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Nicotine, a key ingredient in most e-liquids, is a highly addictive substance

Indeed, albeit e-cigarettes are claimed as safer than traditional smoking, their aerosol contain metals, toxic and carcinogenic molecules and a growing body of evidence in man has been showing how their use negatively impact both cardiovascular and respiratory systems, causing elevated blood pressure, arterial stiffness, vascular endothelial dysfunction, enhanced angiogenesis, cardiorenal fibrosis, accelerated atherosclerotic plaque development, elevate levels of type 2 inflammatory cytokines such as IL-4, IL-5, and IL-13, increased cellular oxidative stress, increased airway reactivity, airflow obstruction, airway inflammation, and emphysema

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To address these evidence gaps, this study aimed to quantify and compare the exposure to smoking across the EU using a wide range of smoking burden indicators and explore how these are associated with sociodemographic and tobacco control factors