Vol.:(0123456789) 1 3 Internal and Emergency Medicine https://doi.org/10.1007/s11739-018-02011-1 IM - ORIGINAL Patterns of e‑cigarette use, biochemically verified smoking status and self‑reported changes in health status of a random sample of vapeshops customers in Greece Eleni Diamantopoulou 1  · Anastasia Barbouni 1  · Kyriakoula Merakou 1  · Areti Lagiou 2  · Konstantinos Farsalinos 1,3,4 Received: 29 October 2018 / Accepted: 13 December 2018 © Società Italiana di Medicina Interna (SIMI) 2019 Abstract To understand the population impact of e-cigarettes, it is important to examine the profile of e-cigarette users. The purpose was to examine the characteristics, patterns of e-cigarette use and smoking status of a random sample of vapeshops custom- ers in Greece. Fourteen vapeshops were randomly selected in the region of Athens. Every third customer buying products for personal use was recruited by a researcher visiting the vapeshops. Current smoking status was assessed by measuring exhaled carbon monoxide (eCO), with a value ≥ 7 ppm being used to classify subjects as current smokers. A questionnaire was used to examine past smoking status, patterns of e-cigarette use, changes in health status and experienced side effects. Logistic regression analysis was performed to identify correlates of being a former smoker. A total of 309 participants were analyzed, with 82.5% being daily e-cigarette users. The vast majority (98%) were smokers before e-cigarette use initiation, with 69.6% of them having eCO < 7 ppm (former smokers). Only 1% were never smokers, and 1% had quit smoking before e-cigarette use initiation; all of them had eCO < 7 ppm. Most participants were using third-generation devices (61.8%) and were using non-tobacco flavors (58.9%). The average liquid consumption was 5 mL/day. Most participants experienced health benefits, mainly improvement in physical status, exercise capacity, olfactory and gustatory senses, while the most common side effects were throat irritation and cough. The strongest correlate of being a former smoker was daily e-cigarette use. Vapeshops customers in Greece are mainly current and former smokers with the majority of them having quit smoking. E-cigarette use by never smokers is rare and none of them subsequently initiate smoking. Keywords Electronic cigarettes · Smoking · Smoking cessation · Nicotine · Vapeshops · Greece Introduction Awareness and use of e-cigarette has increased rapidly in recent years. In the European Union, 11.6% of the popula- tion aged 15 years or older (approximately 48.5 million citi- zens) had tried e-cigarettes, and 1.8% were current users in 2014 [1]. Growing awareness and use of e-cigarettes has also been observed in the USA [2], while in Great Britain there were 3.2 million adult e-cigarette users (6.2% of the adult population), including 1.7 million former smokers (52% of all users), in 2018 [3]. 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 [4]. Additionally, their effect on smoking cessation and reduction is also a matter of debate and disagreement. Obviously, a public health benefit This article is a part of the Topical Collection: Health Impact of Electronic Cigarettes and Tobacco Heating Systems. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11739-018-02011-1) contains supplementary material, which is available to authorized users. * Konstantinos Farsalinos kfarsalinos@gmail.com 1 National School of Public Health, Alexandras Av. 196, 11521 Athens, Greece 2 University of West Attica, 12243 Aigaleo, Greece 3 Onassis Cardiac Surgery Center, Sygrou 356, 17674 Kallithea, Greece 4 Department of Pharmacy, University of Patras, 26500 Rio, Greece