18B.3 Extent of use

Last updated: October 2018

Suggested citation: Greenhalgh, EM, & Scollo, MM. InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2017. Available from: http://www.tobaccoinaustralia.org.au/chapter-18-harm-reduction/indepth-18b-e-cigarettes

In many countries, including Australia, the use of e-cigarettes is growing, with the majority of users being current smokers.1-3   

18B3.1 Trends in use of e-cigarettes in Australia

The National Drug Strategy Household Survey asked respondents about e-cigarettes for the first time in 2013, and in 2016, asked additional questions about frequency of use. Prevalence of e-cigarette usage among Australian smokers, non-smokers (including ex- and never smokers), and persons 12 years and over for both survey years is set out in table 18B.3.1.

Table 18B.3.1 
Lifetime e-cigarette use by smoking status and age, 2013 and 2016 

Source: National Drug Strategy Household Survey 2016 key findings, Table 81

*Estimate has a relative standard error of 25% to 50% and should be used with caution

# Statistically significant change between 2013 and 2016.

(a) Smoked daily, weekly or less than weekly.

(b) Includes both those who have never smoked more than 100 cigarettes and those who have smoked more than 100 cigarettes but report no longer smoking at time of survey 

Note: The question about lifetime use of electronic cigarettes was modified in 2016 and may have impacted how people responded question.

About 9% of the general population aged 18 and over reported in 2016 having ever used e-cigarettes. At 19.2%, lifetime use was highest among young adults aged between 18 and 24 years, with use gradually decreasing by age. Lifetime use of e-cigarettes significantly increased between 2013 and 2016 both among adult smokers (from about 18% to about 31%) and non-smokers (never + ex-smokers; from about 2% to about 5%), and across all age groups except for the oldest. In 2016, the highest rates of ever use appeared to be among 18—24 year olds (49.1% and 13.6% of smokers and non-smokers, respectively, compared to 30.8% and 4.7% in the total adult population). 

Frequency of e-cigarette use by smoking status in 2016 is presented in table 18B.3.2. The overall rate of use among never smokers remained low, with 96.1% of adult never smokers reporting that they had never tried e-cigarettes (compared with 98.7% in 20134). Among ex-smokers, 7.5% reported ever-use, compared with 3.1% in 2013.4   

Although almost one-third of smokers had tried e-cigarettes in 2016, only 4.4% reported current use (daily, weekly, or monthly). 

Table 18B.3.2 
Frequency of e-cigarette use, people aged 14 years or older, 2016 (per cent)

Source: National Drug Strategy Household Survey 2016 key findings, Table 91

*Estimate has a relative standard error of 25% to 50% and should be used with caution

** Estimate has a high level of sampling error (relative standard error of 51% to 90%), meaning that it is unsuitable for most uses 


An online community survey of adults in New South Wales found that 13% had ever used an e-cigarette and, of those, 34% had used an e-cigarette in the past month. Among ever e-cigarette users, 4.6% reported regular daily use over the previous month. Participants who were younger, as well as current and ex-smokers, were more likely to have used e-cigarettes, while women with higher levels of education and income were less likely.5   

Among Australian secondary school students, in 2014, 13% reported that they had ever used an e-cigarette. Use increased with age, from 5% of 12-year-olds to 22% of 17-year-olds, and boys were significantly more likely than girls to report ever-use. Recent (past-month) use was reported by 3% of students, and also increased with age: 5% of 17-year-old students indicated they had recently used an e-cigarette compared with 2% of 12-year-olds.6 Three per cent of all students had used e-cigarettes exclusively, while 11% reported having concurrently used e-cigs with tobacco cigarettes and/or shisha-tobacco. Of the 14% of students who had ever used an e-cigarette, 12% used them exclusively, 55% had used shisha-tobacco, and 65% had smoked tobacco cigarettes at least once in their lifetime. Of the 20% of students who had smoked tobacco cigarettes in their lifetime, 47% had ever used e-cigarettes.7

