E-cigarettes Associated With Depressed Smoking Cessation: A Cross-sectional Study of 28 European Union Countries

Am J Prev Med. 2018 Apr;54(4):603-609. doi: 10.1016/j.amepre.2017.12.017. Epub 2018 Feb 12.


Introduction: Electronic cigarettes (e-cigarettes) are often promoted to assist with cigarette smoking cessation. In 2016-2017, the relationship between e-cigarette use and having stopped smoking among ever (current and former) smokers was assessed in the European Union and Great Britain by itself.

Methods: Cross-sectional logistic regression of the association between being a former smoker and e-cigarette use was applied to the 2014 Eurobarometer survey of 28 European Union countries controlling for demographics.

Results: Among all ever smokers, any regular ever use of nicotine e-cigarettes was associated with lower odds of being a former smoker (unadjusted OR=0.34, 95% CI=0.26, 0.43, AOR=0.43, 95% CI=0.32, 0.58) compared with smokers who had never used e-cigarettes. In unadjusted models, daily use (OR=0.42, 95% CI=0.31, 0.56); occasional use (OR=0.25, 95% CI=0.18, 0.35); and experimentation (OR=0.24, 95% CI=0.19, 0.30) of nicotine e-cigarettes were associated with lower odds of being a former smoker compared with having never used nicotine-containing e-cigarettes. Comparable results were found in adjusted models. Results were similar in Great Britain alone. Among current smokers, daily cigarette consumption was 15.6 cigarettes/day (95% CI=14.5, 16.7) among those who also used e-cigarettes versus 14.4 cigarettes/day (95% CI=13.4, 15.4) for those who did not use them (p<0.05).

Conclusions: These results suggest that e-cigarettes are associated with inhibiting rather than assisting in smoking cessation. On the population level, the net effect of the entry of e-cigarettes into the European Union (and Great Britain) is associated with depressed smoking cessation of conventional cigarettes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Datasets as Topic
  • Electronic Nicotine Delivery Systems / statistics & numerical data*
  • European Union
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nicotine / adverse effects*
  • Smoking / epidemiology*
  • Smoking / therapy
  • Smoking Cessation / methods*
  • Smoking Cessation / statistics & numerical data
  • Tobacco Products / statistics & numerical data
  • United Kingdom / epidemiology


  • Nicotine