18B.3 Extent of use

Last updated: August 2017

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 82

*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 92

*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

18B.3.2 International trends in use of e-cigarettes

International Tobacco Control 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%)).5, 6   

Current use of e-cigarettes among adult never-smokers appears to be consistently less common than among smokers, with reported prevalence of less than 1% the UK,1 Australia,2 Canada,7 and the US.8    

In 2016 in the US, 15.4% of adults had ever used an e-cigarette, and 3.2% currently used e-cigarettes. As in Australia, 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.8 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.3   

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.7   

In the UK in 2017, it was estimated that 5.8% of adults were currently using e-cigarettes, compared with 1.7% in 2012. Of these, just over half (52%) were ex-smokers, while 45% reported dual use (using both conventional and e-cigarettes). Use of e-cigarettes among smokers remained stable since 2014 (from 17.6% to 18%), while use among ex-smokers grew from 4.5% in 2014 to 9.5% in 2017.1  In the EU, the prevalence of ever-use of e-cigarettes increased from 7.2% in 2012 to 11.6% in 2014.9 In 2014, current daily use of e-cigarettes was estimated at 1.08%. Current and former smokers reported higher rates of daily use (2.31%, and 2.18%, respectively), compared to never smokers (0.08%).10 Ever e-cigarette use was reported by 31.1% of current smokers, 10.8% of former smokers, and 2.3% of never smokers.11  

18B.3.3 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. 

In 2014, 13% of Australian secondary school students 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.12   

National data from the US show that in 2016, e-cigarettes were the most commonly used tobacco product among high school (11.3%) and middle school (4.3%) students. During 2015–16, current use of e-cigarettes decreased among all students; however, 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.13 An analysis of trends from 2011 to 2015 in e-cigarette use among US adolescents found that in 2015, 9.4% of girls and 13.2% of boys had used e-cigarettes in the past month. 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).14   

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%.15

In New Zealand, ever-use of e-cigarettes among teenagers tripled from 7% in 2012 to 20% in 2014.16 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 2013.7 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 2013–14.17 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.18  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.19 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.20   

Recent news and research
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References

 

1. Action on Smoking and Health. Use of e-cigarettes among adults in Great Britain 2017. 2017. Available from: http://ash.org.uk/information-and-resources/fact-sheets/use-of-e-cigarettes-among-adults-in-great-britain-2017/

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

3. 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

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]. Melbourne: Cancer Council Victoria; 2016.

5. 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

6. 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

7. Reid J, Hammond D, Rynard V, Madill C, and Burkhalter R, Tobacco use in Canada: Patterns and trends 2017 edition. Waterloo, ON: Propel Centre for Population Health Impact: University of Waterloo; 2017. Available from: https://uwaterloo.ca/tobacco-use-canada/sites/ca.tobacco-use-canada/files/uploads/files/2017_tobaccouseincanada_final_0.pdf.

8. 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

9. 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

10. Farsalinos KE, Poulas K, Voudris V, and Le Houezec J. Prevalence and correlates of current daily use of electronic cigarettes in the European Union: Analysis of the 2014 Eurobarometer survey. Intern Emerg Med, 2017. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28260221

11. Farsalinos KE, Poulas K, Voudris V, and Le Houezec J. Electronic cigarette use in the European Union: Analysis of a representative sample of 27 460 Europeans from 28 countries. Addiction, 2016. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27338716

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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

 

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