Characteristics, Perceived Side Effects and Benefits of Electronic Cigarette Use: A Worldwide Survey of More than 19,000 Consumers

Abstract

Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.

Hormonal contraception among electronic cigarette users and cardiovascular risk: a systematic review

“…In a fourth, the EC test products were provided by an EC company [57], and in a fifth, authors reported having received previous funding from EC companies [50]. One study was sponsored by an EC user advocate group [61] and another by the Italian antismoking league [58]. The remaining six studies were government or university sponsored [51,52,54,55,60] or did not report funding [49].…”

“…Only two of the studies on EC safety reported results by sex [55,56], so we were not able to determine whether EC exposure affected males and females differently. In six of the studies, authors did not standardize EC dosage across the study sample [49,54,[57][58][59][60]; in three, no comparison group was included [51,54,57]; and in one, neither exposures nor outcomes were validated [61].…”

“…Of these, 13 articles met inclusion criteria for this review [49][50][51][52][53][54][55][56][57][58][59][60][61]. One article reported on the clinical outcomes of interest (two cases of MI) [49].…”

“…In 5 of these articles, investigators followed participants for at least 1 week [49,[57][58][59][60], but in 7 articles, authors only reported acute outcomes (changes over b 5 h of exposure) [50][51][52][53][54][55][56]. One article reported on a cross-sectional survey in which EC users reported on perceived changes to health after switching from cigarettes to ECs [61]. Twelve articles included data on both men and women together, with one reporting on women alone [56].…”

“…We identified one poor quality cross-sectional Web-based survey that recruited a global sample of EC users (n=19,411, 4900 women) [61] …”