Researchers have also examined the extent of e-cigarette use and understanding among Australian Aboriginal and Torres Islander smokers, and found that in 2013–14, about one fifth (21%) had tried e-cigarettes. Forty-one per cent had never tried e-cigarettes, and the remaining 38% had not heard of the products.8   

18B3.2 International trends in use of e-cigarettes 

International Tobacco Control  (ITC) Surveys data show wide variation in the prevalence of use of e-cigarettes between countries surveyed, which may be attributable to a range of factors, including but not solely differences in regulatory approaches.  In a study published in 2014, there was considerable cross-country variation by year of data collection and for self-reports of ever having tried e-cigarettes (Australia, (20% in 2013), Malaysia (19% in 2011), Netherlands (18% in 2013), United States (15% in 2010), Republic of Korea (11% in 2010), United Kingdom (10% in 2010), Mexico (4% in 2012), Canada (4% in 2010), Brazil (3% in 2013), and China (2% in 2009)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)).9, 10 Another ITC study found that in 2014, prevalence of current e-cigarette use in the UK was more than twice that of Australia (28.2% vs. 11.9%), and prevalence of daily use in the UK was about four times that of Australia (9.2% vs. 2.5%).11

Current use of e-cigarettes among adult never-smokers appears to be consistently less common than among smokers, with reported overall prevalence of less than 1% in the UK,3 Australia,1 New Zealand,12 Canada,13 and the US.14      

In 2016 in the US, 15.4% of adults had ever used an e-cigarette, and 3.2% currently used e-cigarettes;14 3.8% of men and 2.6% of women reported being a current user.15 Adults aged 18–24 years were the most likely to have ever used an e-cigarette (23.5%) and to currently use e-cigarettes (4.5%); the percentages declined steadily with age. Across all age groups, fewer than one quarter of adults who had ever used an e-cigarette reported current use.14 In 2015, among current e-cigarette users (3.5%), 58.8% also were current smokers, 29.8% were ex- smokers, and 11.4% were never smokers. Among current e-cigarette users aged 45 or over, almost all (98.7%) were either current or ex-smokers, and 1.3% had never been smokers. In contrast, among current e-cigarette users aged 18–24 years, 40.0% had never been cigarette smokers.2 Another study found that in 2016, 1.4% of never smokers reported vaping, and of these users, about 60% were young adults aged 18 to 24.16

In 2015, 13.2% of Canadians aged 15 and over reported having ever tried an e-cigarette; 3.2% had used one in the past 30 days, and 1.0% reported daily use. Use of e-cigarettes increased significantly between 2013 and 2015 (from 8.5% to 13.2%), and prevalence was greater among smokers: 51.0% of current smokers had ever used e-cigarettes in 2015, compared to 7.6% of non-smokers (including ex- and never-smokers); past-month use was 15.5% among current smokers and 1.4% among non-smokers.13  

In the UK in 2018, it was estimated that 6.2% of adults were currently using e-cigarettes, compared with 1.7% in 2012. Of these, just over half (51.6%) were ex-smokers, while 44.2% reported dual use (using both conventional and e-cigarettes).3 In the EU, the prevalence of ever-use of e-cigarettes increased from 7.2% in 2012 to 11.6% in 201417 to 14.6% in 2017.18 In 2017, 1.8% of adults were current regular e-cigarette users; the UK (4.7%) and France (3.7%) had the highest prevalence, while Italy (0.2%) and Bulgaria (0.2%) had the lowest. Almost two in five (37.9%) current smokers reported having tried e-cigarettes, which was higher than for ex-smokers (15.7%) and never smokers (2.7%).18

In New Zealand in 2014, ever-use and current use of e-cigarettes were 13.1% and 0.8% respectively. Prevalence was highest among current smokers (49.9% ever-use and 4.0% current use), followed by ex-smokers (8.4% ever-use and 0.1% current use) and never smokers (3.4% ever-use and 0.1% current use).12

18B.3.3 International trends in use among teenagers

Awareness of and experimentation by children and adolescents also appear to be growing in some countries, and it is of note that experimentation with e-cigarettes may be more common among non-smoking youth than among non-smoking adults. A review of e-cigarette use among adolescents found that use was more likely among those who were male, older, had a higher amount of pocket money, and had more tobacco smoking-related characteristics, such as regular and heavier smoking, and having peers who smoke.19

