Trends in electronic cigarette use in England Robert West Jamie Brown Emma Beard University College London Updated 14 th April 215
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 Monthly household surveys Each month involves a new representative sample of ~18 respondents; smokers ~45 Data collected on electronic cigarettes since second quarter 211 Fidler, et al., 211. '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
Percent Nicotine use by never smokers and long-term ex-smokers 4 3.5 3 2.5 2 1.5 1.5 E-cigarette use by never smokers is negligible Never smoker E-cig NRT Long-term ex-smoker N=22489 never and long-term ex-smokers from Nov 213 5
Percent of smokers and recent exsmokers Prevalence of electronic cigarette use: smokers and recent ex-smokers 5 45 4 35 3 25 2 15 1 5 Prevalence in use of e-cigarettes may have plateaued Any Daily N=16529 adults who smoke or who stopped in the past year; increase p<.1 6
Percent Electronic cigarette use 5 45 4 35 3 25 2 15 1 5 Frequency of use among users is greater in ex-smokers Smoker Ex-smoker Less than weekly Weekly but not daily 1 per day 2-5 per day 6-1 per day 11+ per day N=1655 e-cigarette users not using NRT 7
Percent using the product Electronic cigarette and NRT use across the age range 5 45 4 35 3 25 2 15 1 5 Prevalence of e-cigarette use is broadly evenly distributed across the age range while NRT use is lower among younger people 16-24 25-34 35-44 45-54 55-64 65+ E-cig user NRT user N=8,263 adults who smoke or who stopped in the past year 8
Percent using the product Electronic cigarette and NRT use in men and women 5 45 4 35 3 25 2 15 1 5 Men Prevalence of e-cigarette and NRT use is slightly higher in women Women E-cig user NRT user N=8,263 adults who smoke or who stopped in the past year 9
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 2,84 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 (, 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 Used NRT obtained on prescription Quit as soon as decided versus Used Zyban (bupropion) planned in advance Used Champix (varenicline) Used NRT (licensed nicotine Used specialist behavioural support replacement therapy) bought over the counter 1
Odds ratio Factors associated with odds of success in most recent quit attempt: results Base: Smokers who tried to quit in past 12 months 3 2.8 2.6 2.4 2.2 2 1.8 1.6 1.4 1.2 1.8.6.4.2.76.71 1.1.89 1.4 1.2.9.73 2 1.6 1.1.88.28.31 1.1.84 1.8 1.8 1.2.7 2.6 1.7 2.2 1.5 1.8 1.1 Vertical lines represent 95% confidence intervals; Odds ratio of 1 means no association 11
Percent 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 4 3 2 1 <1 week 1-4 weeks 4-8 weeks 8-12 weeks 12-26 weeks 26-52 weeks 12
Percent using the product Electronic cigarette and NRT use across the social gradient 5 45 4 35 3 25 2 15 1 5 Higher social grades are more likely to use e-cigarettes while there is no clear gradient for NRT AB C1 C2 D E E-cig user NRT user N=8,263 adults who smoke or who stopped in the past year 13
Percent of smokers Use of nicotine products while smoking 5 45 4 35 3 25 2 15 1 5 NRT use continues to decline even after plateau in e-cigarette use E-cigs NRT All nicotine N=15433 smokers, increase p<.1 e-cigs and all nicotine; decrease p<.1 for NRT 14
Percent of ex-smokers Use of nicotine products in recent exsmokers 7 6 5 There continues to be an increase in use of e-cigarettes in recent ex-smokers 4 3 2 E-cigs NRT All nicotine 1 N=196 adults who stopped in the past year; increase p<.1 for e-cigs and all nicotine; decrease p=.3 for NRT 15
Percent Proportion of e-cigarette and NRT users who are smokers 1 9 8 7 6 5 4 3 2 1 The large majority of both e-cigarette and NRT users are dual users (also smoke) E-cigs NRT N=2135 e-cigarette users and N=2224 NRT users of adults who smoke or stopped in past year 16
