trends in electronic cigarette use in england · trends in electronic cigarette use in england...

Trends in electronic cigarette use in

England

Robert West

Jamie Brown

Emma Beard

University College London

www.smokinginengland.info/latest-statistics

Updated 14th April 2015


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

2


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

3


Methods

4

• 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


Nicotine use by 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

5

N=22489 never and long-term ex-smokers from Nov 2013

E-cigarette use by never smokers is

negligible


Prevalence of electronic cigarette use:

smokers and recent ex-smokers

6

0

5

10

15

20

25

30

35

40

45

50

Perc

ent

of sm

okers

and

recent

ex-

sm

okers

Any

Daily

N=16529 adults who smoke or who stopped in the past year; increase p<0.001

Prevalence in use of e-cigarettes may have

plateaued


Electronic cigarette use

7

0

5

10

15

20

25

30

35

40

45

50

Less than

weekly

Weekly but not daily

1 per day 2-5 per day

6-10 per day

11+ per day

Perc

ent

Smoker

Ex-smoker

Frequency of use among users is greater in

ex-smokers

N=1655 e-cigarette users not using NRT


Electronic cigarette and NRT use

across the age range

8

0

5

10

15

20

25

30

35

40

45

50

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

Perc

ent

usin

g t

he p

roduct

E-cig user

NRT user

N=8,263 adults who smoke or who stopped in the past year

Prevalence of e-cigarette use is broadly

evenly distributed across the age range

while NRT use is lower among younger

people


Electronic cigarette and NRT use in

men and women

9

0

5

10

15

20

25

30

35

40

45

50

Men Women

Perc

ent

usin

g t

he p

roduct

E-cig user

NRT user


Prevalence of e-cigarette and NRT use is

slightly higher in women


Factors associated with odds of success in

most recent quit attempt: methods

• N=14,813 smokers and recent ex-smokers who had tried to quit in the

past 12 months of whom 2,084 were currently not smoking

• Predictors all entered together in logistic regression model

– Time since quit attempt started (<1w, 1-4w, 4-8w, 8-12w, 12-26w, 26-52w)

– Gender

– Age group

– Social grade (C2-E routine and manual versus AB-C1 non-manual occupation)

– Year of survey (entered as categorical, data not shown)

– Number of prior quit attempts that year (0, 1, 2, 3+) (data not shown)

– Level of addiction to cigarettes (measured by strength of urges to smoke on

scale from 1 to 6)

– In most recent quit attempt

• Abrupt quit versus cut down first

• Quit as soon as decided versus

planned in advance

• Used NRT (licensed nicotine

replacement therapy) bought

over the counter

• Used NRT obtained on prescription

• Used Zyban (bupropion)

• Used Champix (varenicline)

• Used specialist behavioural support

10


Factors associated with odds of success

in most recent quit attempt: results

0.76

1.1

1.4

0.9

2

1.1

0.31

1.1

1.8 1.8

2.6

2.2

1.8

0.71

0.89

1.2

0.73

1.6

0.88

0.28

0.84

1.2

0.7

1.7 1.5

1.1

0.2 0.4 0.6 0.8

1 1.2 1.4 1.6 1.8

2 2.2 2.4 2.6 2.8

3

Odd

s r

atio

Vertical lines represent 95% confidence intervals; Odds ratio of 1 means

no association

Base: Smokers who tried to quit in past 12 months

11


Factors associated with odds of success in

most recent quit attempt: notes

• The overall model is additive which means that effect of

behavioural support is over and above the positive association

with of success with NRT or Champix; and effects of all these

aids is over and above the positive association with abrupt

quitting

• The time since the quit attempt started can be anywhere up to

12 months and followed the distribution shown below

0

10

20

30

40

<1 week 1-4 weeks

4-8 weeks

8-12 weeks

12-26 weeks

26-52 weeks

Pe

rce

nt

12


Electronic cigarette and NRT use

across the social gradient

13

0

5

10

15

20

25

30

35

40

45

50

AB C1 C2 D E

Perc

ent

usin

g t

he p

roduct

E-cig user

NRT user


Higher social grades are more likely to use

e-cigarettes while there is no clear gradient

for NRT


Use of nicotine products while smoking

14

0

5

10

15

20

25

30

35

40

45

50

Perc

en

t of

sm

okers

E-cigs

NRT

All nicotine

N=15433 smokers, increase p<0.001 e-cigs and all nicotine; decrease p<0.001 for NRT

NRT use continues to decline even after plateau in

e-cigarette use


Use of nicotine products in recent ex-

smokers

15

0

10

20

30

40

50

60

70

Perc

ent

of

ex-s

mokers

E-cigs

NRT

All nicotine

N=1096 adults who stopped in the past year; increase p<0.001 for e-cigs and all

nicotine; decrease p=0.003 for NRT

There continues to be an

increase in use of e-cigarettes

in recent ex-smokers


Proportion of e-cigarette and NRT

users who are smokers

16

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

E-cigs

NRT

N=2135 e-cigarette users and N=2224 NRT users of adults who smoke or

stopped in past year

The large majority of both e-cigarette and NRT

users are ‘dual users’ (also smoke)