National data from the US show that in 2017, e-cigarettes were the most commonly used tobacco product among high school (11.7%) and middle school (3.3%) students. There was a nonlinear increase in e-cigarette use between 2011 and 2017 among middle school (0.6% to 3.3%) and high school students (1.5% to 11.7%).20 Decreases in cigarette and cigar use during 2011–2016 were offset by increases in hookah and e-cigarette use, resulting in no significant change in any tobacco use.21 An analysis of trends from 2011 to 2015 found that in all years, e-cigarette use was associated with use of cigarettes and other tobacco products; however, over time, past month e-cigarette users increasingly comprised those who had never used other tobacco products (from 0.1% in 2011 to 1.8% in 2015 for girls and 0.2% to 2.9% for boys).22 In Canada in 2015, 6.3% of 15–19 year olds reported having used an e-cigarette in the past 30 days, compared with 2.6% in 2013.13

Data from various surveys of 11–16 year olds across the UK show that for 2015-16, ever-use of e-cigarettes ranged from 7% to 18%, and regular (at least weekly) use ranged from 1% to 3%. Among never smokers, ever-use ranged from 4% to 10%, with regular use between 0.1% and 0.5%. Among regular smokers, ever-use ranged from 67% to 92% and regular use 7% to 38%. One survey indicated an increase in the prevalence of ever use of e-cigarettes from 7% (2016) to 11% (2017), but the prevalence of regular remained stable at 1%.23 In 2018 in Great Britain, 2% of 11–18 year olds reported using e-cigarettes at least weekly, 2% reported using them once a month or less, and 12% had tried them just once or twice. Use increased with age; 3% of 11 year olds and 23% of 18 year olds reported having tried an e-cigarette once or twice, and at least weekly use increased from 0% for 11 year olds to 3% of 18 year olds. Six per cent of never smokers reported ever use of e-cigarettes, compared with 51% of former smokers and 71% of current smokers.24  

In New Zealand, ever-use of e-cigarettes among teenagers tripled from 7% in 2012 to 20% in 2014.25 A study in Switzerland found that in 2012, 43% of adolescents had ever tried e-cigarettes, with 19% of them being experimenters and 24% users (i.e., used several times or regularly).26 Awareness and ever-use of e-cigarettes increased significantly among Finnish adolescents from 2013 to 2015; ever-use increased from 17.4% to 25%.27 In Poland, ever-use and current use of e-cigarettes in teenagers aged 15–19 increased from 16% and 5.5% respectively in 2010—11, to 62% and 30% in 2013–14. Current use of e-cigarettes (use in past 30 days) in teenagers aged 15–19 increased from 5.5% in 2010–11 to 29.9% in 2013–14.28 Ever use among 15 year olds in Greece in 2014 was 16.6%, and most of this was experimentation (0.5% reported current e-cigarette use).29 In 13 Eastern European urban areas, one-third of adolescents had used e-cigarettes, and one in five had used e-cigarettes three or more times; 2.6% of never cigarette smokers had used e-cigarettes at least three times.30 In 2015, 54% of French 16-year-olds had tried e-cigarettes, and 20% of those who experimented with e-cigarettes had never tried tobacco cigarettes.31 Over one quarter (28.6%) of Russian adolescents reported having ever used an e-cigarette in 2015, and 2.2% reported past-month use. Ever smokers were substantially more likely to have tried e-cigarettes.32  

A survey of middle-school students in China in 2013–14 found that prevalence of e-cigarette use was 1.2% and prevalence of e-cigarette awareness was 45.0%.33 In South Korea in 2015, the prevalence of e-cigarette ever and current (past 30 days) use among adolescents was 10.1% and 3.9%, respectively.34


Relevant news and research

For recent news items and research on this topic, click here.(Last updated November 2018) 

   

References

1. Australian Institute of Health and Welfare. National Drug Strategy Household Survey 2016 key findings. 2017. Available from: http://www.aihw.gov.au/alcohol-and-other-drugs/data-sources/ndshs-2016/key-findings/

