Abstract
AimsTo provide up‐to‐date estimates of how changes in the prevalence of electronic cigarette (e‐cigarette) use in England have been associated with changes in smoking cessation activities and daily cigarette consumption among smokers in England.DesignTime–series analysis of population trends.SettingEngland.ParticipantsParticipants came from the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. Data were aggregated on approximately 1200 past‐year smokers each quarter (total n = 50 498) between 2007 and 2017.MeasurementsPrevalence of e‐cigarette use in current smokers was used to predict (a) prevalence of quit attempts among last‐year smokers, (b) overall quit rates among last‐year smokers and (c) mean cigarette consumption per day among current smokers. Prevalence of e‐cigarette use during a quit attempt among last‐year smokers was used to predict (a) quit success rate among last‐year smokers and (b) overall quit rates among last‐year smokers.FindingsOverall quit rates increased by 0.054% [95% confidence interval (CI) = 0.032–0.076, P < 0.001] and 0.050% (95% CI = 0.031–0.069, P < 0.001) respectively for every 1% increase in the prevalence of e‐cigarette use by smokers and e‐cigarette use during a quit attempt. Quit success rates increased by 0.060% (95% CI = 0.043–0.078, P < 0.001) for every 1% increase in the prevalence of e‐cigarette use during a quit attempt. No clear evidence was found for an association between e‐cigarette use and either prevalence of quit attempt (BAdj = 0.011, 95% CI = −0.046 to 0.069, P = 0.698) or cigarette consumption (BAdj = 0.019, 95% CI = −0.043 to 0.082, P = 0.542).ConclusionChanges in prevalence of e‐cigarette use in England have been positively associated with the overall quit rates and quit success rates but not clearly associated with the prevalence of quit attempts and mean cigarette consumption.
Highlights
The potential for e-cigarettes to contribute to population health by promoting smoking cessation or reduction remains contested [1]
This study addresses the following questions: 1. What is the association between prevalence of ecigarette use in current smokers and (a) prevalence of quit attempts among last-year smokers, (b) overall quit rates among last-year smokers and (c) mean cigarette consumption per day among current smokers? 2
In adjusted and unadjusted analyses, the data showed no clear association between prevalence of e-cigarette use among current smokers and attempts to quit smoking (B = 0.011, 95% confidence interval (CI) = –0.046 to 0.069, P = 0.698; see Table 1 and Fig. 1 and Supporting information, Table S1)
Summary
The potential for e-cigarettes to contribute to population health by promoting smoking cessation or reduction remains contested [1]. We report a time–series analysis on the association between the prevalence of e-cigarette use and smoking cessation and cigarette consumption among remaining smokers in England up to 2017. Population trend data are limited by the possibility of population-level confounding, such as introduction of policies that may affect overall quitting rates In theory, they may be affected by changes in the demographic or smoking profiles of the population, it would be implausible for sufficiently large changes to occur to influence the results during time intervals of a year or less used in studies of this kind. The three sources of information together (clinical trials, comparative observational studies and population trend data) provide powerful triangulation on the true effect size of widely used aids to cessation such as e-cigarettes. What is the association between prevalence of ecigarette use during a quit attempt among last-year smokers and (a) quit success rate among last-year smokers and (b) overall quit rates among last-year smokers?
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