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 (16 and over) of ~1800 respondents; smokers ~450

• Due to the pandemic, from April 2020 surveys conducted by telephone (rather than face-to-face) and among adults aged 18 and over
• From January 2022 data collection resumed among those aged 16 and over
• Between November 2020 and February 2022, ~0.8% of cases in England were incorrectly weighted 0. This has now been updated and some point estimates over this period have changed slightly (typically 1 d.p.) compared with earlier versions.
• Since May 2022, daily e-cigarette use is calculated on basis of one month per quarter due to changes in the data collection frequency

Data collected on e-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

Summary I

Use of e-cigarettes in adults has increased gradually since 2020, especially among young adults

Use of Juul and heated tobacco products is rare

E-cigarette use by never smokers increased since 2021 but remains relatively rare (<2%) while use among long-term ex-smokers has continued to grow since 2013

E-cigarette use in smokers and recent ex-smokers plateaued between 2013 and 2020 but has grown since

Around half of e-cigarette users and the majority of NRT users are ‘dual users’ (also smoke)

• The proportion of daily e-cigarette and NRT users who are ‘dual users’ is lower

Summary II

Among people who smoked or stopped in the last year:

• Frequency of use among users is greater in ex-smokers
• Majority use devices containing nicotine. Later generation devices were more popular than disposable e-cigarettes to 2021; in 2022 disposables rapidly became more popular.
• Ex-smokers use e-liquids with stronger concentrations of nicotine. A minority of smokers did not know the strength
• Use of 20mg (2%) and stronger nicotine has increased since 2016
• Purchase from specialist vape shops has declined since 2016 as non-specialist purchases have risen
• E-cigarette use is most popular with younger smokers while NRT use is more popular among smokers aged 65+
• Use of e-cigarettes in past-year smokers was initially more popular among higher, but is now similar across, social grades

Summary III

E-cigarette use among smokers plateaued between 2013 and 2020 but has grown recently

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

• Growth in e-cigarette use has been accompanied by a reduction in use of licensed nicotine products and prescription medication but the trajectories appear to be different

The proportion of recent ex-smokers who started using an e-cigarette declined from a peak in 2015

Summary IV

There has been a long-term decline in the prevalence of cigarette smoking but it may have stalled since 2020, except in young adults

The smoking cessation rate, and the success rate in those who have tried to stop smoking, increased after 2011 before plateauing until a further increase in 2020

The rate at which smokers have tried to stop in the past year decreased from 2015 before increasing in 2020

The largest proportion of current smokers believe e-cigarettes are equally harmful as cigarettes

• The proportion who believe they are less harmful has declined since 2014
• The proportion who are unsure about the relative harm increased in 2020 

Conclusions

E-cigarette use remained relatively stable between 2013 and 2020 but has increased gradually since 2020, especially among young adults

E-cigarette use by never smokers increased since 2021 but remains relatively rare (<2%); use among long-term ex-smokers has continued to grow since 2013

Growth in e-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 but it may have stalled recently, except in young adults

The trajectories for smoking prevalence and quit attempts differ from that of prevalence of use of e-cigarettes

Success rates in stopping smoking increased after 2011 and again in 2020