E-cigarette use is strongly associated with smoking cessation in the European Union

By Dr Konstantinos Farsalinos

A study published recently in the journal Tobacco Control examined the association between e-cigarette use and smoking in the Eurobarometer 2017 survey. Last year, another study analyzed the 2014 Eurobarometer, finding that e-cigarette use prevents smoking cessation in Europe. But the study design and conclusion was flawed since the 2014 survey included all former smokers as one group, including the majority who had quit long before e-cigarettes were available. Thankfully, the 2017 survey included a question about time of smoking cessation, so we could analyze former smokers who had quit during the period when e-cigarettes were available.

Unsurprisingly, and in agreement with other studies, we found a strong association between current daily e-cigarette use and being a former (rather than a current) smoker. Specifically, we found that daily e-cigarette use was associated with 5-fold higher odds of having quit smoking in 2015-2017, and with 3-fold higher odds of having quit smoking in 2012-2015. Another important finding of the study was that e-cigarette use was extremely rare among former smokers who had quit before the availability of e-cigarettes, showing that e-cigarettes do not result in relapse to an inhalational habit for these former smokers.

The study provides additional evidence that smokers who are unable or unwilling to quit with other approved methods should be encouraged to switch to e-cigarettes. Unfortunately the current global environment is so intimidating that smokers are discouraged from using e-cigarettes while vapers are relapsing back to smoking due to fear about their health. This is an irony and is in complete disagreement with research on e-cigarettes safety/risk profile and efficacy as smoking substitutes. Unfortunately, emotions, dogmatism and politics are currently prevailing over scientific evidence, and this is damaging for public health. I hope the European authorities will consider the current and many other studies, and take appropriate steps to tackle the misinformation on e-cigarettes.

Konstantinos Farsalinos, MD, MPH is a cardiologist and research fellow at the Onassis Cardiac Surgery Center in Athens-Greece, at the Department of Pharmacy, University of Patras-Greece and at the National School of Public Health-Greece. He is specialized in echocardiography and in smoking and tobacco harm reduction research. He was the lead researcher in Intervendor Study, a joint research project of the European and American Societies of Echocardiography. He has been conducting laboratory, clinical and epidemiological research on smoking, tobacco harm reduction and e-cigarettes as principal investigator since 2011. He has published more than 70 studies and articles in international peer-reviewed scientific journals about smoking, tobacco harm reduction, and e-cigarettes. He was the handling editor and author in a book titled “Analytical assessment of e-cigarettes”, published by Elsevier in 2017.