E-cigarettes in Europe used mostly by the young, current smokers, would-be quitters

A photo of 117mm e-cigarette. Image: Wikipedia.

Most Europeans who have tried electronic cigarettes (e-cigarettes) are young, current smokers, or those who recently tried quitting regular cigarettes, according to a new study from Harvard School of Public Health (HSPH). Nearly 30 million Europeans have tried the battery-operated cigarettes, in spite of the fact that not much is known about their potential risks to health or whether they help smokers trying to quit.

The study will appear online on June 16, 2014 in Tobacco Control. It is the largest study to date on e-cigarette use in the European Union.

"As e-cigarettes represent an emerging market in which the tobacco industry has extensively invested, it is imperative to identify the population subgroups that are more likely to use them and the subsequent implications this might have on ," said Constantine Vardavas, senior research scientist at HSPH's Center for Global Tobacco Control (CGTC), in the Department of Social and Behavioral Sciences. "These new findings show that millions—including many young people and trying to quit—are trying e-cigarettes, which underscores the importance of assessing their potential harm or benefits."

Among smokers, e-cigarette use was more likely among 15­–24 year olds in comparison with older smokers, and among heavier smokers (6­–10 or more cigarettes per day) in comparison with light smokers (5 or fewer cigarettes per day). Notably, the study also indicated that smokers may be experimenting with e-cigarettes as smoking cessation devices, as those who tried to quit in the past year were twice as likely to have ever used e-cigarettes as smokers who had not tried to quit.

E-cigarettes are designed to deliver nicotine and to mimic the sensory perception of smoking without combustion. But their use is controversial: Some think e-cigarettes could be a useful tool in helping people to stop smoking, while others think that those who "vape" e-cigarettes—and thus continue to be addicted to nicotine—might move on to either smoking regular cigarettes or using e-cigarettes in conjunction with conventional tobacco. There is also concern about potential toxins in e-cigarette fluid or vapor and the short-term health effects.

Researchers analyzed data from a 2012 Eurobarometer survey about Europeans' attitudes towards tobacco—including 26,566 youth and adults from 27 European countries—to determine the prevalence of e-cigarette use in Europe and who is most likely to use them. They found that one in five current smokers (20.3%), one in 20 ex-smokers (4.4%), and one in 100 (1.1%) of those who have never smoked have tried e-cigarettes at least once. Extrapolating the data, the authors estimate that in 2012, over 29 million European adults had tried e-cigarettes—a staggering number, especially taking into account that this was before the significant boom of the industry.

The study's results show potentially both sides of the coin in the "miracle vs. menace" debate over e-cigarettes, said Vardavas. On one side, switching to e- has been discussed as a harm reduction strategy; on the other, the renormalization of smoking—or 'vaping' in this context—and maintained nicotine addiction at a population level may significantly hinder tobacco endgame efforts, he said.

Vardavas said more research is needed to determine ' impact on individual and population health, on nicotine addiction, and on quitting smoking—all of which could help inform government regulatory standards regarding the manufacturing and marketing of the products.

More information: "Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries," Constantine I. Vardavas, Filippos Filippidis, Israel T. Agaku, Tobacco Control, DOI: 10.1136/tobaccocontrol-2013-051394 , June 16, 2014.

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