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Tob Control. 2019 Jan 18. pii: tobaccocontrol-2018-054726. doi: 10.1136/tobaccocontrol-2018-054726. [Epub ahead of print]

Electronic cigarettes in Italy: a tool for harm reduction or a gateway to smoking tobacco?

Author information

Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy.
National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy.
Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), School of Medicine, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.



More than a decade after electronic cigarettes (e-cigarette) hit the European market, we are still debating whether they may help or hinder tobacco control. It is therefore useful to explore the potential net effect of e-cigarette use in the general population.


We annually conduct a face-to-face survey on smoking in Italy on a representative sample of the general population aged 15 years or over (52.4 million). A total of 15 406 subjects were interviewed in 2014-2018. We investigated the consequences of using e-cigarettes on tobacco smoking behaviour among ever and regular e-cigarette users.


In all, 5.7% of our sample reported ever e-cigarette use. Multivariate analyses showed more use by men, ex-smokers and current smokers. E-cigarette use decreased with age and increased with education and calendar year. Only 1.1% of subjects were regular e-cigarette users. This prevalence rose from 0.4% in 2014-2015 to 1.8% in 2016-2017 and was 1.3% in 2018. Among 522 ever users, 13.2% stopped smoking after trying e-cigarettes and 22.2% started smoking or relapsed after using e-cigarettes. The corresponding estimates among regular users were 24.7% and 28.0%, respectively.


Among Italian e-cigarette users, those (re)starting smoking after using e-cigarettes outnumber those who stop smoking after using e-cigarettes. From a public health point of view, e-cigarettes may have an unfavourable net effect. Consequently, if we are not able to prevent sales of e-cigarettes to non-smokers, this product will more likely stimulate smoking tobacco than reduce harm.


cessation; denormalization; electronic nicotine delivery devices; harm reduction

Conflict of interest statement

Competing interests: None declared.

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