Percent of smokers trying to stop 29-3 29-4 21-1 21-2 21-3 21-4 211-1 211-2 211-3 211-4 212-1 212-2 212-3 212-4 213-1 213-2 213-3 213-4 214-1 214-2 214-3 214-4 215-1 Aids used in most recent quit attempt 5 45 4 35 3 25 2 15 1 5 E-cigarette use for quitting is still increasing somewhat E-cigs NRT OTC NRT Rx Champix Beh'l supp N=178 adults who smoke and tried to stop or who stopped in the past year 17
Aids used in most recent quit attempt 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% % 29 21 211 212 213 214 NHS Med Rx/E-cigs Nothing/NRT-OTC 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.5% to the decreased prevalence (~2, additional ex-smokers) Approx odds of success relative to nothing and NRT-OTC: 1.5 Moderately effective 3. Most effective N=9783 adults who smoke and tried to stop or who stopped in the past year; 29 is Jul to Dec 18
Percent who report having ever smoked regularly Take-up of smoking 1 9 8 7 6 5 4 3 2 1 Proportion of people under 25 years who have ever smoked regularly has remained constant N=12931 people aged 16-24 19
Percent smoking cigs or using nicotine Prevalence of nicotine/cigarette use 25 2 15 1 5 Cigarette consumption has decreased as has overall nicotine use Cigarettes Nicotine or cigarettes N=73795 adults, decrease p<.1 for cigarettes and p<.1 for overall nicotine use 2
Percent Cigarette smoking prevalence 3 25 24.2 Cigarette smoking prevalence continues to decline 2 22. 21.5 21.4 2.7 2. 19.3 18.5 17.9 15 1 5 27 (N=2279) 28 (N=1899) 29 (N=21137) 21 (N=24794) 211 (N=21879) 212 (N=2133) 213 (N=22167) 214 (N=217) 215 (Mar) (N=4952) Base: All adults Graph shows prevalence estimate upper lower 95% confidence intervals 21
Percent Decrease in smoking prevalence 5 4 3 The rate of decline in cigarette smoking prevalence has been relatively stable 2 2.1 1.5.2.6.7.8.7.6 27-28 28-29 29-21 21-211 211-212 212-213 213-214 214-215 (Mar) Base: All adults 22
Percent Stopped smoking in past 12 months 12 1 8 6 6.7 5.6 5. 4.8 4.6 6.2 6.1 7.2 6.6 4 2 The smoking cessation have increased since 211 27 (N=5959) 28 (N=462) 29 (N=4973) 21 (N=5775) 211 (N=4892) 212 (N=4726) 213 (N=471) 214 (N=4152) 215 (Mar) (N=979) Base: Adults who smoked in the past year Graph shows prevalence estimate upper lower 95% confidence intervals 23
Percent Tried to stop smoking in past year 5 45 4 35 3 42.5 39.8 37. 35.9 33.5 34.4 38.5 37.3 31.2 25 2 15 1 The rate at which smokers have tried to stop in the past year increased from 211 and has decreased in 1 st quarter of 215 5 27 (N=5959) 28 (N=462) 29 (N=4973) 21 (N=5775) 211 (N=4892) 212 (N=4726) 213 (N=471) 214 (N=4152) 215 (Mar) (N=979) Base: Adults who smoked in the past year Graph shows prevalence estimate upper lower 95% confidence intervals 24
Percent Success rate for stopping in those who tried 3 25 2 15 15.7 14.1 13.6 13.4 13.7 17.6 15.8 19.1 18.6 1 5 The success rate in those who have tried to stop smoking increased from 211 27 (N=2533) 28 (N=1829) 29 (N=1833) 21 (N=268) 211 (N=1637) 212 (N=1627) 213 (N=1729) 214 (N=1485) 215 (Mar) (N=299) Base: Smokers who tried to stop n the past year Graph shows prevalence estimate upper lower 95% confidence intervals 25
Per capita daily consumption The nicotine/cigarette market 3 The cigarette and nicotine market are both declining 2.5 2 1.5 1 Nicotine Cigarettes.5 N=73747 adults Nicotine data only from last year smokers nondaily nicotine: <1 pw=.1, 1+ pw=.5 26
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 211 Use of e-cigarettes by never smokers remains very rare and similar to use of licensed nicotine products E-cigarettes may have helped approximately 2, smokers to stop in 214 who would not have stopped otherwise 27