title: Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26 566 youth and adults from 27 Countries.
abstract: OBJECTIVE
  This study assessed the prevalence and determinants of e-cigarette use among persons aged ≥15 years in 27 European Union (EU) member countries during 2012.
  
  
  METHODS
  The 2012 Eurobarometer 385 (77.1) survey was analysed for n=26 566 respondents. Knowledge, perception of harm, and determinants of e-cigarettes use were assessed, while separate regression analyses among current (n=7352) and former cigarette smokers (n=5782) were performed. National estimates of the number of e-cigarette users were also extrapolated.
  
  
  RESULTS
  20.3% of current smokers, 4.7% of ex-smokers, and 1.2% of never cigarette smokers in the EU reported having ever used an e-cigarette (overall approximately 29.3 million adults). Among smokers, ever e-cigarette use was more likely among 15-24-year-olds (aOR 3.13, 95% CI 2.22 to 4.54) and 25-39-year-olds (aOR 2.00, 95% CI 1.47 to 2.78) in comparison to older smokers, and among those who smoked 6-10 cigarettes/day (aOR 1.53, 95% CI 1.10 to 2.13) or 11-20 cigarettes/day (aOR 2.07, 95% CI 1.52 to 2.81) in comparison to very light smokers (≤5 cigarettes/day). Moreover, e-cigarette use was more likely among smokers who had made a past year quit attempt (aOR 2.08, 95% CI 1.67 to 2.58). E-cigarette use among ex-smokers was associated only with the respondents' age, with younger ex-smokers being more likely to have ever used an e-cigarette.
  
  
  CONCLUSIONS
  A substantial number of EU adults have ever used e-cigarettes. Ever users were more likely to be younger, current smokers, or past-year quit attempters. These findings underscore the need to evaluate the potential long term impact of e-cigarette use on consumer health, cessation and nicotine addiction and formulate a European framework for e-cigarette regulation within the revised EU Tobacco Product Directive.
authors.affiliation: Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Constantine I
authors.initials: CI
authors.lastname: Vardavas
authors.affiliation: Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Filippos T
authors.identifier: http://orcid.org/0000-0002-2101-2559
authors.initials: FT
authors.lastname: Filippidis
authors.affiliation: Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Israel T
authors.initials: IT
authors.lastname: Agaku
mesh_terms: D000293:Adolescent; D000328:Adult; D066300:Electronic Nicotine Delivery Systems / Q000706:statistics & numerical data*; D005062:European Union; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Global health; Non-cigarette tobacco products; Public opinion; Surveillance and monitoring