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Exposure to secondhand aerosol of electronic cigarettes in indoor settings in 12 European countries: data from the TackSHS survey
    1. 1 Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Catalonia, Spain
    2. 2 Tobacco Control Research Group, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
    3. 3 Department of Clinical Sciences, University of Barcelona (UB), L'Hospitalet de Llobregat, Catalonia, Spain
    4. 4 CIBER Respiratory Diseases (CIBERES), Madrid, Spain
    5. 5 Department of Environmental Health Sciences, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy
    6. 6 School of Public Health, Universita Vita-Salute San Raffaele, Milano, Lombardia, Italy
    7. 7 CAPHRI-School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, The Netherlands
    8. 8 Institute for Social Marketing, University of Stirling, Stirling, Scotland, UK
    9. 9 TobaccoFree Research Institute Ireland (TFRI), Dublin, Ireland
    10. 10 Respiratory DepartmentH, Hospital Universitario de la Princesa, Madrid, Spain
    1. Correspondence to Esteve Fernández, Tobacco Control Unit, Catalan Institute of Oncology (ICO), 08908 L'Hospitlet de Llobregat, Catalonia, Spain; efernandez{at}


    Introduction Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries.

    Methods In 2017–2018, we conducted a cross-sectional study, the TackSHS survey, on a representative sample of the population aged ≥15 years in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spain). We described the prevalence and duration of exposure to SHA in several indoor settings among 11 604 e-cigarette non-users. Individual-level and country-level characteristics associated with SHA exposure were also explored using multilevel logistic regression analyses.

    Results Overall, 16.0% of e-cigarette non-users were exposed to SHA in any indoor setting at least weekly, ranging from 4.3% in Spain to 29.6% in England. The median duration of SHA exposure among those who were exposed was 43 min/day. ‘Other indoor settings’ (eg, bar and restaurant) was reported as the place where most of e-cigarette non-users were exposed (8.3%), followed by workplace/educational venues (6.4%), home (5.8%), public transportation (3.5%) and private transportation (2.7%). SHA exposure was more likely to occur in certain groups of non-users: men, younger age groups, those with higher level of education, e-cigarette past users, current smokers, those perceiving SHA harmless and living in countries with a higher e-cigarette use prevalence.

    Conclusions We found inequalities of SHA exposure across and within European countries. Governments should consider extending their tobacco smoke-free legislation to e-cigarettes to protect bystanders, particularly vulnerable populations such as young people.

    Trial registration number NCT02928536.

    • electronic nicotine delivery devices
    • surveillance and monitoring
    • secondhand smoke
    • environment

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    • Collaborators Catalan Institute of Oncology (ICO); Bellvitge Biomedical Research Institute (IDIBELL), Spain: Esteve Fernández, Yolanda Castellano, Marcela Fu, Montse Ballbè, Beladenta Amalia, Olena Tigova; Public Health Agency of Barcelona (ASPB), Spain: Maria José López, Xavier Continente, Teresa Arechavala, Elisabet Henderson; Istituto di Ricerche Farmacologiche Mario Negri IRCCS (IRFMN), Italy: Silvano Gallus, Alessandra Lugo, Xiaoqiu Liu, Cristina Bosetti, Elisa Borroni, Enrico Davoli; Istituto DOXA, Worldwide Independent Network/Gallup International Association, Italy: Paolo Colombo; University of Stirling (UNISTIR), the UK: Sean Semple, Rachel O’Donnell, Ruaraidh Dobson; TobaccoFree Research Institute Ireland (TFRI), Ireland: Luke Clancy, Sheila Keogan, Hannah Byrne; Hellenic Cancer Society - George D. Behrakis Research Lab (HCS), Greece: Panagiotis Behrakis, Anna Tzortzi, Constantine Vardavas, Vergina Konstantina Vyzikidou, Gerasimos Bakelas, George Mattiampa; Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Italy: Roberto Boffi, Ario Ruprecht, Cinzia De Marco, Alessandro Borgini, Chiara Veronese, Martina Bertoldi, Andrea Tittarelli; Istituto per lo Studio, la Prevenzione, e la Rete Oncologica (ISPRO), Italy: Giuseppe Gorini, Giulia Carreras, Barbara Cortini, Simona Verdi, Alessio Lachi, Elisabetta Chellini; Polytechnic University of Cartagena (UPCT), Spain: Ángel López Nicolás, Marta Trapero-Bertran, Daniel Celdrán Guerrero; European Network on Smoking and Tobacco Prevention (ENSP), Belgium: Cornel Radu-Loghin, Dominick Nguyen, Polina Starchenko; Fundación para la Investigación Biomédica del Hospital Universitario La Princesa (IISP), Spain: Joan B Soriano, Julio Ancochea, Tamara Alonso, María Teresa Pastor, Marta Erro, Ana Roca, Patricia Pérez, Elena García Castillo.

    • Contributors BA, EF and SG had the original idea for the study; SG, XL and AL contributed to the finalisation of the survey questionnaire; BA and XL carried out the statistical analysis with the supervision of AL; BA wrote the first draft of the article in collaboration with XL, AL, MF, EF and SG; AO, SS, LC, JBS and PAvdB made substantial contributions to conception, design and interpretation of data; all the authors contributed to manuscript preparation and approved its final version prior to submission. SG and EF are the guarantors.

    • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 681040. BA received the support of a fellowship from 'La Caixa' Foundation (ID 100010434; Fellowship code: LCF/BQ/IN17/11620013). AL was supported by a fellowship from the Italian Association for Cancer Research (AIRC). The Tobacco Control Research Group at ICO-IDIBELL (BA, EF and MF) is partly supported by the Ministry of Universities and Research, Government of Catalonia (2017SGR319) and thanks CERCA Programme Generalitat de Catalunya for the institutional support to IDIBELL. EF is partly supported by the Instituto de Salud Carlos III, Government of Spain, cofunded by the European Regional Development Fund (FEDER; INT16/00211 and INT17/00103). The work of SG was partially funded by the Italian League Against Cancer (LILT, Milan).

    • Disclaimer This paper reflects only the authors' views and the European Commission is not responsible for any use that may be made of the information it contains.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval We obtained the approval from a local ethics committee in each of the 12 countries. The study protocol has been registered in (ID: NCT02928536). All respondents received detailed information about the survey before they provided their consent to participate.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Please see at the conditions of use and how to request the data.