Farsalinos KE, Poulas K, Voudris V, Le Houezec J
British Medical Journal (BMJ)
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AIMS: To assess prevalence of electronic cigarette (e-cigarette) use, reported changes in smoking status due to e-cigarette use and correlates of e-cigarette use in the European Union (EU) member states in 2014.
DESIGN: Cross-sectional survey of EU citizens representative of the population (Special Eurobarometer 429).
SETTING: All 28 member states of the EU.
PARTICIPANTS: 27,460 EU citizens aged ≥ 15 years (after excluding those who responded “Do not know” to the questions about smoking status and e-cigarette use).
MEASUREMENTS: Descriptive analysis (%, 95%CI) of e-cigarette use prevalence (current use, past use and past experimentation) according to smoking status, self-reported changes in smoking status according to patterns of e-cigarette use, and logistic regression analysis to examine correlates of e-cigarette use, especially sociodemographic factors and smoking status.
FINDINGS: Ever e-cigarette use was reported by 31.1% (30.0-32.2%) of current smokers, 10.8% (10.0-11.7%) of former smokers, and 2.3% (2.1-2.6%) of never smokers. Past experimentation [7.2% (6.9-7.5%)] was more common than current [1.8% (1.6-1.9%)] and past use [2.6% (2.4-2.8%)]. Extrapolated to the whole population, about 48.5 million EU citizens were ever e-cigarette users, with 76.8% using nicotine-containing e-cigarettes. Initiation with e-cigarettes was reported by 0.8% (0.6-0.9%) of participants who reported ever use of any tobacco-related product. Only 1.3% (1.1-1.5%) of never smokers used nicotine-containing e-cigarettes, with 0.09% (0.04-0.14%) reporting daily nicotine use. Smoking cessation due to e-cigarette use was reported by 35.1% (30.7-39.5%) of current e-cigarette users, while a further 32.2% (29.9-36.5%) reported smoking reduction. An estimated 6.1 and 9.2 million EU citizens had quit and reduced smoking with the use of e-cigarettes respectively. Being current (OR: 21.23, 95%CI: 18.32-24.59) or former smokers (OR: 6.49, 95%CI: 5.49-7.67) were the strongest correlates of ever e-cigarette use.
CONCLUSIONS: E-cigarette use in the European Union appears to be largely confined to current or former smokers, while current use and nicotine use by people who have never smoked is rare. Over 30% of current e-cigarette users polled reported smoking cessation and reduction.