Trends in e-cigarette use – where to from here?

Trends in e-cigarette use – where to from here?

Presenter: Hayden McRobbie

Author names: McRobbie, H.

Author affiliations: University of New South Wales

Introduction: Fewer Australians are smoking combustible cigarettes. The national smoking prevalence is down to 11.0% and reflects the strong tobacco control efforts of the governmental and non-governmental sectors.

Smoking cessation remains one of the best interventions preventing and managing a wide range of illnesses. People who smoke now have a range of effective options for smoking cessation, however long-term abstinence rates remain, in general, less than 20%. Over the past decade e-cigarettes have become increasingly popular among smokers, and in some countries are now the most commonly used tool to aid smoking cessation. However, there have also been upwards trends in the use of e-cigarettes among never smokers.

Aims: This presentation summarises the key findings of the NDSHS 2019 and compares and contrasts with trends in e-cigarette use in other countries. It also presents the latest evidence on e-cigarettes for smoking cessation.

Methods: A narrative review.

Results: Globally there has been an increase in the use of e-cigarettes. Among those who smoke, use of an e-cigarette is less harmful than smoking. However, regular use in non-smokers is likely to be associated with some risk to health and wellbeing, although the degree of harm has not yet been quantified.

In Australia, the National Drug Strategy Household Survey (NDSHS 2019) showed that 1 in 10 smokers had used an e-cigarette in the past year, with around a third reporting use as an aid to quit smoking. Daily use of e-cigarettes is most common in smokers (3.2%) and ex-smokers (2.2%) and showed a significant increase from the proportions of daily use in 2016 (1.5% and 0.8%, respectively. Daily use among never smokers remains low (0.2%) and unchanged from 2016. There has been a statistically significant increase in current used (defined as using daily, weekly, monthly, or less than monthly) in people aged 18-24 years from 6.8% in 2016 to 18.7% in 2019. The proportion of this age group that smoke tobacco cigarettes in 2019 is 9.2% (11.6% in 2016).

Recent systematic reviews show moderately strong evidence that e-cigarettes can assist with smoking cessation, where nicotine containing e-cigarettes are probably more effective that nicotine replacement therapy and non-nicotine e-cigarettes at aiding abstinence from smoking for at least six months. Data suggest that some e-cigarettes can deliver nicotine in a very similar way to smoking. This would be advantageous to smokers trying to quit but represents some risk when used by non-smokers.

Implications: Whilst there are many unknowns about the health risks associated with long-term use of e-cigarettes, they are an effective tool for smoking cessation. There is good rationale for providing access to people who smoke to use as a smoking cessation aid, whilst also having policy measures that restrict access by young non-smokers.