2. Centers for Disease Control and Prevention. Quickstats: Cigarette smoking status among current adult e-cigarette users, by age group—National Health Interview Survey, United States, 2015. Morbidity and Mortality Weekly Report, 2016; 65:1177. Available from: http://dx.doi.org/10.15585/mmwr.mm6542a7

3. Action on Smoking and Health. Use of e-cigarettes (vapourisers) among adults in Great Britain. 2018. Available from: http://ash.org.uk/download/use-of-e-cigarettes-among-adults-in-great-britain-2017/

4. Centre for Behavioural Research in Cancer. Analysis of Australian Institute of Health and Welfare National Drug Strategy Household Survey, 2013 [computer file; Australian data archive, the Australian national university]. 2016. 

5. Twyman L, Watts C, Chapman K, and Walsberger SC. Electronic cigarette use in New South Wales, Australia: Reasons for use, place of purchase and use in enclosed and outdoor places. Australian and New Zealand Journal of Public Health, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30152006

6. White V and Williams T. Australian secondary school students’ use of tobacco, alcohol, and over-the-counter and illicit substances in 2014. 2016. Available from: http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/Publishing.nsf/content/E9E2B337CF94143CCA25804B0005BEAA/%24File/National-report_ASSAD_2014.pdf

7. Williams T and White V. What factors are associated with electronic cigarette, shisha-tobacco and conventional cigarette use? Findings from a cross-sectional survey of Australian adolescents? Substance Use and Misuse, 2018:1–11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29336657

8. Thomas DP, Lusis N, van der Sterren AE, and Borland R. Electronic cigarette use and understanding among a national sample of Australian Aboriginal and Torres Strait Islander smokers. Nicotine & Tobacco Research, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30053109

9. Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, et al. Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC project. International Journal of Environmental Research and Public Health, 2014; 11(11):11691–704. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25421063

10. Gravely S, Fong GT, Cummings KM, Yan M, Quah AC, et al. Correction: Gravely, s., et al. Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC project. Int. J. Environ. Res. Public health 2014, 11, 11691-11704. International Journal of Environmental Research and Public Health, 2015; 12(5):4631–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25922990

11. Lee C, Yong HH, Borland R, McNeill A, and Hitchman SC. Acceptance and patterns of personal vaporizer use in Australia and the United Kingdom: Results from the international tobacco control survey. Drug and Alcohol Dependence, 2018; 185:142–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29448147

12. Li J, Newcombe R, and Walton D. The prevalence, correlates and reasons for using electronic cigarettes among New Zealand adults. Addictive Behaviors, 2015; 45:245–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25744712

13. Reid J, Hammond D, Rynard V, Madill C, and Burkhalter R. Tobacco use in Canada: Patterns and trends 2017 edition. 2017. Available from: https://uwaterloo.ca/tobacco-use-canada/sites/ca.tobacco-use-canada/files/uploads/files/2017_tobaccouseincanada_final_0.pdf

14. Centers for Disease Control and Prevention. Quickstats: Percentage of adults who ever used an e-cigarette and percentage who currently use e-cigarettes, by age group—National Health Interview Survey, United States, 2016. Morbidity and Mortality Weekly Report, 2017; 66:892. Available from: http://dx.doi.org/10.15585/mmwr.mm6633a6

15. Centres for Disease Control and Prevention. Quickstats: Percentage of adults aged ≥18 years who currently use e-cigarettes, by sex and age group — National Health Interview Survey, 2016. Morbidity and Mortality Weekly Report, 2018; 66:1412. Available from: https://www.cdc.gov/mmwr/volumes/66/wr/mm665152a7.htm?s_cid=mm665152a7_w

16. Mirbolouk M, Charkhchi P, Orimoloye OA, and et al. E-cigarette use without a history of combustible cigarette smoking among US adults: Behavioral risk factor surveillance system, 2016. Annals of Internal Medicine, 2018. Available from: http://dx.doi.org/10.7326/M18-1826

17. Filippidis FT, Laverty AA, Gerovasili V, and Vardavas CI. Two-year trends and predictors of e-cigarette use in 27 European Union member states. Tobacco Control, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27220621

