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E-cigarettes – insights from England

E-cigarettes – insights from England

Professor Ann McNeill

1Institute of Psychiatry, Psychology and Neuroscience, King’s College London.


The Government’s Tobacco Control Plan committed Public Health England to update the evidence base regularly on e-cigarettes, and as lead author of these evidence reviews since 2015, this presentation will summarise evidence on e-cigarette use in relation to cigarette smoking and the regulatory frameworks for both e-cigarettes and tobacco cigarettes. The evidence reviews draw on a variety of different data sources including government and non-governmental nationally representative surveys.

Aside from prohibition, England has one of the more robust regulatory frameworks for e-cigarettes worldwide which balances effective and regulated products which are attractive and accessible to adult smokers whilst not being appealing to never smokers. Importantly, the framework encourages access to e-cigarettes and other less harmful nicotine products among disadvantaged, as much as advantaged, smokers. The English government recently stated its intention to go completely smoke-free by 2030.

Smoking prevalence has continued to decrease in England with an all-time low of 14% recorded among adults in 2019, but has plateaued over recent years among schoolchildren at around 5%. E-cigarette use increased rapidly when e-cigarettes entered the market but their use has plateaued in recent years at around 6% among adults. There has been no rapid rises of e-cigarettes among youth as witnessed elsewhere with around 5% saying they use currently (at least occasionally). Use is concentrated in people who have experience of smoking, for example less than 1% of young people who have never smoked are current vapers. Data from randomised controlled trials, stop smoking services and observational studies in England indicate that e-cigarettes are helping smokers to stop. However, around a third of adult smokers say they have never tried an e-cigarette and harm perceptions are increasingly out of line with the evidence.

E-cigarettes are seen as one of a large battery of measures to support England’s smokefree target but regular monitoring continues to be essential to ensure potential benefits are maximized whilst managing potential risks.


Conflicts of interest: I have not taken funding from the tobacco, e-cigarette or pharmaceutical industries. I have a tenured academic position and my research income is from governmental and non-governmental bodies.

Email: ann.mcneill@kcl.ac.uk