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

Citation

Amalia B, Rodríguez A, Henderson E, Fu M, Continente X, Tigova O, Semple S, Clancy L, Gallus S, Fernández E, López MJ & the TackSHS Project Investigators (2021) How widespread is electronic cigarette use in outdoor settings? A field check from the TackSHS project in 11 European countries. Environmental Research, 193, Art. No.: 110571. https://doi.org/10.1016/j.envres.2020.110571

Abstract
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
e-cigarette; Electronic nicotine delivery systems; Passive exposure; Outdoor settings

Journal
Environmental Research: Volume 193

• Accepted manuscript