Trends in electronic cigarette use in England
1UCL, London, UK
England is a country with a relatively strong tobacco control climate that regulates electronic cigarettes as consumer products but with marketing restrictions and a ban on sale to those under 18 years of age. Understanding trends in e-cigarette use in such a country can be informative in assessing appropriate policies in relation to these products internationally. The Smoking Toolkit Study (STS www.smokinginengland.info) involves monthly national household surveys of representative samples of the population aged 16+ years and focuses on key performance indicators on smoking and smoking cessation. It has been running since November 2006. Key findings to date are: 1) after an initial rapid growth, prevalence of e-cigarette plateaued in late 2013, 2) daily use account for about 2/3rds of use, 3) there is continued growth in use of e-cigarettes to aid attempts to stop smoking, 4) e-cigarettes used without health professional involvement appear similarly effective to stop-smoking medicines obtained on prescription with limited behavioural support and more effective than use of no aid or licensed nicotine products bought from a shop, 5) use of e-cigarettes by never smokers remains negligible (0.2%) and similar to licensed nicotine products, 6) use of e-cigarettes by long-term ex-smokers remains low (3.5%) and similar to licensed nicotine products, 7) population rates of attempts to stop smoking do not appear to have been affected by the growth in e-cigarette use, 8) increased use of e-cigarettes may have increased the population rates of success at stopping smoking among those who try, leading to an estimated additional 17,000 ex-smokers in 2014, 9) there is a growing belief among smokers that e-cigarettes are at least as harmful as tobacco cigarettes.