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
• "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."

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

Use of Juul and heated tobacco products is rare

E-cigarette use by never smokers remains rare but use among long-term ex-smokers has grown

E-cigarette use in smokers and recent ex-smokers has plateaued

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

Frequency of use among users is greater in ex-smokers

The majority contain nicotine and later generation devices are more popular with ex-smokers

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 and online purchases have risen

E-cigarette use is least popular with older smokers while NRT use is lower among younger smokers

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 has plateaued among smokers

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

The long-term decline in the prevalence of cigarette smoking continues

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 has remained relatively stable since 2013

Current use of e-cigarettes by never smokers remains very rare and similar to use of licensed nicotine products; use among long-term ex-smokers appears to be increasing

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

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