Abstract
Objectives
The aim of this study was to assess the relationship between the prevalence of e-cigarette use and country-level factors across 28 European countries.
Methods
The study objectives were addressed in an ecological design in which both exposures and outcomes were measured at the country level. Data from the Eurobarometer Report, the Eurostat database and the WHO observatory were analyzed. Bivariate and multivariate analyses were performed considering the rates of current and ever smokers of e-cigarettes as dependent variables, and socio-economic factors, health status and policies against tobacco as independent variables.
Results
Both the rate of current smokers and ever smokers of e-cigarette were positively associated to the offer of help to quit tobacco use (P < 0.01; P = 0.04) and to the raise of taxes on tobacco (P = 0.01; P = 0.01). The warn on dangers of tobacco negatively correlated with the rate of e-cigarette current smokers. The rate of current e-cigarette smokers correlated with the rate of current smokers and with national Gross Domestic Product, while the rate of ever e-cigarette smokers did not correlate with any socio-economic factor.
Conclusions
Our analysis suggests that both policy and non-policy factors are associated with the geographical variability seen in the prevalence of e-cigarette use. Policies against the consumption of conventional tobacco products may lead to an increase of e-cigarette smokers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bader P, Boisclair D, Ferrence R (2011) Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis. Int J Environ Res Public Health 8(11):4118–4139. doi:10.3390/ijerph8114118
Bala M, Strzeszynski L, Topor-Madry R, Cahill K (2013) Mass media interventions for smoking cessation in adults. Cochrane Database Syst Rev 6:CD004704. doi:10.1002/14651858.CD004704.pub3
Ben Taleb Z, Kenneth W, Asfar T, Bahelah R, Maziak W (2015) Predictors of adherence to pharmacological and behavioral treatment in a cessation trial among smokers in Aleppo, Syria. Drug Alcohol Depend. doi:10.1016/j.drugalcdep.2015.05.038
Bhatnagar A, Whitsel LP, Ribisl KM, Bullen C, Chaloupka F, Piano MR, Robertson RM et al (2014) Electronic cigarettes: a policy statement from the American Heart Association. Circulation 130(16):1418–1436. doi:10.1161/CIR.0000000000000107
Brown J, West R, Beard E, Michie S, Shahab L, McNeill A (2014) Prevalence and characteristics of e-cigarette users in Great Britain: findings from a general population survey of smokers. Addict Behav 39(6):1120–1125. doi:10.1016/j.addbeh.2014.03.009
Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J, Walker N (2013) Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet (London, England) 382(9905):1629–1637. doi:10.1016/S0140-6736(13)61842-5
Database—Eurostat (2015) http://ec.europa.eu/eurostat/data/database. Accessed 24 June 2015
European Commission (2015) Attitudes of Europeans towards tobacco and electronic cigarettes. Special Eurobarometer 429, European Union. doi:10.2875/728026
Famele M, Ferranti C, Abenavoli C, Palleschi L, Mancinelli R, Draisci R (2015) The chemical components of electronic cigarette cartridges and refill fluids: review of analytical methods. Nicotine Tob Res 17(3):271–279. doi:10.1093/ntr/ntu197
Fong GT, Hammond D, Hitchman A (2013) WHO. The impact of pictures on the effectiveness of tobacco warnings. Bull World Health Organ. http://www.who.int/bulletin/volumes/87/8/09-069575/en/
Global Health Observatory Data Repository (2015) WHO. http://apps.who.int/gho/data/node.main.1241?lang=en. Accessed 24 June 2015
Grana R, Benowitz N, Glantz SA (2013) Background paper on e-cigarettes (electronic nicotine delivery systems). Center for Tobacco Control Research and Education, University of California, San Francisco eScholarship. http://escholarship.org/uc/item/13p2b72n
Gualano MR, Passi S, Bert F, La Torre G, Scaioli G, Siliquini R (2014) Electronic cigarettes: assessing the efficacy and the adverse effects through a systematic review of published studies. J Public Health (Oxf). doi:10.1093/pubmed/fdu055
Hammond D, Geoffrey TF, Borland F, Cummings KM, McNeill A, Driezen P (2013) Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study. Am J Prev Med 32(3):202–209. doi:10.1016/j.amepre.2006.11.011
Kadowaki J, Vuolo M, Kelly BC (2015) A review of the current geographic distribution of and debate surrounding electronic cigarette clean air regulations in the United States. Health Place 31:75–82. doi:10.1016/j.healthplace.2014.11.003
Kaplan A (2015a) Can electronic cigarettes assist patients with smoking cessation? Yes. Can Fam Phys 61(6):499–500
Kaplan A (2015b) Rebuttal: can electronic cigarettes assist patients with smoking cessation? Yes. Can Fam Phys 61(6):e255
Levitz S (2015a) Can electronic cigarettes assist patients with smoking cessation? No. Can Fam Phys 61(6):500–501
Levitz S (2015b) Rebuttal: can electronic cigarettes assist patients with smoking cessation? No. Can Fam Phys 61(6):e256
Mannocci A, Colamesta V, Mipatrini D, Boccia A, Terzano C, La Torre G (2013) How would plain packaging and pictorial warning impact on smoking reduction, cessation and initiation? Epidemiol Prev 37(6):400–405
Manzoli L, Flacco ME, Fiore M, La Vecchia C, Marzuillo C, Gualano MR, Liguori G et al (2015) Electronic cigarettes efficacy and safety at 12 months: cohort study. PLoS One 10(6):e0129443. doi:10.1371/journal.pone.0129443
McKee M (2014) Electronic cigarettes: proceed with great caution. Int J Public Health 59(5):683–685. doi:10.1007/s00038-014-0589-z
McKee M, Capewell S (2015) Evidence about electronic cigarettes: a foundation built on rock or sand? BMJ 351:h4863. doi:10.1136/bmj.h4863
McKee M, Chapman S, Daube M, Glantz S (2014) The debate on electronic cigarettes. Lancet 384(9960):2107. doi:10.1016/S0140-6736(14)62366-7
Pokhrel P, Herzog TA, Muranaka N, Fagan P (2015) Young adult e-cigarette users’ reasons for liking and not liking e-cigarettes: a qualitative study. Psychol Health. doi:10.1080/08870446.2015.1061129
Ramo DE, Young-Wolff KC, Prochaska JJ (2015) Prevalence and correlates of electronic-cigarette use in young adults: findings from three studies over five years. Addict Behav 4:142–147. doi:10.1016/j.addbeh.2014.10.019
Smith JE (2014) Electronic cigarettes: a safer alternative or potential poison? Home Healthc Nurse 32(9):532–535. doi:10.1097/NHH.0000000000000138
Vardavas CI, Filippidis FI, Agaku IT (2014) Determinants and prevalence of e-cigarette use throughout the European Union: a secondary analysis of 26566 youth and adults from 27 countries. Tob Contr. doi:10.1136/tobaccocontrol-2013-051394
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the special issue “Electronic Cigarettes and Public Health”.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
La Torre, G., Mipatrini, D. Country-level correlates of e-cigarette use in the European Union. Int J Public Health 61, 269–275 (2016). https://doi.org/10.1007/s00038-016-0792-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00038-016-0792-1