reported statistically significantly lower odds of current established (≥ 100-lifetime cigarettes and past-30-day use) (AOR 0.22 95% CI 0.10–0.50) or daily (AOR 0.22 95% CI 0.06–0.77) cigarette use among individuals who experimented exclusively with e-cigarettes (experimenting before the age of 18 years) compared with individuals who did not experiment with e-cigarettes. Findings from this study also suggested statistically significantly higher odds of reporting current established cigarette smoking among individuals who first experimented with e-cigarettes and then with cigarettes, compared with individuals who did not experiment with e-cigarettes (AOR 1.89 95% CI 1.09–3.27); however, no significant difference in the odds of daily smoking was shown (AOR 0.73 95% CI NR).

Quantitative synthesis of best available evidence

Meta-analyses were performed by calculating pooled ORs from studies presenting AORs on initiation of cigarette smoking among naïve (individuals who never smoked cigarettes) cigarette smokers who either ever used or never used e-cigarettes. A meta-analysis evaluating the association between regular e-cigarette use and initiation of cigarette smoking was not possible, given that only one study reported adjusted outcomes for this association. Additionally, a meta-analysis evaluating e-cigarette use and initiation and progression to regular smoking was not possible, due to differences in definitions of e-cigarette use and/or outcome measures between studies (full results in Supplemental Section 17 : Meta-Analytic Results; all relevant code is publicly available [DOI: https://doi.org/10.5281/zenodo.10927677 ]).

Twelve studies met all the inclusion criteria and were included in the meta-analysis for initiation of cigarette smoking [ 34 , 43 , 52 , 56 , 59 , 63 , 66 , 76 , 77 , 80 , 81 , 84 ]. All 12 studies included individuals who never smoked cigarettes who were evaluated for initiation of cigarette smoking (minimum inclusion criteria = 1 puff). The studies compared an e-cigarette use group (regardless of frequency, volume, and duration) to a control group of e-cigarette never-users. The results from each study controlled for age, gender, race/ethnicity, and other covariates. All studies were longitudinal in design and had a combined analytic sample of 57,730 respondents.

For the 12 studies, the AORs ranged from 1.35 to 7.41. Pooling their results, the overall OR was 3.71 (95% CI 2.86–4.81). The test for the overall effect of the model was noted to be statistically significant ( p  < 0.00001). Heterogeneity tests revealed an I 2 of 76% and a X 2 of 45.18 ( p  < 0.00001) (Fig.  2 ). An assessment of publication bias—via the development of a funnel plot—was generally symmetrical, suggesting an absence of publication bias (Fig.  3 ).

Meta-analysis of odds of initiation of cigarette smoking among individuals who never smoked cigarettes who used e-cigarettes

Funnel plot for publication bias

Additionally, a sensitivity analysis excluding studies with a “Fair” quality rating was conducted—resulting in the exclusion of four studies [ 43 , 63 , 80 , 81 ]. Results of the eight studies with “Good” rating, presented a pooled OR of 3.96 (95% CI 3.10–5.07), with an I 2 of 60% and a X 2 of 17.64 ( p  < 0.00001) (Fig.  4 ).

Sensitivity analysis of odds of initiation of cigarette smoking among individuals who never smoked cigarettes who used e-cigarettes—excluding studies rated as “fair” quality

A sub-group analysis was conducted based on the country where the study was implemented (US-based or outside the US). The sub-group analysis stratified the results of eight studies conducted in the US [ 43 , 52 , 56 , 59 , 63 , 76 , 77 , 81 ] and four studies conducted outside of the US [ 34 , 66 , 80 , 84 ]. In the eight US studies, AORs ranged from 1.35 to 7.41, and the pooled overall OR was 3.63 (95% CI 2.54–5.18). The test for overall effect revealed that the results were significant ( p  < 0.00001), while heterogeneity was noted with I 2 of 79% and X 2 of 32.77 ( p  < 0.0001). In the studies outside the US the AORs ranged from 2.42 to 5.09 and the pooled OR was 3.94 (95% CI 2.62–5.95), with a significant test for overall effect ( p  < 0.00001), and I 2 of 70% and X 2 of 9.96 ( p  < 0.00001). The test for subgroup difference presented an I 2 of 0% and X 2 of 0.09 ( p  = 0.76) (Fig.  5 ).

