Introduction:
Aim: To describe the prevalence of e-cigarette use and exposure to e-cigarette aerosols in public settings in 6 European countries

Material and Methods:
We used baseline data (2016) of the International Tobacco Control 6 European (ITC 6E Country Survey) under the EUREST-PLUS Project and part of the larger ITC Project, conducted in national representative samples of 1,000 adult smokers per country in Germany, Greece, Hungary, Poland, Romania, and Spain. This analysis focuses on participants’ awareness of e-cigarettes (n=4,142). We described the prevalence of e-cigarette use in different settings as seen by participants in the last month (general public places, indoor settings banning smoking cigarettes, and workplaces) overall, by socio-demographics and according to participants’ e-cigarette use. We described how frequently non-users felt exposed to e-cigarette aerosols by independent variables, and how comfortable users felt using e-cigarettes around other people, overall and by country.

Results:
31.0% of participants had seen people using e-cigarettes in general public places (from 12.3% in Spain to 55.2% in Greece), mainly among men, participants aged 18-24, highly educated, and current e-cigarette users. Overall, 19.7% of participants had seen using e-cigarettes in indoor places where smoking cigarettes was forbidden and 14.5% in workplaces. Among non-users seeing others using e-cigarettes in public places (n=3,979), 3.6% reported feeling exposed to e-cigarettes’ aerosol “frequently” and 33.1% “occasionally” (lowest in Spain and highest in Greece). Among 109 e-cigarette users, 43.1% felt comfortable using them around other people, 48.1% felt neutral, and 8.8% felt uncomfortable. Similar trends were observed by country, except in Greece and Romania, where highest prevalence was observed in those feeling comfortable (59.1% and 48.7%, respectively).

Conclusions:
Prevalence of use and exposure to e-cigarettes as seen by European smokers is variable among countries. The perception of exposure to aerosols is high.

Funding Statement:
The EUREST-PLUS Study takes place with the financial support of the European Commission, Horizon 2020 HCO-6-2015 program (EUREST-PLUS: 681109; C. Vardavas) and the University of Waterloo (GT. Fong). Additional support was provided to the University of Waterloo by the Canadian Institutes of Health Research (FDN-148477). GT. Fong was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research.