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Prof Robert West

Professor of Health Psychology

Director of Tobacco Studies

Cancer Research UK

Trends in electronic cigarette use in

England

Robert West

Jamie Brown

Emma Beard

University College London

www.smokinginengland.info/latest-statistics

Updated 18th October 2014


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

4


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

5


Methods

6

• 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:

smokers and recent ex-smokers

7

0

5

10

15

20

25

30

35

40

45

50

Perc

ent

of sm

okers

and

recent

ex-

sm

okers

Any

Daily

N=14490 adults who smoke or who stopped in the past year; increase p<0.001

Prevalence of e-cigarette use has not increased

since Q3 2013


Prevalence of e-cigarette use: never

smokers and long-term ex-smokers

0

0.5

1

1.5

2

2.5

3

3.5

4

Never smoker Long-term ex-smoker

Perc

ent

E-cig NRT

8

N=14619 never and long-term ex-smokers from Nov 2013

E-cigarette use by never smokers is

negligible and similar to NRT use


Prevalence of nicotine products while

smoking

9

0

5

10

15

20

25

30

35

40

45

50

Perc

en

t of sm

okers

E-cigs

NRT

All nicotine

N=13531 smokers, increase p<0.001 e-cigs and all nicotine; decrease p=0.001 for NRT

Increase in use of e-cigarettes while smoking has

more than offset a decrease in NRT use


Prevalence of nicotine products in

recent ex-smokers

10

0

10

20

30

40

50

60

70

Perc

ent

of

ex-s

mokers

E-cigs

NRT

All nicotine

N=959 adults who stopped in the past year; increase p<0.001 for e-cigs and all

nicotine; decrease p=0.002 for NRT

Increase in use of e-cigarettes

has offset a reduction in NRT

use that began earlier


Proportion of e-cigarette users who are

smokers

11

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

N=1745 e-cigarette users of adults who smoke or stopped in past year

The large majority of e-cigarette users

also smoke


E-cigarette use and smoking in

different age groups

12

0

5

10

15

20

25

30

35

40

45

50

16-24 25-34 35-44 45-54 55-64 65+

Perc

en

t

E-cig user

Cigarette smoker

N=32,291 adults from 2013 onwards

Prevalence of e-cigarette use follows a

similar pattern to smoking


E-cigarette use

13

0

5

10

15

20

25

30

35

40

45

50

Lessthan

weekly

Weeklybut notdaily

1 per day 2-5 perday

6-10 perday

11+ perday

Perc

ent

Smoker

Ex-smoker

Frequency of use among users is greater in

recent ex-smokers

N=1323 e-cigarette users not using NRT


Aids used in most recent quit attempt

14

0

5

10

15

20

25

30

35

40

45

502

00

9-3

20

09

-4

20

10

-1

20

10

-2

20

10

-3

20

10

-4

2011-1

20

11

-2

20

11

-3

20

11

-4

20

12

-1

20

12

-2

20

12

-3

20

12

-4

20

13

-1

20

13

-2

20

13

-3

20

13

-4

20

14

-1

20

14

-2

20

14

-3

Perc

ent

of sm

okers

try

ing t

o s

top

E-cigs

NRT OTC

NRT Rx

Champix

Beh'l supp

N=9438 adults who smoke and tried to stop or who stopped in the past year

E-cigarettes are the most

popular aid to cessation


Quit attempts and quit success

15

0

5

10

15

20

25

30

35

40

45

50

% try

ing

to

qu

it in

pa

st 1

2m

N=15788 adults who smoke or stopped in the past 12 months; both increases, p<0.001

There has been an increase in both quit attempts and quit success

0

1

2

3

4

5

6

7

8

9

10

% w

ho

qu

it in

pa

st 1

2m


Prevalence of nicotine/cigarette use

16

0

5

10

15

20

25

Perc

ent

sm

okin

g c

igs o

r usin

g

nic

otine

Cigarettes

Nicotine or cigarettes

N=63950 adults, decrease p<0.001 for cigarettes and overall nicotine use

NB e-cigarette use assessed only in past year smokers until Oct 2013 and assumed to be 0 prior to this – since Nov 2013

prevalence in never and long term ex-smokers ~ 0.2%.

Cigarette and nicotine use prevalence

show an overall decline


Modelling impact on prevalence

17

E-cigarettes have grown the use of

moderately effective aids to

cessation from 24% to 35%; use of

most effective methods has

decreased from 4% to 3%

At stable quit attempt rate of 37%

this contributed 0.05% to the

decreased prevalence (~20,000

additional ex-smokers)

Approx odds of success relative to

nothing and NRT-OTC:

1.5 Moderately effective

3.0 Most effective

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014

NHS Med Rx/E-cigs Nothing/NRT-OTC

N=9438 adults who smoke and tried to stop or who stopped in the past year; 2009 is Jul to Dec, 2014 is Jan to Sept


Key points: Trends since Q2 2011

• Prevalence of e-cigarette use increased rapidly until Q3 in 2013 but

has not grown for 12 months

• 20% of smokers and 30% of recent ex-smokers use e-cigarettes;

use of e-cigarettes by never-smokers and long-term ex-smokers

remains extremely rare

• 30% of quit attempts involve use of e-cigarettes making them the

most popular method of stopping smoking

• Growth in electronic cigarette use has:

– increased the prevalence of use of ‘moderately’ effective methods of stopping

(those that are approximately 50% better than NRT bought over the counter or

nothing)

– been accompanied by an increase in the incidence of quit attempts and quit

success

• Prevalence of both smoking and use of any nicotine product has

declined 18

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