Latest trends on smoking in England from the Smoking Toolkit Study Robert West Jamie Brown Last updated: 5th September 2017 www.smokinginengland.info jamie.brown@ucl.ac.uk

Methods Data collected during monthly household survey Each month involves a new representative sample of ~ 1800 respondents Running since November 2006 and has accumulated more than 200,000 respondents of whom more than 48,000 are ‘last-year smokers’ 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

Cigarette smoking prevalence Base: All adults

Cigarette smoking by social grade 23.3% 16.9% 11.7% A-C1: Professional to clerical occupation C2-E: Manual occupation 3-month moving average

Tried to stop smoking in past year Base: Adults who smoked in the past year

Tried to stop by social grade A-C1: Professional to clerical occupation C2-E: Manual occupation

Success rate for stopping in those who tried Base: Smokers who tried to stop in the past year

Stopped smoking in past 12 months Base: Adults who smoked in the past year

Support used in quit attempts No aid E-cig NRT OTC Med Rx NHS NRT OTC: Nicotine replacement therapy bought over the counter; Med Rx: Prescription medication; NHS: NHS Stop Smoking Service; E-cig: E-cigarette. .

Aids used in most recent quit attempt N=12859 adults who smoke and tried to stop or who stopped in the past year; method is coded as any (not exclusive) use

GP-triggered quit attempts

Motivation to quit A-C1: Professional to clerical occupation C2-E: Manual occupation

Harm reduction NRT: Nicotine replacement therapy

Prevalence of electronic cigarette use: smokers and recent ex-smokers N=25587 adults who smoke or who stopped in the past year; increase p<0.001

Nicotine use by never smokers and long-term ex-smokers N=59195 never and long-term ex-smokers from Nov 2013

Proportion of e-cigarette and NRT users who are smokers N=3869 e-cigarette users and N=1975 NRT users of adults

Proportion of daily e-cigarette and NRT users who are smokers N=2193 e-cigarette users and N=805 NRT users of adults

Electronic cigarette use N=3227 e-cigarette users not using NRT

Characteristics of the e-cigarette N=730 e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

E-liquid N=615 nicotine containing e-cigarette users who smoke or who stopped in the past year surveyed since Aug 16

Source N=730 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 N=17,337 adults who smoke or who stopped in the past year and were surveyed between 2013-2017 Q1

Electronic cigarette and NRT use in men and women N=17,337 adults who smoke or who stopped in the past year and were surveyed between 2013-2017 Q1

Electronic cigarette and NRT use across the social gradient N=17,337 adults who smoke or who stopped in the past year and were surveyed between 2013-2017 Q1

Pharmacological support Data from RCTs; Cochrane reviews (NRT 2013; Varenicline, Cytisine 2016; E-cigarettes 2017) *Estimated by combining effect sizes; All comparisons are active medication versus placebo in context of behavioural support; bars show 95% confidence intervals

Psychological support Data from RCTs; Cochrane reviews (2017, 2017, 2013, 2016); Indirect estimates compared with nothing; Insufficient data on smartphone apps; Mixed data on websites; bars show 95% confidence intervals

Factors associated with odds of success in most recent quit attempt Base: 14,813 smokers who tried to quit in past 12 months

Key points Smoking prevalence is declining and quitting is increasing Use of prescription medication and NRT OTC is declining GPs appear to be playing a declining role in triggering quitting Use of e-cigarettes increased rapidly but now seems to have plateaued Real-world evidence on effectiveness of different cessation aids appears to match evidence from RCTs except for NRT OTC which does not appear to increase quit rates