The team represent the University of West Attica, National School of Public Health, Onassis Cardiac Surgery Centre, and the University of Patras. The work, “Patterns of e-cigarette use, biochemically verified smoking status and self-reported changes in health status” was published in the journal Internal and Emergency Medicine last week.
The team write: “The rising popularity of e-cigarettes has been a controversial public health issue. There is a lot of debate on whether e-cigarettes represent part of the solution in the smoking problem, used as a risk reduction strategy, or whether they simply attract non-smokers, and may increase their chance of initiating smoking.”
They believe that surveys of vapers show substantial quit smoking rates, but feel the research often experiences “self-selection bias” and does “not recruit representative samples of all consumers”. Therefore, they aimed to conduct a “real-world” study to overcome inaccurate self-report of the smoking status.
The team randomly selected 14 vape shops in Athens from a list of 132. The stores agreed to take part and researchers visited the stores three to four times per week, each visit lasting for 3-4 hours. Rather than asking every customer, only every third one was selected.
In total, 314, customers were asked to complete a survey, having had measurements and details taken. Smoking status was verified by measuring the carbon monoxide content of exhaled breath, using a calibrated device.
- 98.0% of the participants were smokers before vaping
- Only 3 participants (1.0%) said they had never smoked in the past
- 285 (92.2% of all participants) were daily smokers
- 18 (5.8%) were occasional smokers
- Daily smokers had an average daily consumption of 25 cigarettes per day
- 18 participants (5.8%) had tried using a quit smoking service
- Half had attempted to quit smoking without the use of any medications or other aids
- Most participants (94.0%) reported that they thought it would be difficult or very difficult to quit smoking before vaping
“The study identified that almost all customers were smokers at e-cigarette use initiation, while the majority were frequent (daily) e-cigarette users and were no longer smoking, as verified by eCO.”
Importantly, as the gateway myth is often touted as a reason to restrict vaping, “the small minority of customers who were not smoking at e-cigarette use initiation remained smoke-free at the time of the survey.”
“These findings appear reassuring for the concerns that e-cigarettes might be appealing to never smokers. Additionally, the fact that e-cigarette users who were not smoking at the time of initiation had eCO < 7 ppm rejects the gateway to smoking concerns, at least for adults.”
The team concluded: “This study of a random sample of adult vape shops customers in Athens showed that the vast majority were current and former smokers, with most of them being able to quit smoking after e-cigarette use initiation. The study failed to identify any gateway to smoking effects for the small minority of customers who had never smoked or had quit smoking before e-cigarette use initiation. Health benefits and limited side effects were reported, which could be a motivation for sustained e-cigarette use. The study indicates that e-cigarette use in Greece has positive public benefits, which is in agreement with a recently published population study.”
Resources:
- "Patterns of e-cigarette use, biochemically verified smoking status and self-reported changes in health status” by Farsalinos, Diamantopoulou, Barbouni, Merakou, and Lagiou - https://link.springer.com/article/10.1007/s11739-018-02011-1
