Trends in electronic cigarette use in England Robert West Emma Beard Jamie Brown University College London Updated 4 th May 2016

Background Electronic cigarette use has become prevalent in many countries In England, electronic cigarettes are currently regulated as consumer products It is important to track use of electronic cigarettes and assess how far they appear to be promoting or detracting from reduction in prevalence of cigarette smoking 2

Aims To track use of electronic cigarettes over time and assess how far any increase is accompanied by changes in: –use of other aids to cessation or smoking reduction –key performance indicators for tobacco control smoking prevalence smoking cessation rates attempts to stop smoking success of attempts to stop smoking To assess prevalence of use of electronic cigarettes in people who have never smoked regularly or stopped for more than a year To estimate changes in the total tobacco and nicotine market 3

Methods 4 Monthly household surveys Each month involves a new representative sample of ~1800 respondents; smokers ~450 Data collected on electronic cigarettes since second quarter 2011 Fidler, et al., 'The smoking toolkit study': a national study of smoking and smoking cessation in England. BMC Public Health 11:479 For more info see

Nicotine use by never smokers and long-term ex-smokers 5 E-cigarette use by never smokers remains negligible but use among long- term ex-smokers has grown N=38414 never and long-term ex-smokers from Nov 2013

Prevalence of electronic cigarette use: smokers and recent ex-smokers 6 N=20760 adults who smoke or who stopped in the past year; increase p<0.001 Use of e-cigarettes in smokers and recent ex- smokers is growing slowly

Proportion of e-cigarette and NRT users who are smokers 7 N=2496 e-cigarette users and N=1344 NRT users of adults The majority of both e-cigarette and NRT users are ‘dual users’ (also smoke)

Electronic cigarette use 8 N=2406 e-cigarette users not using NRT

Electronic cigarette and NRT use across the age range 9 Prevalence of e-cigarette use is broadly evenly distributed across the age range while NRT use is lower among younger people N=12,464 adults who smoke or who stopped in the past year and were surveyed between

Electronic cigarette and NRT use in men and women 10 Prevalence of e-cigarette and NRT use is slightly higher in women N=12,464 adults who smoke or who stopped in the past year and were surveyed between

Electronic cigarette and NRT use across the social gradient 11 Higher social grades are more likely to use e-cigarettes while there is no clear gradient for NRT N=12,464 adults who smoke or who stopped in the past year and were surveyed between

Use of nicotine products while smoking 12 N=19393 smokers, increase p<0.001 e-cigs and all nicotine; decrease p<0.001 for NRT E-cigarette use may be increasing slowly among smokers

Use of nicotine products in recent ex- smokers 13 N=1367 adults who stopped in the past year; increase p<0.001 for e-cigs and all nicotine; decrease p<0.001 for NRT E-cigarette use is increasing among ex-smokers

Aids used in most recent quit attempt 14 N=11375 adults who smoke and tried to stop or who stopped in the past year; method is coded as any (not exclusive) use E-cigarette use for quitting is still increasing

E-cigarette use after quitting 15 N=826 adults who stopped in the past year and did not report using an e-cigarette to help during the quit attempt The proportion of recent ex-smokers who started using an e-cigarette after they quit appears to be increasing

Take-up of smoking 16 N=16067 people aged Proportion of people under 25 years who have ever smoked regularly has remained constant

Prevalence of nicotine/cigarette use 17 N=94039 adults, decrease p<0.001 for cigarettes and p<0.001 for overall nicotine use There is some indication of a possible slowing in the long-term decline in cigarette prevalence

Cigarette smoking prevalence 18 Graph shows prevalence estimate and upper and lower 95% confidence intervals Base: All adults Cigarette smoking prevalence continued to decline until 2014 but the long-term decline may have slowed in 2015

Decrease in smoking prevalence 19 Base: All adults The rate of decline in cigarette smoking prevalence was relatively stable but may have stalled in 2015

Stopped smoking in past 12 months 20 Graph shows prevalence estimate and upper and lower 95% confidence intervals Base: Adults who smoked in the past year The smoking cessation rate increased from 2011 including the highest rate in 2014

Tried to stop smoking in past year 21 Graph shows prevalence estimate and upper and lower 95% confidence intervals Base: Adults who smoked in the past year The rate at which smokers have tried to stop in the past year increased from 2011 but decreased in 2015

Success rate for stopping in those who tried 22 Graph shows prevalence estimate and upper and lower 95% confidence intervals Base: Smokers who tried to stop n the past year The success rate in those who have tried to stop smoking increased from 2011

Proportion of smokers believing e- cigarettes less harmful than cigarettes 23 N=5544 current smokers A declining minority of current smokers believe e-cigarettes are less harmful than cigarettes

The nicotine/cigarette market 24 N=93879 adults Nicotine data only from last year smokers nondaily nicotine: <1 pw=0.1, 1+ pw=0.5 The nicotine market declined until the 2 nd quarter of 2015 but may have plateaued

Conclusions Growth in e-cigarette use has slowed since 2013 Current use of e-cigarettes by never smokers remains very rare and similar to use of licensed nicotine products; use among long-term ex-smokers appears to be increasing Growth in electronic cigarette use has been accompanied by a reduction in use of licensed nicotine products and prescription medication but the trajectories appear to be different The trajectories for smoking prevalence and quit attempts differ from that of prevalence of use of e-cigarettes Success rates in stopping smoking have increased since