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E-cigarette use is strongly associated with recent smoking cessation: an analysis of a representative population sample in Greece

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The purpose was to examine the association between e-cigarette use and smoking cessation according to quit duration in Greece in 2017. A cross-sectional survey of a representative sample of adults living in Attica prefecture was performed in May 2017 through telephone interviews. The present analysis was confined to current and former smokers (n = 2568). Logistic regression analyses were performed with current and current daily e-cigarette use being the dependent variables and demographics and smoking status (current smokers vs smoking cessation for ≤ 12 months, 13–36 months, 36–72 months, and > 72 months) being independent variables. Almost half of former smokers (47.7%) had quit smoking for ≤ 72 months. Current e-cigarette use was more prevalent among former smokers of ≤ 12 months (26.2%) and 13–36 months (27.0%), and was rare among former smokers of > 72 months (1.0%). Current e-cigarette use was strongly associated with smoking cessation for ≤ 12 months (OR 6.12, 95% CI 4.11–9.10, P < 0.001) and 13–36 months (OR 6.28, 95% CI 4.25–9.28, P < 0.001). Current daily e-cigarette use was also strongly associated with smoking cessation for ≤ 12 months (OR 10.41, 95% CI 6.56–16.53, P < 0.001) and 13–36 months (OR 11.18, 95% CI 7.12–17.55, P < 0.001). Current and current daily e-cigarette use were not significantly associated with smoking cessation for 37–72 months, and were negatively associated with smoking cessation for > 72 months. Current and current daily e-cigarette use are strongly associated with recent smoking cessation in Greece, suggesting a positive public health impact in a country with the highest prevalence of smoking in the European Union. E-cigarettes do not appear to promote relapse in long term former smokers. Duration of smoking cessation and frequency of e-cigarette use should be taken into consideration when examining the association between e-cigarette use and smoking cessation in population studies.

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  1. Farsalinos K (2018) Electronic cigarettes: an aid in smoking cessation, or a new health hazard? Ther Adv Respir Dis 12:1753465817744960

    Article  Google Scholar 

  2. Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C et al (2013) EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study. PLoS One 8:e66317

    Article  CAS  Google Scholar 

  3. Bullen C, Howe C, Laugesen M, McRobbie H, Parag V, Williman J et al (2013) Electronic cigarettes for smoking cessation: a randomised controlled trial. Lancet 382:1629–1637

    Article  Google Scholar 

  4. Adriaens K, Van Gucht D, Declerck P, Baeyens F (2014) Effectiveness of the electronic cigarette: an 8-week Flemish study with 6-month follow-up on smoking reduction, craving and experienced benefits and complaints. Int J Environ Res Public Health 11:11220–11248

    Article  Google Scholar 

  5. Halpern SD, Harhay MO, Saulsgiver K, Brophy C, Troxel AB, Volpp KG (2018) A pragmatic trial of e-cigarettes, incentives, and drugs for smoking cessation. N Engl J Med 378(24):2302–2310.

    Article  PubMed  Google Scholar 

  6. Borderud SP, Li Y, Burkhalter JE, Sheffer CE, Ostroff JS (2014) Electronic cigarette use among patients with cancer: characteristics of electronic cigarette users and their smoking cessation outcomes. Cancer 120(22):3527–3535. 2014 Sep 22)

    Article  PubMed  Google Scholar 

  7. Brose LS, Hitchman SC, Brown J, West R, McNeill A (2015) Is the use of electronic cigarettes while smoking associated with smoking cessation attempts, cessation and reduced cigarette consumption? A survey with a 1-year follow-up. Addiction 110:1160–1168

    Article  Google Scholar 

  8. Manzoli L, Flacco ME, Fiore M, La Vecchia C, Marzuillo C, Gualano MR, Liguori G, Cicolini G, Capasso L, D’Amario C, Boccia S, Siliquini R, Ricciardi W, Villari P (2015) Electronic cigarettes efficacy and safety at 12 months: cohort study. PLoS One 10(6):e0129443. 2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. 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 113:391–404

    Article  Google Scholar 

  10. Farsalinos KE, Stimson GV (2014) Is there any legal and scientific basis for classifying electronic cigarettes as medications? Int J Drug Policy 25(3):340–345.

