professor robert west - e-cigarette summit 2014
TRANSCRIPT
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Prof Robert West
Professor of Health Psychology
Director of Tobacco Studies
Cancer Research UK
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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
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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
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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
5
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www.smokinginengland.info/latest-statistics
Methods
6
• 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
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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
Perc
ent
of sm
okers
and
recent
ex-
sm
okers
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
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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
Perc
ent
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
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www.smokinginengland.info/latest-statistics
Prevalence of nicotine products while
smoking
9
0
5
10
15
20
25
30
35
40
45
50
Perc
en
t of sm
okers
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
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www.smokinginengland.info/latest-statistics
Prevalence of nicotine products in
recent ex-smokers
10
0
10
20
30
40
50
60
70
Perc
ent
of
ex-s
mokers
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
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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
Perc
ent
N=1745 e-cigarette users of adults who smoke or stopped in past year
The large majority of e-cigarette users
also smoke
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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+
Perc
en
t
E-cig user
Cigarette smoker
N=32,291 adults from 2013 onwards
Prevalence of e-cigarette use follows a
similar pattern to smoking
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www.smokinginengland.info/latest-statistics
E-cigarette use
13
0
5
10
15
20
25
30
35
40
45
50
Lessthan
weekly
Weeklybut notdaily
1 per day 2-5 perday
6-10 perday
11+ perday
Perc
ent
Smoker
Ex-smoker
Frequency of use among users is greater in
recent ex-smokers
N=1323 e-cigarette users not using NRT
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www.smokinginengland.info/latest-statistics
Aids used in most recent quit attempt
14
0
5
10
15
20
25
30
35
40
45
502
00
9-3
20
09
-4
20
10
-1
20
10
-2
20
10
-3
20
10
-4
2011-1
20
11
-2
20
11
-3
20
11
-4
20
12
-1
20
12
-2
20
12
-3
20
12
-4
20
13
-1
20
13
-2
20
13
-3
20
13
-4
20
14
-1
20
14
-2
20
14
-3
Perc
ent
of sm
okers
try
ing t
o s
top
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
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www.smokinginengland.info/latest-statistics
Quit attempts and quit success
15
0
5
10
15
20
25
30
35
40
45
50
% try
ing
to
qu
it in
pa
st 1
2m
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
% w
ho
qu
it in
pa
st 1
2m
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www.smokinginengland.info/latest-statistics
Prevalence of nicotine/cigarette use
16
0
5
10
15
20
25
Perc
ent
sm
okin
g c
igs o
r usin
g
nic
otine
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
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www.smokinginengland.info/latest-statistics
Modelling impact on prevalence
17
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
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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 18