Characteristics and correlates of electronic cigarette product attributes and undesirable events during e-cigarette use in six countries of the EUREST-PLUS ITC Europe Surveys
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European Network on Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
University of Crete (UoC), Heraklion, Greece
University of Athens (UoA), Athens, Greece
King’s College London (KCL), London, United Kingdom
Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
Institut Català d’Oncologia (ICO) and Bellvitge Biomedical Research Institute (IDIBELL), Catalonia, Spain
School of Medicine and Health Sciences, Universitat de Barcelona, Catalonia, Spain
Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
University of Medicine and Pharmacy ‘Grigore T.Popa’, Iasi, Romania
Aer Pur Romania, Bucharest, Romania
Health Promotion Foundation (HPF), Warsaw, Poland
London School of Hygiene and Tropical Medicine, London, United Kingdom
University of Waterloo (UW), Waterloo, Canada
Ontario Institute for Cancer Research, Toronto, Canada
Publish date: 2018-08-05
Tob. Induc. Dis. 2018;16(Suppl 2):A1
*EUREST PLUS Consortium List as collaborators: European Network on Smoking and Tobacco Prevention (ENSP), Belgium: Constantine Vardavas, Andrea Glahn, Christina N. Kyriakos, Dominick Nguyen, Cornel Radu-Loghin, Polina Starchenko University of Crete (UoC), Greece: Aristidis Tsatsakis, Charis Girvalaki, Sophia Papadakis, Manolis Tzatzarakis, Alexander Vardavas Kantar Public (TNS), Belgium: Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière Smoking or Health Hungarian Foundation (SHHF), Hungary: Tibor Demjén, Judit Kiss, Anna Piroska Kovacs Catalan Institut of Oncology (ICO); Bellvitge Biomedical Research Institute (IDIBELL), Spain: Esteve Fernández, Yolanda Castellano, Marcela Fu, Olena Tigova, Sarah Nogueira Kings College London (KCL), United Kingdom: Ann McNeill, Katherine East, Sara C. Hitchman Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Germany: Ute Mons, Sarah Kahnert University of Athens (UoA), Greece: Yannis Tountas, Panagiotis Behrakis, Filippos T. Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Ioanna Petroulia, Chara Tzavara University of Medicine and Pharmacy ‘Grigore T.Popa’ Iasi, Romania: Antigona Trofor, Marius Eremia, Lucia Lotrean, Florin Mihaltan European Respiratory Society (ERS), Switzerland; Goethe University Frankfurt, Germany: Gernot Werde, Tamaki Asano, Claudia Cichon, Amy Far, Céline Genton, Melanie Jessner, Linnea Hedman, Christer Janson, Ann Lindberg, Beth Maguire, Sofia Ravara, Valérie Vaccaro, Brian Ward University of Maastricht (UniMaas), Netherlands: Marc Willemsen, Hein de Vries, Karin Hummel, Gera Nagelhout Health Promotion Foundation (HPF), Poland: Witold A. Zatoński, Aleksandra Herbeć, Kinga Janik- Koncewicz, Krzysztof Przewoźniak, Mateusz Zatoński University of Waterloo (UW); Ontario Institute for Cancer Research, Canada: Geoffrey T. Fong, Thomas Agar, Pete Driezen, Shannon Gravely, Anne C.K. Quah, Mary E. Thompson
This study assessed characteristics and correlates associated with e-cigarette product attributes and identified correlates of experiencing undesirable events during e-cigarette use among adult smokers across six European Union (EU) Members States (MS) prior to the implementation of the Tobacco Products Directive (TPD) in 2016.

We conducted a cross-sectional survey with a nationally representative sample of adult cigarette smokers from six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) reporting e-cigarette use; randomly selected through a multistage cluster sampling design from June to September 2016. Stepwise logistic regressions were used to identify factors associated with use of flavors, noticing health warnings, mixing e-liquids, experiencing ‘dry puff’, e-liquid leaking during use and e-liquid spilling during refill.

Current daily or weekly prevalence of e-cigarette use among this sample of adult smokers was 7.5%. The most common attributes of e-cigarettes used included those that are flavored, contain nicotine, and are of tank style. Noticing health warnings on e-cigarette packaging and leaflets, respectively, was low (10.2% and 28%, respectively). Use of e-liquid refill nozzle caps, described as easy for a child to open, was associated with spilling during refill (OR=6.73; 95% CI: 2.02–22.37). Participants who adjusted occasionally or regularly the power (voltage) or temperature of their e-cigarette had greater odds of ever experiencing a ‘dry puff’ (OR=6.01; 95% CI: 2.68–13.46). Mixing different e-liquids was associated with leaking during use (OR=7.78; 95% CI: 2.45–24.73) and spilling during refill (OR=8.54; 95% CI: 2.29–31.88).

Ongoing evaluation of factors associated with e-cigarette attributes and of the correlates of experiencing e-cigarette undesirable events during use, related to product design, is crucial to monitoring the impact of the implementing Acts of the EU TPD.

Christina N. Kyriakos   
European Network for Smoking and Tobacco Prevention (ENSP), Belgium, Chaussee d’Ixelles 144, 1050 Brussels, Belgium
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