Sub-group meta-analysis of odds of initiation of cigarette smoking among individuals who never smoked cigarettes who used e-cigarettes from studies conducted in the US and outside the US

As with the main analysis, a sensitivity analysis of the subgroup analysis based on country was performed, excluding studies graded as “Fair” quality, which resulting in the exclusion of three US-based studies [ 43 , 63 , 81 ], and one study from outside the US [ 80 ]. Pooled results from the remaining five US studies revealed a statistically significant pooled OR of 4.01 (95% CI 2.95–5.47; p  < 0.00001) with an I 2 of 47% and a X 2 of 7.54 ( p  = 0.11). In the remaining studies outside the US the AORs ranged from 2.42 to 5.09 and the pooled OR was 3.83 (95% CI 2.29–5.07), with a significant test for overall effect ( p  < 0.00001), and I 2 of 80% and X 2 of 9.94 ( p  < 0.00001). The test for subgroup difference presented an I 2 of 0% and X 2 of 0.02 ( p  = 0.88) (Fig.  6 ).

Sub-group meta-analysis of odds of initiation of cigarette smoking among individuals who never smoked cigarettes who used e-cigarettes from studies conducted in the US and outside the US—excluding studies rated as “fair” quality

The current systematic review identified a number of “good” quality studies (according to the Downs and Black quality metrics [ 29 ]) that evaluated the association between e-cigarette use and initiation of cigarette smoking, and initiation of and progression to regular cigarette smoking. Over half of the included studies controlled for age, gender, and race/ethnicity and reported adjusted results to provide a higher level of evidence. This review focused on such studies in the quantitative and qualitative synthesis of results.

A meta-analysis of 12 studies evaluating initiation of cigarette smoking indicated an increased odds (3.7 times higher) for individuals who have ever used e-cigarettes compared with individuals who are not using e-cigarettes and no indication of publication bias among the studies was observed [ 34 , 43 , 51 , 56 , 59 , 63 , 66 , 76 , 77 , 80 , 81 , 84 ]. These findings are consistent with previously-conducted meta-analyses, all of which reported increased odds of initiation associated with e-cigarettes: O’Brien et al. [ 16 ] reported 4.06 times higher odds among teenagers; Soneji et al. [ 13 ] reported 3.5 times higher odds among a study population of adolescents and young adults; Chan et al. [ 14 ] and Khouja et al. [ 15 ] both reported 2.9 times higher odds, in populations of youth and youth-young adults, respectively; and Baenziger et al. [ 18 ] and Adermark et al. [ 19 ] reported 3.2 and 3.3 times higher odds, respectively, in samples from the general population.

Only one study, also included in the meta-analysis, reported on initiation of cigarette smoking in individuals with regular use of e-cigarettes, providing outcome data for initiation of cigarette smoking based on the frequency of e-cigarette use at baseline (from 1–2 uses/day to everyday use) [ 77 ]. Wills et al. [ 77 ] found an upward trend for the probability of initiation of cigarette smoking and increased e-cigarette use. Thirty-seven adjusted studies not included in the meta-analysis showed a similar trend, with a higher probability or incidence of initiation of cigarette smoking in the e-cigarette user group [ 36 , 37 , 41 , 42 , 44 , 46 , 47 , 49 , 50 , 52 , 53 , 54 , 55 , 57 , 58 , 60 , 61 , 62 , 64 , 67 , 68 , 70 , 71 , 72 , 73 , 74 , 78 , 79 , 82 , 83 , 85 , 86 , 87 , 88 , 89 , 90 , 91 ]. These studies had similar definitions for e-cigarette use, with any or ever use at baseline, any e-cigarette use in the past 12 months, or any use in the past 30 days. All but one of these studies defined cigarette use as any cigarette use at follow-up, while the remaining study evaluated regular smoking, although definition of regular smoking was not provided.

