Electronic Cigarette Use in 12 European Countries. Results from the TackSHS Survey

Background: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. Methods: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). Overall, 11,876 participants, representative of the population aged ≥15 years in each country, provided information on electronic cigarette. Findings: 2·4% (95% C.I. 2·2-2·7) of the subjects (2·5% men and 2·4% women; 0·4% never, 4·4% current- and 6·5% ex-smokers) reported current use of electronic cigarette, ranging from 0.6% in Spain to 7·2% in England. Of the 272 electronic cigarette users, 52·6% were dual users (i.e., users of both electronic and conventional cigarettes) and 58·8% used liquids with nicotine. In all, 65·1% reported using electronic cigarette in at least one indoor setting where smoking is forbidden, in particular in workplaces (34·9%) as well as bars and restaurants (41·5%). Multivariable logistic regression analysis showed that electronic cigarette use was lower among older individuals (p for trend <0·001) and higher among individuals with high level of education (p for trend 0·040). Participants from countries with higher tobacco cigarette prices more frequently reported electronic cigarette use (odds ratio 3·62; 95% CI 1·80-7·30). Trial Registration: The study protocol is registered at ClinicalTrials.gov (ID: NCT02928536). Interpretation: Extrapolated to the whole adult population of these 12 European countries, it is estimated that more than 8·3 million people use electronic cigarettes. The majority also smoked conventional cigarettes (dual users), used electronic cigarettes with nicotine and consumed electronic cigarettes in smoke-free indoor areas. Funding: European Union’s Horizon 2020 (grant agreement No 681040). Italian League Against Cancer (LILT, Milan). Declaration of Interest: All Authors have no interests to declare. Ethical Approval: Approval for the study was obtained from a local Ethics Committee in each of the 12 countries. The interviewers informed all participants about details of the survey and all participants provided their consent.