Electronic cigarette use in Greece: an analysis of a representative population sample in Attica prefecture

Background: The purpose was to assess prevalence and correlates of electronic cigarette (e-cigarette) use in Greece in 2017. Methods: A cross-sectional survey of a representative sample of 4058 adults living in Attica prefecture (35% of the Greek adult population) was performed in May 2017 through telephone interviews. Prevalence and frequency of e-cigarette use were assessed according to the smoking status, and logistic regression analysis was performed to identify correlates of use. Results: Current smoking was reported by 32.6% of participants. Ever e-cigarette use was reported by 54.1% (51.4-56.8%) of current smokers, 24.1% (21.7-26.5%) of former smokers and 6.5% (5.3-7.7%) of never smokers. Past experimentation was the most prevalent pattern of e-cigarette use among ever users (P < 0.001). Almost 80% of ever and 90% of current e-cigarette users were using nicotine. Extrapolated to the whole Attica population (3.1 million), there were 1 million current smokers, 848,000 ever e-cigarette users and 155,000 current e-cigarette users. The majority of current e-cigarette users (62.2%) were former smokers. Only 0.2% of never smokers were current e-cigarette users. One out of 20 participants considered e-cigarettes a lot less harmful than smoking. Being current or former smoker were the strongest correlates current e-cigarette use (OR 30.82, 95% CI 10. 21-69.33 and OR 69.33, 95% CI 23.12-207.90 respectively). Conclusions: E-cigarette use in Greece is largely confined to current or former smokers, while current use and nicotine use by never smokers is extremely rare. The majority of current e-cigarette users were former smokers. Most participants overestimate the harmfulness of e-cigarettes relative to smoking.