The authors developed an online questionnaire that was available in 10 languages – Czech, English, French, German, Greek, Hungarian, Italian, Polish, Russian, and Spanish. Responses were collected between April 2013 and July 2013. Participants were over the age of 18 and “current, former or never smokers were eligible.”
The authors identified current and former smokers, which were used in the sample. The authors separately evaluated e-cigarette users that reported no prior combustible cigarette use.
A total of “19,441 participants were included in the analysis, with 88 (0.5%) mentioning that they were not smokers while 19,353 reported being smokers before initiating [e-cigarette] use.” Overwhelmingly, participants were from Europe as reported by 74.7 percent of survey respondents, and 20.7 percent were from America, 1.8 percent from Asia, 1.1 percent from Australia, and 0.2 percent from Africa. Of the total sample, 81 percent reported “they had completely quit smoking at the time of participation to the survey.”
The authors found that former smokers had smoked for a longer duration that current smokers. Nearly “one-third of current smokers were smoking occasionally (less than daily) while the rest mentioned that their daily consumption was reduced from 20 to 4 cigarettes per day.”
The median duration of e-cigarette use “was 10 months, with 97.1% using it on a daily basis.” A majority of participants reported using second generation vaping devices and mods, “while only 3.7% reporting using cigarette-like devices.” Over one-third of participants reported using DIY liquids, and the authors observed a reduction in nicotine strengths from 18mg at initiation to 12mg at the time of the survey.
Overwhelmingly, survey participants reported using e-cigarettes to “reduce or completely quit smoking and to reduce exposure of family members to second-hand smoking.”
Regarding health-related issues due to their e-cigarette use, 57.9 percent of participants reported “at least one adverse symptom,” with the most commonly reported symptom being “sore or dry mouth and throat.” More than 90 percent of participants reported adverse symptoms being resolved.
Survey participants also reported improved health. Indeed, more than half “reported better breathing, olfactory and gustatory senses, endurance and physical status in general after initiation of [e-cigarette] use.” Further, “former smokers reported more beneficial effects compared to current smokers.” Regarding chronic health conditions, former smokers reported improvements to their condition, and “the highest proportion reporting improvement were participants with COPD.”
The authors conclude that based on their findings, “it seems that [e-cigarettes] are used as long-term substitutes to smoking,” and their use “can be effective even in subjects who are highly dependent on smoking and are heavy smokers.”
Implications: This study was one of the first worldwide surveys of e-cigarette users with a significant number of participants. Its findings suggest that many e-cigarette users use such products to quit smoking and report reduced harms, as well as report smoking cessation.
Background: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use.
Methods: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers.
Results: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions.
Conclusions: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.
Tobacco and Alcohol News Analysis and Commentary, Huge Survey of Dedicated Electronic Cigarette Users Confirms that Quitting Smoking or Greatly Reducing the Amount Smoked are the Main Reasons for Vaping, 2014Read Report