Internal and Emergency Medicine

, Volume 14, Issue 6, pp 843–851 | Cite as

Patterns of e-cigarette use, biochemically verified smoking status and self-reported changes in health status of a random sample of vapeshops customers in Greece

  • Eleni Diamantopoulou
  • Anastasia Barbouni
  • Kyriakoula Merakou
  • Areti Lagiou
  • Konstantinos FarsalinosEmail author
Part of the following topical collections:
  1. Health Impact of Electronic Cigarettes and Tobacco Heating Systems


To understand the population impact of e-cigarettes, it is important to examine the profile of e-cigarette users. The purpose was to examine the characteristics, patterns of e-cigarette use and smoking status of a random sample of vapeshops customers in Greece. Fourteen vapeshops were randomly selected in the region of Athens. Every third customer buying products for personal use was recruited by a researcher visiting the vapeshops. Current smoking status was assessed by measuring exhaled carbon monoxide (eCO), with a value ≥ 7 ppm being used to classify subjects as current smokers. A questionnaire was used to examine past smoking status, patterns of e-cigarette use, changes in health status and experienced side effects. Logistic regression analysis was performed to identify correlates of being a former smoker. A total of 309 participants were analyzed, with 82.5% being daily e-cigarette users. The vast majority (98%) were smokers before e-cigarette use initiation, with 69.6% of them having eCO < 7 ppm (former smokers). Only 1% were never smokers, and 1% had quit smoking before e-cigarette use initiation; all of them had eCO < 7 ppm. Most participants were using third-generation devices (61.8%) and were using non-tobacco flavors (58.9%). The average liquid consumption was 5 mL/day. Most participants experienced health benefits, mainly improvement in physical status, exercise capacity, olfactory and gustatory senses, while the most common side effects were throat irritation and cough. The strongest correlate of being a former smoker was daily e-cigarette use. Vapeshops customers in Greece are mainly current and former smokers with the majority of them having quit smoking. E-cigarette use by never smokers is rare and none of them subsequently initiate smoking.


Electronic cigarettes Smoking Smoking cessation Nicotine Vapeshops Greece 



No funding was provided for this study.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest for the past 36 months.

Human and animal rights statement

The study was approved by the ethics committee of the National School of Public Health in Athens, Greece.

Informed consent

All participants signed a written informed consent before participating to the study.

Supplementary material

11739_2018_2011_MOESM1_ESM.pptx (41 kb)
Supplementary material 1 (PPTX 41 kb) Supplementary Figure 1. Participants’ responses to the question “Before initiating e-cigarette use, how easy or difficult did you consider quitting smoking?”