18. Laverty AA, Filippidis FT, and Vardavas CI. Patterns, trends and determinants of e-cigarette use in 28 European Union member states 2014-2017. Preventive Medicine, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30144487

19. Perikleous EP, Steiropoulos P, Paraskakis E, Constantinidis TC, and Nena E. E-cigarette use among adolescents: An overview of the literature and future perspectives. Front Public Health, 2018; 6:86. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29632856

20. Wang T, Gentzke A, Sharapova S, Cullen K, Ambrose B, et al. Tobacco product use among middle and high school students — United States, 2011–2017. Morbidity and Mortality Weekly Report, 2018; 67:629–33. Available from: http://dx.doi.org/10.15585/mmwr.mm6722a3

21. Jamal A, Gentzke A, and Hu S. Tobacco use among middle and high school students—United States, 2011–2016. Morbidity and Mortality Weekly Report, 2017; 66:597–603. Available from: http://dx.doi.org/10.15585/mmwr.mm6623a1

22. Chaffee B, Couch E, and Gansky S. Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015. PLoS ONE, 2017; 12(5):e0177073. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28475634

23. Bauld L, MacKintosh A, Eastwood B, Ford A, Moore G, et al. Young people’s use of e-cigarettes across the United Kingdom: Findings from five surveys 2015–2017. International Journal of Environmental Research and Public Health, 2017; 14(9):973. Available from: http://www.mdpi.com/1660-4601/14/9/973

24. Action on Smoking and Health. Use of e-cigarettes among young people in Great Britain. Fact Sheet, 2018. Available from: http://ash.org.uk/download/use-of-electronic-cigarettes-among-children-in-great-britain/

25. White J, Li J, Newcombe R, and Walton D. Tripling use of electronic cigarettes among New Zealand adolescents between 2012 and 2014. Journal of Adolescent Health, 2015; 56(5):522–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25907651

26. Suris JC, Berchtold A, and Akre C. Reasons to use e-cigarettes and associations with other substances among adolescents in Switzerland. Drug and Alcohol Dependence, 2015; 153:140–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26077606

27. Kinnunen JM, Ollila H, Lindfors PL, and Rimpela AH. Changes in electronic cigarette use from 2013 to 2015 and reasons for use among Finnish adolescents. International Journal of Environmental Research and Public Health, 2016; 13(11). Available from: https://www.ncbi.nlm.nih.gov/pubmed/27834885

28. Goniewicz ML, Gawron M, Nadolska J, Balwicki L, and Sobczak A. Rise in electronic cigarette use among adolescents in Poland. Journal of Adolescent Health, 2014; 55(5):713–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25344033

29. Fotiou A, Kanavou E, Stavrou M, Richardson C, and Kokkevi A. Prevalence and correlates of electronic cigarette use among adolescents in Greece: A preliminary cross-sectional analysis of nationwide survey data. Addictive Behaviors, 2015; 51:88–92. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26240943

30. Kristjansson AL, Mann MJ, Sigfusson J, Sarbu EA, Grubliauskiene J, et al. Prevalence of e-cigarette use among adolescents in 13 eastern European towns and cities. Public Health, 2017; 147:66–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28404498

31. Rennie LJ, Bazillier-Bruneau C, and Rouesse J. Harm reduction or harm introduction? Prevalence and correlates of e-cigarette use among French adolescents. The Journal of Adolescent Health, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26852249

32. Kong G, Idrisov B, Galimov A, Masagutov R, and Sussman S. Electronic cigarette use among adolescents in the Russian Federation. Substance Use and Misuse, 2016:1–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27767370

33. Xiao L, Parascandola M, Wang C, and Jiang Y. Perception and current use of e-cigarettes among youth in China. Nicotine & Tobacco Research, 2018. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30053201

34. Lee JA, Lee S, and Cho H-J. The relation between frequency of e-cigarette use and frequency and intensity of cigarette smoking among south Korean adolescents. International Journal of Environmental Research and Public Health, 2017; 14(3):305. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5369141/


 

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