Trends in Electronic Cigarette Use in England: WWW - Smokinginengland.info/latest-Statistics

Trends in electronic cigarette use in
England
www.smokinginengland.info/latest-statistics
Robert West
Jamie Brown
Emma Beard
University College London
Updated 4th April 2014
Background
• Electronic cigarette use has become prevalent in

many countries
• In England, electronic cigarettes are regulated as
consumer products
• It is important to track use of electronic cigarettes
and assess who far they are 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
• motivation to stop smoking
• 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
• 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
4
Prevalence of electronic cigarette use:
smokers and recent ex-smokers
50
Percent of smokers and recent ex-
Growth in prevalence of e-cigarette use may have

slowed
37.5
smokers
Any
25
Daily
12.5
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=11,666 adults who smoke or who stopped in the past year; increase p<0.001
5
Electronic cigarette use
50
• Frequency of use among users is greater
in ex-smokers
37.5
Percent
Smoker
25 Ex-smoker
12.5
0
Less than weekly 1 per day 6-10 per day
N=875 e-cigarette users not using NRT

6
Prevalence of nicotine products while
smoking
50
Increase in use of e-cigarettes while smoking has
more than offset a decrease in NRT use
37.5
Percent of smokers
25 E-cigs
NRT
All nicotine
12.5
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=10,843 smokers, increase p<0.001 e-cigs and all nicotine; decrease p=0.025 for NRT
7
Prevalence of nicotine products in
recent ex-smokers
50 Increase in use of e-cigarettes
has offset a reduction in NRT
use that began earlier
Percent of ex-smokers
37.5
25 E-cigs
NRT
All nicotine
12.5
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=702 adults who stopped in the past year; increase p<0.001 for e-cigs; decrease
p<0.001 for NRT
8
Proportion of e-cigarette users who are
smokers
100
75
Percent
The large majority of e-cigarette users are

50 using them to reduce smoking
25
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=11,663 adults who smoke or who stopped in the past year, except 21013-4 onwards which include never smokers and
long-term ex-smokers
9
Aids used in most recent quit attempt
50
Percent of smokers trying to stop
Increase in use of e-cigarettes for quitting has been

accompanied by a small reduction in use of other aids
37.5 except behavioural support which has been static
25 E-cigs
NRT OTC
NRT Rx
12.5 Champix
Beh'l supp
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=4,935 adults who smoke and tried to stop or who stopped in the past year
10
Motivation to quit
7
There has been a small increase in motivation
Motivation to Stop Score (1-7)
to quit which predated the increase in e-

5.5 cigarette use
2.5
1
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=13,014 adults who smoke; increase p<0.001

11
Quit attempts
25
Percentage trying to quit in past
There has been a small increase in quit attempts

18.8
3m
12.5
6.3
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=14,024 adults who smoke or who stopped in the past 3 months; increase p=0.005
12
Quitting
10
There has been an increase in the rate of
Percent who have smoked in
the past year who do not
quitting smoking
7.5
smoke now
2.5
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=14,027 adults who smoked in the past year; increase p<0.001
13
Prevalence of nicotine/cigarette use
25
Percent smoking cigs or using
18.8
nicotine
12.5 Cigarette consumption has decreased as

has overall nicotine use Cigarettes
Nicotine or
6.3
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
N=64,222 adults, decrease p<0.001 for both lines

14
Cigarette smoking prevalence
25 24.2
22.0 21.5 21.4 20.7 20.0 19.3
18.8 17.8
Percent
12.5
6.3 www.smokinginengland.info
0
2007 (N=22079) 2009 (N=21137) 2011 (N=21879) 2013 (N=22167)
Base: All adults
Graph shows prevalence estimate and upper and lower 95% confidence intervals 15
Decrease in smoking prevalence
5
www.smokinginengland.info
3.8
Percent
2.5
2.1
1.5
1.3
0.7 0.8
0.5 0.6
0.2
0
2007 to 2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-20132013-Mar 2014
Base: All adults

16
Stopped smoking in past 12 months
12
9 8.7
6.7
Percent
6.2 6.1
6 5.6
5.0 4.8 4.6
0
2007 (N=5959) 2009 (N=4973) 2011 (N=4892) 2013 (N=4710)
Base: Adults who smoked in the past year
Tried to stop smoking in past year
44 42.5
39.8 40.3
38.5
37.0 35.9
33.5 34.4
33
Percent
22
11
0
2007 (N=5959) 2009 (N=4973) 2011 (N=4892) 2013 (N=4710)
Base: Adults who smoked in the past year
Success rate for stopping in those who
tried
26 • www.smokinginengland.info
21.4
19.5 17.6
15.7 15.8
14.1
Percent
13.6 13.4 13.7

13
6.5
0
2007 (N=2533) 2009 (N=1833) 2011 (N=1637) 2013 (N=1729)
Base: Smokers who tried to stop n the past year
Nicotine use by never smokers and
long-term ex-smokers
3
E-cigarette use by never smokers is
negligible
2.3
Percent
1.5
0.8
0
Never smoker Long-term ex-smoker
E-cig NRT
N=8,380 from Nov 2013
20
The nicotine/cigarette market
3 The cigarette and nicotine market

are both declining
2.25
Per capita daily
consumption
1.5 Nicotine
Cigarettes
0.75
0
2011-2 2011-4 2012-2 2012-4 2013-2 2013-4
Nicotine data only from last year smokers

N=42,347 adults nondaily nicotine: <1 pw=0.1, 1+ pw=0.5
21
Conclusions
• The increase in electronic cigarette use prevalence may have slowed

• Growth in electronic cigarette use has been accompanied by a
reduction, albeit smaller, in use of licensed nicotine products and
prescription medication but not use of behavioural support
• Evidence does not support the view that electronic cigarettes are
undermining motivation to quit or reduction in smoking prevalence
• Use of e-cigarettes by never smokers remains extremely rare
• Evidence conflicts with the view that electronic cigarettes are
undermining tobacco control or ‘renormalizing’ smoking, and they
may be contributing to a reduction in smoking prevalence through
increased success at quitting smoking
22

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Trends in electronic cigarette use in

• Electronic cigarette use has become prevalent in

• Monthly household surveys

Growth in prevalence of e-cigarette use may have

N=875 e-cigarette users not using NRT

The large majority of e-cigarette users are

Increase in use of e-cigarettes for quitting has been

to quit which predated the increase in e-

N=13,014 adults who smoke; increase p<0.001

There has been a small increase in quit attempts

N=14,027 adults who smoked in the past year; increase p<0.001

12.5 Cigarette consumption has decreased as

N=64,222 adults, decrease p<0.001 for both lines

Base: All adults

Base: All adults

Base: Adults who smoked in the past year

Base: Adults who smoked in the past year

13.6 13.4 13.7

Base: Smokers who tried to stop n the past year

N=8,380 from Nov 2013

3 The cigarette and nicotine market

Nicotine data only from last year smokers

• The increase in electronic cigarette use prevalence may have slowed

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