Trends in electronic cigarette use in England www.smokinginengland.info/latest-statistics Robert West Emma Beard Jamie Brown University College London Updated 11th January 2019

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

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

Methods 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., 2011. 'The smoking toolkit study': a national study of smoking and smoking cessation in England. BMC Public Health 11:479 For more info see www.smokinginengland.info

Prevalence of e-cigarette use Use of e-cigarettes has remained stable since late 2013 N=105117 adults from Nov 2013

Nicotine use by never smokers and long-term ex-smokers E-cigarette use by never smokers remains negligible but use among long-term ex-smokers has grown N=84434 never and long-term ex-smokers from Nov 2013

Prevalence of electronic cigarette use: smokers and recent ex-smokers E-cigarette use in smokers and recent ex-smokers has plateaued N=31173 adults who smoke or who stopped in the past year

Proportion of e-cigarette and NRT users who are smokers The majority of both e-cigarette and NRT users are ‘dual users’ (also smoke) N=5472 e-cigarette users and N=2749 NRT users

Proportion of daily e-cigarette and NRT users who are smokers A smaller proportion of both e-cigarette and NRT daily users are ‘dual users’ (also smoke) N=3181 e-cigarette daily users and N=1114 NRT daily users of adults

Electronic cigarette use N=4089 e-cigarette users not using NRT

Characteristics of the e-cigarette N=1795 e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

E-liquid N=1522 nicotine containing e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

Source N=1795 e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

Electronic cigarette and NRT use across the age range in 2017 E-cigarette use is least popular with older smokers while NRT use is lower among younger smokers N=3684 adults who smoke or who stopped in the past year and were surveyed in 2017

Electronic cigarette and NRT use in men and women in 2017 N=3684 adults who smoke or who stopped in the past year and were surveyed in 2017

Electronic cigarette and NRT use across the social gradient in 2017 There is no clear social gradient in use of e-cigarettes or NRT N=3684 adults who smoke or who stopped in the past year and were surveyed in 2017

Use of nicotine products while smoking E-cigarette use has plateaued among smokers N=29099 smokers

Use of nicotine products in recent ex-smokers E-cigarette use among recent ex-smokers has declined from a peak in 2016 N=2074 adults who stopped in the past year

Aids used in most recent quit attempt E-cigarette use for quitting has declined from a peak in 2016 N=14550 adults who smoke and tried to stop or who stopped in the past year; method is coded as any (not exclusive) use

Current e-cigarette use after quitting The proportion of recent ex-smokers who started using an e-cigarette appears to be declining N=1203 adults who stopped in the past year and did not report using an e-cigarette to help during the quit attempt

Take-up of smoking Proportion of people aged 16-24 years who have ever smoked regularly has slowly declined N=24132 people aged 16-24

Prevalence of nicotine/cigarette use N=105117 adults

Cigarette smoking prevalence The long-term decline in the prevalence of cigarette smoking continues Base: All adults Graph shows prevalence estimate and upper and lower 95% confidence intervals

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

Tried to stop smoking in past year The rate at which smokers have tried to stop in the past year increased from 2011 but then decreased until 2016 Base: Adults who smoked in the past year Graph shows prevalence estimate and upper and lower 95% confidence intervals

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

Harm perceptions of e-cigarettes compared with cigarettes A declining minority of current smokers believe e-cigarettes are less harmful than cigarettes or are unsure. An increasing proportion believe they are equally harmful N=15250 current smokers who do not currently use e-cigarettes

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 There has been a long-term decline in the prevalence of cigarette smoking since 2007 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 2011