How widespread is electronic cigarette use in outdoor settings? A field check from the TackSHS project in 11 European countries

Environ Res. 2021 Feb:193:110571. doi: 10.1016/j.envres.2020.110571. Epub 2020 Dec 3.


Exposure to secondhand aerosol from electronic cigarettes (e-cigarettes) may pose harms to bystanders, but they are used in many indoor settings. Less evidence exists on e-cigarette use in outdoor settings. This study aims to assess the use of e-cigarettes in outdoor settings in Europe. A cross-sectional study was conducted at the entrances of primary schools (N = 200), children's playgrounds (N = 200), and outdoor hospitality venues (N = 220) during 2017-2018 in major cities of 11 European countries. We performed 30-min observations and recorded e-cigarette use at three-time points: at 0 min, 15 min, and 30 min. We described the number and proportion of settings with e-cigarette use observed at any of the three-time points according to country and other contextual variables. Results showed that there were 22 (11.0%) school entrances, eight (4.0%) playgrounds, and 47 (21.3%) outdoor hospitality venues where e-cigarette use was observed at any time point. School entrances and outdoor hospitality venues with observed e-cigarette use were more frequently found in countries with a higher prevalence (≥1.4%) of e-cigarette use (school entrances: 18.0% vs. 4.0%; p = 0.002, outdoor hospitality venues: 26.7% vs. 15.0%, p = 0.036). In conclusion, the outdoor setting with the highest visibility of e-cigarette use was outdoor areas of hospitality venues. Although still limited, e-cigarettes were also used in outdoor settings frequented by children. Governments should consider measures to restrict e-cigarette use outdoors to protect the health of bystanders, particularly in areas where children may be present.

Keywords: Electronic nicotine delivery systems; Outdoor settings; Passive exposure; e-cigarette.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cities
  • Cross-Sectional Studies
  • Electronic Nicotine Delivery Systems*
  • Europe / epidemiology
  • Humans
  • Tobacco Smoke Pollution* / analysis
  • Vaping*


  • Tobacco Smoke Pollution