Six studies compared initiation of cigarette smoking with e-cigarette use between study groups that were susceptible or not susceptible to cigarette smoking [ 34 , 52 , 57 , 68 , 90 , 91 ]. E-cigarette use was either not associated with an increase in smoking initiation in individuals using e-cigarettes susceptible to cigarette smoking [ 52 , 90 ], or the effect of e-cigarette use on initiation of cigarette smoking was less in individuals using e-cigarettes susceptible to cigarette smoking [ 34 , 57 , 68 , 91 ].

The limited data from one study evaluating e-cigarettes with or without nicotine pointed to a higher probability of initiating cigarette smoking with nicotine-containing e-cigarettes [ 57 ]. With regards to “switching” or “dual-use” following initiation of cigarette smoking, two studies found that the odds of reporting dual use among exclusive e-cigarette ever users (versus never users) were higher than the odds of reporting switching from exclusive e-cigarette use to exclusive current cigarette smoking [ 52 , 80 ]. In both studies, analyses of current (past 30-day) e-cigarette users reported similarly higher odds of dual-use compared with switching.

Twelve adjusted studies evaluated initiation of and progression to regular cigarette smoking for individuals using e-cigarettes versus individuals who are not using e-cigarettes [ 37 , 40 , 45 , 48 , 54 , 61 , 65 , 66 , 69 , 72 , 73 , 86 ], two of which applied measures of regular e-cigarette use [ 40 , 48 ]. Both studies generally found no significant associations between regular e-cigarette use and progression to regular cigarette smoking; however, one result suggested that established e-cigarette users were significantly less likely to transition to exclusive cigarette smoking than non-established e-cigarette users [ 48 ]. In terms of studies applying definitions of non-regular e-cigarette use, based on the variability in the results, and variations in the definition of a “regular” cigarette smoker, the current data regarding initiation of and progression to regular cigarette smoking does not support drawing conclusions. This is illustrated in the study by Friedman et al. [ 69 ], which reported statistically lower odds of both current established and daily cigarette use among individuals who experimented exclusively with e-cigarettes(non-established use prior to the age of 18 years old) compared with individuals who did not experiment with e-cigarettes. Conversely, this study also found statistically significantly higher odds of current established cigarette use among individuals who experimented with e-cigarettes first, then with cigarettes, compared with individuals who did not experiment with e-cigarettes; however, no significant difference in the odds of daily smoking was found between e-cigarette-then-cigarette experimenters compared with individuals who did not experiment with e-cigarettes.

Finally, only one adjusted study evaluated age of initiation of cigarette smoking [ 75 ]. Notably, although McCabe et al. [ 75 ] reported a significantly lower age among current e-cigarette users, age of regular (daily) cigarette smoking was not significantly different between current and non-current e-cigarette users.

The current systematic review exhibited three major strengths. Firstly, its comprehensive search methodology yielded a large number of studies for review. Secondly, the current review had a clearly defined PICOS, which assured the identification of the strongest evidence relevant to the research question. Thirdly, guidelines for this review ensured that only demographically adjusted and methodologically consistent studies were included in the quantitative syntheses. Finally, the strict adherence to AMSTAR-2 and PRISMA guidelines ensured the transparency and replicability of this review while minimizing any risk of various forms of bias (e.g. individual study design; industry sponsorship) to provide an unbiased and comprehensive synthesis of this evidence base. Collectively, these strengths support the robustness of this review in terms of comprehensiveness and methodological rigor.

Although the meta-analysis indicated a higher odds for initiation of cigarette smoking among individuals using e-cigarettes—a result generally supported by the studies included in the qualitative synthesis—interpretation of the results is limited for many critical reasons. Specifically, the definition of e-cigarette use was not restricted to regular use. While doing so would have provided the strongest evidence on potential associations with the initiation of cigarette smoking, such a restriction would have yielded too few studies. Instead, the review was broadened to include any measure of e-cigarette use, with most studies measuring ever or current (past-30-day) use. Also, few studies examined initiation and/or progression to regular cigarette smoking, instead applying definitions of cigarette smoking that were more consistent with temporary experimentation and not true initiation, such as ever or current (past-30-day) smoking. Further, included studies were not restricted by specific confounding variables representing common liabilities between e-cigarette use and cigarette smoking, as this would have critically reduced the number of included studies in this review. The common-liability model considers the sequencing of drug use initiation, addiction, and addiction severity and posits that there are common sources of variation in the risk for specific addictions [ 11 ]. This model is critical for consideration given the empirical mixed signals that support or contradict the gateway hypothesis. However, the limited number of studies controlling for confounding variables related to common liability highlights the need for more robust studies to effectively measure the causal relationship between e-cigarette use and the initiation of cigarette smoking.

