Background:
In Europe, after an initial rapid spread of electronic cigarettes, their use increased only slightly. Also, in Italy, the prevalence of adult ever users remained stable, around 5% in 2013–2018. There is a lack of information on the patterns and settings of electronic cigarette use and on its possible adverse events.

Objective:
To fill this knowledge gap, we conducted a survey among Italian ever smokers attending selected Italian smoking cessation services (SCS).

Methods:
From June 2016 to July 2018, 395 adult ever smokers who were also current or former electronic cigarette users, were enrolled from 12 SCSs of the Associazione Italiana Pneumologi Ospedalieri (AIPO) from northern, central and southern Italy.

Results:
In all, 12.4% of ever smokers were regular, 9.4% occasional, and 78.2% past users of electronic cigarettes. Among ever users, 93.8% consumed electronic cigarettes with nicotine, 95.9% used refillable devices, 76.6% purchased an electronic cigarette device or its liquid in vape shops. The mean duration of use was 3.7 months and the mean number of puffs per day was 86. Overall, 71.5% used electronic cigarettes in at least one smoke-free indoor environment, 53.7% in workplaces, 49.5% in restaurants and bars, 33.5% in train/metro stations or airports, and 18.4% in public transport. The use of electronic cigarettes in smoke-free environments significantly decreased with age and increased with duration of use and nicotine dependence. In our sample, 47.1% reported at least one adverse event attributable to electronic cigarette use, 19.5% dry cough, 12.0% dry mouth, 7.6% throat or mouth irritation, and 6.8% sore throat.

Conclusions:
In Italy, most conventional cigarette smokers use electronic cigarettes where smoking conventional cigarettes is prohibited. About half of users reported one or more symptoms attributable to electronic cigarettes, despite the relatively short duration of use, suggesting that they should not be underestimated.