Aids used in most recent quit attempt

17

0

5

10

15

20

25

30

35

40

45

50

2009-3

2009-4

2010-1

2010-2

2010-3

2010-4

20

11-1

20

11-2

20

11-3

20

11-4

2012-1

2012-2

2012-3

2012-4

2013-1

2013-2

2013-3

2013-4

2014-1

2014-2

2014-3

2014-4

2015-1

Perc

ent

of sm

okers

try

ing t

o s

top

E-cigs

NRT OTC

NRT Rx

Champix

Beh'l supp

N=10078 adults who smoke and tried to stop or who stopped in the past year

E-cigarette use for quitting is still increasing somewhat


Aids used in most recent quit attempt

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2009 2010 2011 2012 2013 2014

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

18 N=9783 adults who smoke and tried to stop or who stopped in the past year; 2009 is Jul to Dec

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


Take-up of smoking

19

0

10

20

30

40

50

60

70

80

90

100

Perc

ent

who r

eport

havin

g e

ver

sm

oked r

egula

rly

N=12931 people aged 16-24

Proportion of people under 25 years who

have ever smoked regularly has remained

constant


Prevalence of nicotine/cigarette use

20

0

5

10

15

20

25

Perc

ent

sm

okin

g c

igs o

r usin

g n

icotine

Cigarettes

Nicotine or cigarettes

N=73795 adults, decrease p<0.001 for cigarettes and p<0.001 for overall nicotine use

Cigarette consumption has decreased

as has overall nicotine use


Cigarette smoking prevalence

24.2 22.0 21.5 21.4 20.7 20.0 19.3 18.5 17.9

0

5

10

15

20

25

30

2007 (N=22079)

2008 (N=18990)

2009 (N=21137)

2010 (N=24794)

2011 (N=21879)

2012 (N=21330)

2013 (N=22167)

2014 (N=20170)

2015 (Mar) (N=4952)

Pe

rce

nt

21 Graph shows prevalence estimate and upper and lower 95% confidence intervals

Base: All adults

Cigarette smoking prevalence continues

to decline


Decrease in smoking prevalence

2.1

0.5 0.2

0.6 0.7 0.8 0.7 0.6

0

1

2

3

4

5

2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 (Mar)

Pe

rce

nt

22 Base: All adults

The rate of decline in cigarette smoking

prevalence has been relatively stable


Stopped smoking in past 12 months

6.7

5.6 5.0 4.8 4.6

6.2 6.1

7.2 6.6

0

2

4

6

8

10

12

2007 (N=5959)

2008 (N=4602)

2009 (N=4973)

2010 (N=5775)

2011 (N=4892)

2012 (N=4726)

2013 (N=4710)

2014 (N=4152)

2015 (Mar) (N=979)

Pe

rce

nt


Base: Adults who smoked in the past year

The smoking cessation have

increased since 2011


Tried to stop smoking in past year

42.5 39.8

37.0 35.9 33.5 34.4

38.5 37.3

31.2

0

5

10

15

20

25

30

35

40

45

50

2007 (N=5959)

2008 (N=4602)

2009 (N=4973)

2010 (N=5775)

2011 (N=4892)

2012 (N=4726)

2013 (N=4710)

2014 (N=4152)

2015 (Mar) (N=979)

Pe

rce

nt


Base: Adults who smoked in the past year

The rate at which smokers have tried

to stop in the past year increased from

2011 and has decreased in 1st quarter

of 2015


Success rate for stopping in those who

tried

15.7 14.1 13.6 13.4 13.7

17.6 15.8

19.1 18.6

0

5

10

15

20

25

30

2007 (N=2533)

2008 (N=1829)

2009 (N=1833)

2010 (N=2068)

2011 (N=1637)

2012 (N=1627)

2013 (N=1729)

2014 (N=1485)

2015 (Mar) (N=299)

Pe

rce

nt


Base: Smokers who tried to stop n the past year

The success rate in those who

have tried to stop smoking

increased from 2011


The nicotine/cigarette market

26

0

0.5

1

1.5

2

2.5

3

Per

capita d

aily

consum

ption

Nicotine

Cigarettes

N=73747 adults

Nicotine data only from last year smokers

nondaily nicotine: <1 pw=0.1, 1+ pw=0.5

The cigarette and nicotine market

are both declining


Conclusions

• Growth in e-cigarette use has slowed and contrary to earlier

indications appears fairly stable over the past 2 years

• Growth in electronic cigarette use has been accompanied by a

reduction, albeit smaller, in use of licensed nicotine products and

prescription medication but the trajectories are very different

suggesting no causal connection

• Rates of quitting smoking increased from 2011

• Use of e-cigarettes by never smokers remains very rare and similar

to use of licensed nicotine products

• E-cigarettes may have helped approximately 20,000 smokers to

stop in 2014 who would not have stopped otherwise

27

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