- The document analyzes trends in electronic cigarette use in England based on monthly household surveys conducted by Robert West and colleagues at University College London. - It finds that prevalence of e-cigarette use increased rapidly until late 2013 but has remained stable since, with 20% of smokers and 30% of recent ex-smokers now using e-cigarettes. - E-cigarettes have become the most popular aid for quit attempts, and their increased use has been accompanied by rises in quit attempts and success rates at the population level.

1. Prof Robert West
Professor of Health Psychology
Director of Tobacco Studies
Cancer Research UK

2. 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

3. www.smokinginengland.info/latest-statistics
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

4. www.smokinginengland.info/latest-statistics
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
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5. www.smokinginengland.info/latest-statistics
Methods
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•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

6. www.smokinginengland.info/latest-statistics
Prevalence of e-cigarette use: smokers and recent ex-smokers
7
0
5
10
15
20
25
30
35
40
45
50
Percent of smokers and recent ex- smokers
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

7. www.smokinginengland.info/latest-statistics
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
Percent
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

8. www.smokinginengland.info/latest-statistics
Prevalence of nicotine products while smoking
9
0
5
10
15
20
25
30
35
40
45
50
Percent of smokers
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

9. www.smokinginengland.info/latest-statistics
Prevalence of nicotine products in recent ex-smokers
10
0
10
20
30
40
50
60
70
Percent of ex-smokers
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

10. www.smokinginengland.info/latest-statistics
Proportion of e-cigarette users who are smokers
11
0
10
20
30
40
50
60
70
80
90
100
Percent
N=1745 e-cigarette users of adults who smoke or stopped in past year
The large majority of e-cigarette users also smoke

11. www.smokinginengland.info/latest-statistics
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+
Percent
E-cig user
Cigarette smoker
N=32,291 adults from 2013 onwards
Prevalence of e-cigarette use follows a similar pattern to smoking

12. www.smokinginengland.info/latest-statistics
E-cigarette use
13
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
Percent
Smoker
Ex-smoker
Frequency of use among users is greater in recent ex-smokers
N=1323 e-cigarette users not using NRT

13. www.smokinginengland.info/latest-statistics
Aids used in most recent quit attempt
14
0
5
10
15
20
25
30
35
40
45
50
2009-3
2009-4
2010-1
2010-2
2010-3
2010-4
2011-1
2011-2
2011-3
2011-4
2012-1
2012-2
2012-3
2012-4
2013-1
2013-2
2013-3
2013-4
2014-1
2014-2
2014-3
Percent of smokers trying to stop
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

14. www.smokinginengland.info/latest-statistics
Quit attempts and quit success
15
0
5
10
15
20
25
30
35
40
45
50
% trying to quit in past 12m
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
% who quit in past 12m

15. www.smokinginengland.info/latest-statistics
Prevalence of nicotine/cigarette use
16
0
5
10
15
20
25
Percent smoking cigs or using nicotine
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

16. www.smokinginengland.info/latest-statistics
Modelling impact on prevalence
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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

17. www.smokinginengland.info/latest-statistics
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
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