    Article  PubMed  Google Scholar 

  11. European Commission (2017) Eurobarometer 458. Attitudes of Europeans towards tobacco and electronic cigarettes. Accessed 9 Oct 2018

  12. 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(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Filippidis FT (2016) Tobacco control: a victim of political instability in Greece. Lancet 387:338–339

    Article  Google Scholar 

  14. Joossens L, Raw M (2016) The Tobacco Control Scale 2016 in Europe. Accessed 30 Nov 2018

  15. Delnevo CD, Giovenco DP, Steinberg MB, Villanti AC, Pearson JL, Niaura RS, Abrams DB (2016) Patterns of electronic cigarette use among adults in the United States. Nicotine Tob Res 18(5):715–719.

    Article  PubMed  Google Scholar 

  16. Farsalinos KE, Spyrou A, Tsimopoulou K, Stefopoulos C, Romagna G, Voudris V (2014) Nicotine absorption from electronic cigarette use: comparison between first and new-generation devices. Sci Rep 26(4):4133

    Google Scholar 

  17. Kulik MC, Lisha NE, Glantz SA (2018) E-cigarettes associated with depressed smoking Cessation: a cross-sectional study of 28 European Union Countries. Am J Prev Med 54:603–609

    Article  Google Scholar 

  18. Amato MS, Boyle RG, Levy D (2016) How to define e-cigarette prevalence? Finding clues in the use frequency distribution. Tob Control 25:e24–e29

    Article  Google Scholar 

  19. Levy DT, Yuan Z, Luo Y, Abrams DB (2017) The relationship of e-cigarette use to cigarette quit attempts and cessation: insights from a large, nationally representative US Survey. Nicotine Tob Res.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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 12:757–763

    Article  Google Scholar 

  21. Hartwell G, Thomas S, Egan M, Gilmore A, Petticrew M (2017) E-cigarettes and equity: a systematic review of differences in awareness and use between sociodemographic groups. Tob Control 26:e85–e91

    Article  Google Scholar 

  22. Piñeiro B, Correa JB, Simmons VN, Harrell PT, Menzie NS, Unrod M, Meltzer LR, Brandon TH (2016) Gender differences in use and expectancies of e-cigarettes: online survey results. Addict Behav 52:91–97

    Article  Google Scholar 

  23. Friedman AS, Horn SJL (2018) Socioeconomic disparities in electronic cigarette use and transitions from smoking. Nicotine Tob Res.

    Article  Google Scholar 

  24. Giovenco DP, Lewis MJ, Delnevo CD (2014) Factors associated with E-cigarette use: a national population survey of current and former smokers. Am J Prev Med 47:476–480

    Article  Google Scholar 

  25. 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 111:2032–2040

    Article  Google Scholar 

  26. Adkison SE, O’Connor RJ, Bansal-Travers M et al (2013) Electronic nicotine delivery systems: international tobacco control four-country survey. Am J Prev Med 44:207–215

    Article  Google Scholar 

  27. King BA, Patel R, Nguyen KH, Dube SR (2015) Trends in awareness and use of electronic cigarettes among US adults, 2010–2013. Nicotine Tob Res 17:219–227

    Article  Google Scholar 

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Correspondence to Konstantinos Farsalinos.

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Authors report no conflicts of interest for the past 36 months.

Statement of human and animal rights

This study was approved by the ethics committee of the Onassis Cardiac Surgery Center (reference nr: 591/14.12.16).

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All participants provided verbal informed consent at the beginning of the telephone interview before participating to the study.

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This article is part of the Topical Collection: Health Impact of Electronic Cigarettes and Tobacco Heating Systems.

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Farsalinos, K., Siakas, G., Poulas, K. et al. E-cigarette use is strongly associated with recent smoking cessation: an analysis of a representative population sample in Greece. Intern Emerg Med 14, 835–842 (2019).

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