Transcript The PRIME Theory of motivation and its application to

Trends in electronic cigarette use in
England
Robert West
Jamie Brown
Emma Beard
University College London
www.smokinginengland.info
Updated 21st March 2014
Background
• Electronic cigarette use has become prevalent in
many countries
• In England, electronic cigarettes are regulated
as consumer products
• It is important to track use of electronic
cigarettes and assess who far they are
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
motivation to stop smoking
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 ~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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Percent of smokers and recent exsmokers
Prevalence of electronic cigarette use:
smokers and recent ex-smokers
50
45
40
Prevalence of e-cigarette use has plateaued at
16% of current and recent smokers
35
30
25
20
15
Any
Daily
10
5
0
N=11,318 adults who smoke or who stopped in the past year; increase p<0.001
5
Percent
Electronic cigarette use
50
45
40
35
30
25
20
15
10
5
0
Frequency of use among users is greater in
ex-smokers
Smoker
Ex-smoker
Less
than
weekly
Weekly 1 per day 2-5 per 6-10 per 11+ per
but not
day
day
day
daily
N=821 e-cigarette users not using NRT
6
Prevalence of nicotine products while
smoking
50
Percent of smokers
45
40
35
Increase in use of e-cigarettes while smoking has
more than offset a decrease in NRT use
30
25
20
15
E-cigs
NRT
All nicotine
10
5
0
N=10,529 smokers, increase p<0.001 e-cigs and all nicotine; decrease p=0.025 for NRT 7
Prevalence of nicotine products in
recent ex-smokers
50
Percent of ex-smokers
45
40
35
Increase in use of e-cigarettes
has been offset by reduction in
NRT use
30
25
20
15
E-cigs
NRT
All nicotine
10
5
0
N=674 adults who stopped in the past year; increase p<0.001 for e-cigs;
decrease p<0.001 for NRT
8
Proportion of e-cigarette users who are
smokers
100
90
Percent
80
70
60
50
The large majority of e-cigarette users
are using them to reduce smoking
40
30
20
10
0
N=11,316 adults who smoke or who stopped in the past year, except 21013-4 onwards which include never smokers
and long-term ex-smokers
9
Aids used in most recent quit attempt
50
Percent of smokers trying to stop
45
40
35
Increase in use of e-cigarettes for quitting has been
accompanied by a smaller reduction in use of other
aids except behavioural support
30
25
20
15
10
5
E-cigs
NRT OTC
NRT Rx
Champix
Beh'l supp
0
N=4,810 adults who smoke and tried to stop or who stopped in the past year
10
Motivation to quit
Motivation to Stop Score (1-7)
7
6
There has been a small increase in motivation
to quit
5
4
3
2
1
N=12,699 adults who smoke; increase p<0.001
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Percentage trying to quit in past 3m
Quit attempts
25
There has been a small increase in quit attempts
20
15
10
5
0
N=14,024 adults who smoke or who stopped in the past 3 months; increase p=0.005
12
Percent who have smoked in the past
year who do not smoke now
Quitting
10
9
8
7
6
5
4
3
2
1
0
There has been an increase in the rate of
quitting smoking
N=14,027 adults who smoked in the past year; increase p<0.001
13
Percent smoking cigs or using nicotine
Prevalence of nicotine/cigarette use
25
Cigarette consumption has decreased
as has overall nicotine use
20
15
10
Cigarettes
Nicotine or cigarettes
5
0
N=64,222 adults, decrease p<0.001 for both lines
14
Cigarette smoking prevalence
30
25
24.2
22.0
Percent
20
21.5
21.4
20.7
20.0
19.3
17.8
15
10
5
0
2007
2008
2009
2010
2011
2012
2013
2014 (Mar)
(N=22079) (N=18990) (N=21137) (N=24794) (N=21879) (N=21330) (N=22167) (N=5022)
Base: All adults
Graph shows prevalence estimate and upper and lower 95% confidence intervals
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Decrease in smoking prevalence
5
4.5
4
Percent
3.5
3
2.5
2.1
2
1.5
1.5
1
0.6
0.5
0.5
0.7
0.8
0.2
0
2007 to
2008
2008-2009 2009-2010 2010-2011 2011-2012 2012-2013
Base: All adults
2013-Mar
2014
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Stopped smoking in past 12 months
12
10
Percent
8
6
8.7
6.7
5.6
6.2
5.0
4.8
6.1
4.6
4
2
0
2007
2008
2009
2010
2011
2012
2013 2014 (Mar)
(N=5959) (N=4602) (N=4973) (N=5775) (N=4892) (N=4726) (N=4710) (N=1026)
Base: Adults who smoked in the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals
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Tried to stop smoking in past year
50
45
40
42.5
39.8
37.0
35.9
Percent
35
38.5
33.5
40.3
34.4
30
25
20
15
10
5
0
2007
2008
2009
2010
2011
2012
2013
2014 (Mar)
(N=5959) (N=4602) (N=4973) (N=5775) (N=4892) (N=4726) (N=4710) (N=1026)
Base: Adults who smoked in the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals
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Success rate for stopping in those who
tried
30
25
21.4
Percent
20
17.6
15.7
15
14.1
13.6
13.4
15.8
13.7
10
5
0
2007
2008
2009
2010
2011
2012
2013
2014 (Mar)
(N=2533) (N=1829) (N=1833) (N=2068) (N=1637) (N=1627) (N=1729) (N=395)
Base: Smokers who tried to stop n the past year
Graph shows prevalence estimate and upper and lower 95% confidence intervals
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Nicotine use by never smokers and
long-term ex-smokers
3.5
3
E-cigarette use by never smokers is
negligible
Percent
2.5
2
1.5
1
0.5
0
Never smoker
E-cig
N=8,380 from Nov 2013
Long-term ex-smoker
NRT
20
The nicotine/cigarette market
Per capita daily consumption
3
The cigarette and nicotine market
are both declining
2.5
2
1.5
1
Nicotine
Cigarettes
0.5
0
N=42,347 adults
Nicotine data only from last year smokers
nondaily nicotine: <1 pw=0.1, 1+ pw=0.5
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Conclusions
• The increase in electronic cigarette use prevalence may have
stalled
• Growth in electronic cigarette use has been accompanied by a
reduction, albeit smaller, in use of licensed nicotine products and
prescription medication but not use of behavioural support
• Evidence does not support the view that electronic cigarettes are
undermining motivation to quit or reduction in smoking prevalence
• Use of e-cigarettes by never smokers remains extremely rare
• Evidence conflicts with the view that electronic cigarettes are
undermining tobacco control or ‘renormalizing’ smoking, and they
may be contributing to a reduction in smoking prevalence through
increased success at quitting smoking
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