  1. 1.
    Farsalinos KE, Poulas K, Voudris V, Le Houezec J (2016) Electronic cigarette use in the European Union: analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction 111:2032–2040CrossRefGoogle Scholar
  2. 2.
    Xu Y, Guo Y, Liu K, Liu Z, Wang X (2016) E-cigarette awareness, use, and harm perception among adults: a meta-analysis of observational studies. PLoS One 11:e0165938CrossRefGoogle Scholar
  3. 3.
    ASH UK. Use of e-cigarettes (vapourisers) among adults in Great Britain. Accessed 29 Nov 2018
  4. 4.
    Farsalinos K (2018) Electronic cigarettes: an aid in smoking cessation, or a new health hazard? Ther Adv Respir Dis 12:1753465817744960CrossRefGoogle Scholar
  5. 5.
    Dawkins L, Turner J, Roberts A, Soar K (2013) “Vaping” profiles and preferences: an online survey of electronic cigarette users. Addiction 108:1115–1125CrossRefGoogle Scholar
  6. 6.
    Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V (2014) Characteristics, perceived side effects and bene fits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Int J Environ Res Public Health 11:4356–4373CrossRefGoogle Scholar
  7. 7.
    Villanti AC, Feirman SP, Niaura RS, Pearson JL, Glasser AM, Collins LK, Abrams DB (2018) How do we determine the impact of e-cigarettes on cigarette smoking cessation or reduction? Review and recommendations for answering the research question with scientific rigor. Addiction 113:391–404CrossRefGoogle Scholar
  8. 8.
    Farsalinos KE, Siakas G, Poulas K, Voudris V, Merakou K, Barbouni A (2018) Electronic cigarette use in Greece: an analysis of a representative population sample in Attica prefecture. Harm Reduct J 15:20CrossRefGoogle Scholar
  9. 9.
    Middleton ET, Morice AH (2000) Breath carbon monoxide as an indication of smoking habit. Chest 117:758–763CrossRefGoogle Scholar
  10. 10.
    Pattinson J, Lewis S, Bains M, Britton J, Langley T (2018) Vape shops: who uses them and what do they do? BMC Public Health 18:541CrossRefGoogle Scholar
  11. 11.
    Gucht DV, Adriaens K, Baeyens F (2017) Online vape shop customers who use e-cigarettes report abstinence from smoking and improved quality of life, but a substantial minority still have vaping-related health concerns. Int J Environ Res Public Health 14:E798CrossRefGoogle Scholar
  12. 12.
    Tackett AP, Lechner WV, Meier E, Grant DM, Driskill LM, Tahirkheli NN, Wagener TL (2015) Biochemically verified smoking cessation and vaping beliefs among vape store customers. Addiction 110:868–874CrossRefGoogle Scholar
  13. 13.
    Cheney MK, Gowin M, Wann TF (2016) Vapor store owner beliefs and messages to customers. Nicotine Tob Res 18:694–699CrossRefGoogle Scholar
  14. 14.
    Allem JP, Unger JB, Garcia R, Baezconde-Garbanati L, Sussman S (2015) Tobacco attitudes and behaviors of vape shop retailers in Los Angeles. Am J Health Behav 39:794–798CrossRefGoogle Scholar
  15. 15.
    Nayak P, Kemp CB, Redmon P (2016) A qualitative study of vape shop operators’ perceptions of risks and benefits of e-cigarette use and attitude toward their potential regulation by the US Food and Drug Administration, Florida, Georgia, South Carolina, or North Carolina, 2015. Prev Chronic Dis 13:E68CrossRefGoogle Scholar
  16. 16.
    Hart JL, Walker KL, Sears CG, Lee AS, Smith C, Siu A, Keith R, Ridner SL (2016) Vape shop employees: public health advocates? Tob Prev Cessat. Google Scholar
  17. 17.
    Coleman BN, Rostron B, Johnson SE, Ambrose BK, Pearson J, Stanton CA, Wang B, Delnevo C, Bansal-Travers M, Kimmel HL, Goniewicz ML, Niaura R, Abrams D, Conway KP, Borek N, Compton WM, Hyland A (2017) Electronic cigarette use among US adults in the Population Assessment of Tobacco and Health (PATH) Study, 2013–2014. Tob Control 26(e2):e117–e126CrossRefGoogle Scholar
  18. 18.
    Farsalinos KE, Poulas K, Voudris V, Le Houezec J (2017) Prevalence and correlates of current daily use of electronic cigarettes in the European Union: analysis of the 2014 Eurobarometer survey. Intern Emerg Med 12(6):757–763CrossRefGoogle Scholar
  19. 19.
    Levy DT, Yuan Z, Luo Y, Abrams DB (2018) The relationship of e-cigarette use to cigarette quit attempts and cessation: insights from a large, nationally representative US survey. Nicotine Tob Res 20:931–939CrossRefGoogle Scholar
  20. 20.
    Pearson JL, Hitchman SC, Brose LS, Bauld L, Glasser AM, Villanti AC, McNeill A, Abrams DB, Cohen JE (2018) Recommended core items to assess e-cigarette use in population-based surveys. Tob Control 27:341–346CrossRefGoogle Scholar
  21. 21.
    Etter JF (2016) A longitudinal study of cotinine in long-term daily users of e-cigarettes. Drug Alcohol Depend 160:218–221CrossRefGoogle Scholar
  22. 22.
    Polosa R, Caponnetto P, Cibella F, Le-Houezec J (2015) Quit and smoking reduction rates in vape shop consumers: a prospective 12-month survey. Int J Environ Res Public Health 12:3428–3438CrossRefGoogle Scholar
  23. 23.
    Farsalinos KE, Gillman G (2018) Carbonyl emissions in e-cigarette aerosol: a systematic review and methodological considerations. Front Physiol 8:1119CrossRefGoogle Scholar
  24. 24.
    Talih S, Salman R, Karaoghlanian N, El-Hellani A, Saliba N, Eissenberg T, Shihadeh A (2017) “Juice Monsters”: sub-ohm vaping and toxic volatile aldehyde emissions. Chem Res Toxicol 30:1791–1793CrossRefGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.National School of Public HealthAthensGreece
  2. 2.University of West AtticaAigaleoGreece
  3. 3.Onassis Cardiac Surgery CenterKallitheaGreece
  4. 4.Department of PharmacyUniversity of PatrasRioGreece

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