Trends in electronic cigarette use in England www.smokinginengland.info/latest-statistics Robert West Hannah Proudfoot Emma Beard Jamie Brown University College London Updated 25th April 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 and heat-not-burn use N=110276 adults from Nov 2013 (E-cig); N=15475 adults from Aug 2018 (Juul); N=48017 adults from Jan 2017 (HNB: heat-not-burn)

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

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

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)

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

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

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

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

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

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

Source N=1952 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 2018 N=3784 adults who smoke or who stopped in the past year and were surveyed in 2018

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

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

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

Use of nicotine products while smoking N=29897 smokers

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

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

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

Uptake of smoking N=24941 people aged 16-24

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 16-24 years who have ever smoked regularly has slowly declined

Prevalence of nicotine/cigarette use N=110204 adults

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

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

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

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

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

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

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