The majority of studies looked at how an e-cigarette-using population, individuals who never smoked cigarettes at baseline, developed cigarette smoking practices at follow-up. Though this information is indeed fundamental, it is equally important to understand the concepts of switching and dual-use. There are two possible trajectories that lead to an outcome of cigarette smoking among individuals using e-cigarettes. Between the baseline and follow-up surveys, (1) the e-cigarette user could begin cigarette smoking simultaneous with his/her e-cigarette use (dual use); or, (2) the e-cigarette user could eventually stop using the e-cigarette and after some time start smoking cigarettes (switchers). Information regarding whether individuals switched or dual used was limited, with only one adjusted study presenting specific data regarding single or dual use [ 52 ].

Further, 49 of 55 included studies reported on “youth”, “adolescent” and/or “young adult” populations, limiting the utility of the conclusions, as studies in youth and/or young adults are not necessarily translatable to older adults. Indeed, there is evidence that cigarette and e-cigarette smoking behaviors differ in different age groups. For example, one study determined that young adults (18–29 years of age) were more likely to be occasional smokers and reported lower daily consumption compared with older individuals who smoke cigarettes (30 years of age or older) [ 95 ]. Moreover, different age groups may vary in terms of their perceptions of and willingness to take risks, views of smoking addiction, perception of relative cigarette and e-cigarette health risks and/or benefits, and responses to behavioral interventions [ 96 ], which may differentially influence smoking behaviors and inherently, smoking cessation.

Finally, the duration of follow-up for the available studies was generally limited with most studies limited to 12 months in duration. This introduces the potentially limitation to observe whether cigarette smoking behavior actually persisted after initiation, i.e., true initiation and not simply temporary experimentation [ 2 ]. This may explain why so few of the included studies evaluated progression to regular cigarette smoking.

In conclusion, more robust studies are required to determine whether there is an association between e-cigarette use and initiation of cigarette smoking and progression to regular smoking. Based on findings from this review, the available studies neither sufficiently measure e-cigarette use—or cigarette smoking—in a manner consistent with examining causality, nor sufficiently account for known or suspected confounding variables to support robust determinations regarding e-cigarette use and cigarette smoking behaviors. Thus, the utility of the evidence base for policymakers, healthcare providers, and researchers is limited.

Availability of data and materials

All data and materials considered in this review are publicly available.

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Acknowledgements

The authors would like to acknowledge Thera-Business (Ontario CANADA) for providing their systematic review expertise to all study activities across all levels of the updated review process. The authors would also like to thank Dr. Geoffrey Curtin, a retired employee of RAI Services Company, for his scientific contributions during the conceptualization of this review.

All study activities were executed by providers external to RAI Services Company (Thera-Business), who were financially compensated for services according to contractual terms with RAI Services Company. RAI Services Company is a wholly owned subsidiary of Reynolds American Inc., whose operating companies manufacture and market tobacco products. The conception, analysis, and writing for this manuscript was a collaboration between Thera-Business and RAI Services Company.

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Mimi M. Kim, Isabella Steffensen, Red Thaddeus D. Miguel, Tanja Babic & Julien Carlone

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MMK conceived the study. MMK, IS, RDM, TB, and JC collected and analysed project data. MMK, IS, and RDM defined the study design, selection of measures, interpretation of data, and co-wrote the manuscript. All authors have read and approved the final article. The corresponding author attests that the listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Kim, M.M., Steffensen, I., Miguel, R.T.D. et al. A systematic review and meta-analysis of the association between e-cigarette use among non-tobacco users and initiating smoking of combustible cigarettes. Harm Reduct J 21 , 99 (2024). https://doi.org/10.1186/s12954-024-01013-x

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DOI : https://doi.org/10.1186/s12954-024-01013-x

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