Secondhand exposure to e-cigarette aerosols among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC Europe Surveys

Abstract

INTRODUCTION Electronic cigarette (e-cigarette) use has grown significantly in some European Union (EU) Member States (MS). A better understanding of the exposure to secondhand e-cigarette aerosols (SHA) is necessary to develop and implement comprehensive regulations on e-cigarette use in public places. This study aims to assess the observation of e-cigarette use in public places, the self-reported exposure to SHA, and the level of users’ comfort using e-cigarettes in the presence of others. METHODS This is a cross-sectional study of the Wave 1 International Tobacco Control 6 European Countries Survey recruiting adult smokers (n=6011) across six EU MS: Germany, Greece, Hungary, Poland, Romania, and Spain, within the EURESTPLUS Project. A descriptive analysis was conducted to estimate the prevalence (%) of observed e-cigarette use in different places, frequency of self-reported exposure to SHA, and level of comfort using e-cigarettes in the presence of others. RESULTS In all, 31.0% of smokers observed others using e-cigarette in public places, 19.7% in indoor places where smoking is banned, and 14.5% indoors at work. Almost 37% of smokers reported to be ever exposed to SHA, ranging from 17.7% in Spain to 63.3% in Greece. The higher prevalence of observed e-cigarette use and passive exposure to SHA was reported by smokers of younger age, of higher educational level and those being current or former e-cigarette users. Part (8.8%) of the smokers who were also e-cigarette users reported feeling uncomfortable using e-cigarettes in the presence of others. CONCLUSIONS A third of smokers from six EU MS reported being exposed to SHA. Prevalence differences were observed among the countries. In the context of scarce evidence on long-term health effects of exposure to SHA, precautionary regulations protecting bystanders from involuntary exposure should be developed.

Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey

“…Men, young, highly educated, current smokers and e-cigarette past users were more likely to be exposed to SHA in indoor settings. These determinants of SHA exposure were also true for smokers as has been shown in a study among six European countries 23. Being in the youngest age groups or the higher educational level were also positive determinants for e-cigarette use and awareness about e-cigarettes 53–55.…”

“…A previous study, conducted among smokers in six European countries (Germany, Greece, Hungary, Poland, Romania and Spain) from June to September 2016, also identified differences in SHA exposure prevalence across countries, with Spain having the lowest exposure (18%) and Greece having the highest one (63%) 23. The variation of SHA exposure across countries may reflect a diverse country’s e-cigarette use prevalence in Europe.…”

“…Most of the SHA exposure occurred in ‘other indoor settings’, which include bars and restaurants where smoking, but not e-cigarette use is prohibited in all the 12 countries examined 49. A previous European study indicated a 20% prevalence of e-cigarette use in indoor places where smoking was banned 23. The greater opportunity of using e-cigarette compared with smoking conventional cigarettes in enclosed spaces, including pubs, bars and restaurants, has been mentioned as one of the motivations of using e-cigarettes in such settings 27 50.…”

“…The WHO recommends to Parties of the Framework Convention on Tobacco Control to consider the prohibition of e-cigarette use in indoor settings or at least in those places where smoking is already banned 22. In Europe, e-cigarette use has been frequently observed in indoor places where smoking is normally banned, such as workplaces, bars, restaurants and train and metro stations 23–25. Evading smoke-free regulation has been reported by e-cigarette users as one of the main reasons for the use of e-cigarettes 26–28.…”

“…According to the 2015 National Youth Tobacco Survey data, exposure to SHA in indoor or outdoor public places was reported by one in four middle-school and high-school students in the USA, including 4.4 million who were e-cigarette non-users and one million not exposed to SHS 31. Recent data from six European countries indicated that 37% of smokers (e-cigarette non-users) were exposed to SHA, ranging from 18% in Spain to 63% in Greece 23. However, there has been no study on exposure to SHA from e-cigarettes among the general population in Europe.…”