1. Trends in electronic cigarette use in England
Robert West
Hannah Proudfoot
Emma Beard
Jamie Brown
University College London
Updated 25th April 2019

2. 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

3. 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

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

5. Prevalence of e-cigarette and heat-not-burn use
N= adults from Nov 2013 (E-cig); N=15475 adults from Aug 2018 (Juul);
N=48017 adults from Jan 2017 (HNB: heat-not-burn)

6. Nicotine use by never smokers and long-term ex-smokers
N=88740 never and long-term ex-smokers from Nov 2013

7. Nicotine use by long-term ex-smokers (> and <=5 years)
N=14543 ex-smokers >5 years from Nov 2013; N=3986 ex-smokers <=5 years from Nov 2013

8. Prevalence of electronic cigarette use: smokers and recent ex-smokers
Are these adults who stopped in past year?
N=32024 adults who smoke or who stopped in the past year (N=8639 asked about HNB; N=2678 asked about Juul)

9. Proportion of e-cigarette and NRT users who are smokers
N=5741 e-cigarette users; N=2854 NRT users

10. Proportion of daily e-cigarette and NRT users who are smokers
N=3355 e-cigarette daily users and N=1168 NRT daily users of adults

11. Summary I
Use of e-cigarettes in adult population has remained stable since late 2013
Use of Juul and HNB products is currently rare
E-cigarette use by never smokers remains negligible but use among long-term ex-smokers has grown
E-cigarette use in smokers and recent ex-smokers has plateaued
The majority of both e-cigarette and NRT users are ‘dual users’ (also smoke)
A smaller proportion of both e-cigarette and NRT daily users are ‘dual users’ (also smoke)
Taken from comments in individual slides

12. Electronic cigarette use
N=4229 e-cigarette users not using NRT

13. Characteristics of the e-cigarette
N=1952 e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

14. E-liquid
N=1656 nicotine containing e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

15. Source
N=1952 e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

16. Electronic cigarette and NRT use across the age range in 2018
N=3784 adults who smoke or who stopped in the past year and were surveyed in 2018

17. Electronic cigarette and NRT use in men and women in 2018
N=3784 adults who smoke or who stopped in the past year and were surveyed in 2018

18. Electronic cigarette and NRT use across the social gradient in 2018
N=3784 adults who smoke or who stopped in the past year and were surveyed in 2018

19. Summary II Frequency of use among users is greater in ex-smokers
The majority contain nicotine and later generation devices are more popular with ex-smokers
Ex-smokers use e-liquids with stronger concentrations of nicotine. A minority of smokers did not know the strength.
Specialist vape shops are most popular source for purchase
E-cigarette use is least popular with older smokers while NRT use is lower among younger smokers
There is no clear social gradient in use of e-cigarettes or NRT
Taken from comments in individual slides

20. Use of nicotine products while smoking
N=29897 smokers

21. Use of nicotine products in recent ex-smokers
N=2127 adults who stopped in the past year

22. Aids used in most recent quit attempt
N=14777 adults who smoke and tried to stop or who stopped in the past year; method is
coded as any (not exclusive) use; N=3402 adults asked on HNB and N=727 on Juul

23. Current e-cigarette use after quitting
N=1230 adults who stopped in the past year and did not report using an e-cigarette to help during the quit attempt

24. Uptake of smoking
N=24941 people aged 16-24

25. Summary III E-cigarette use has plateaued among smokers
E-cigarette use among recent ex-smokers has declined from a peak in 2016
E-cigarette use for quitting has declined from a peak in 2016
The proportion of recent ex-smokers who started using an e-cigarette declined from a peak in 2015
Proportion of people aged years who have ever smoked regularly has slowly declined

26. Prevalence of nicotine/cigarette use
N= adults

27. Cigarette smoking prevalence
Base: All adults
Graph shows prevalence estimate and upper and lower 95% confidence intervals

28. Stopped smoking in past 12 months
Base: Adults who smoked in the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals

29. Tried to stop smoking in past year
Base: Adults who smoked in the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals

30. Success rate for stopping in those who tried
Base: Smokers who tried to stop in the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals

31. Harm perceptions of e-cigarettes compared with cigarettes
N=16048 current smokers who do not currently use e-cigarettes

32. Summary IV
The long-term decline in the prevalence of cigarette smoking continues
The smoking cessation rate increased from 2011
The rate at which smokers have tried to stop in the past year increased from 2011 but then decreased until 2016
The success rate in those who have tried to stop smoking increased from 2011
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

33. 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