E-cigarettes an evidence update A report commissioned by Public Health England

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E-cigarettes: an evidence updatesignificantly lower in Australia than in the UK in 2013, the use of EC increased at thesame rate in Australia and the UK between 2010 and 2013 [183].Canada took a similar approach to regulating EC as Australia by prohibiting the sale ofEC with nicotine through existing laws. However, a recent House of Commons reportstated that the current regulatory approach was not working to restrict access to EC withnicotine [184]. Canada has now put forward recommendations to develop a newlegislative framework for EC that would most likely allow the sale of EC with nicotine[184]. There has been only one population-level survey of EC use in Canada. The 2013Canadian Tobacco, Alcohol and Drugs Survey (CTADS) of Canadians 15 years andolder found that 9% had ever tried an EC, with trial being higher among young peopleaged 15–19 years at 20% [185]. Use in the past 30 days was lower at 2%, with past 30day use being higher among young people aged 15–19 years at 3%. Of those who triedan EC, 55% stated the EC did not contain nicotine, while 26% reported it did containnicotine, with 19% reporting uncertainty. Whether the EC they tried contained nicotine isuncertain given (1) the ban on the sale of EC with nicotine, and (2) reports that manyEC sold and bought in Canada are labelled as not containing nicotine but actuallycontain nicotine [184]. Although it is difficult to make comparisons due to differentsurvey methods and questions, the percentage of young people (15–19 years) whohave tried EC in Canada (20%) is roughly similar to the percentage who have tried ECin GB in 2014 (reported at 8%, 15%, 18%, and 19%, for ages 15 to 18, respectively).Summary of findingsAlthough EC use may be lower in countries with more restrictions, these restrictionshave not prevented EC use. Overall, use is highest among current smokers, with lownumbers of non-smokers reporting ever use. Current use of EC in other countries isassociated with being a smoker or ex-smoker, similar to the findings in the UK. EC useis frequently misreported, with experimentation presented as regular use. Increases inyouth EC trial and use are associated with decreases in smoking prevalence in allcountries, with the exception of one study from Poland.Policy implicationsooFuture research should continue to monitor and evaluate whether different ECpolicies across countries are related to EC use and to smoking cessation andsmoking prevalence.Consistent and agreed measures of trial, occasional and regular EC use amongyouth and adults are urgently needed to aid comparability.88
E-cigarettes: an evidence updateAcknowledgementsWe are grateful to Elle Wadsworth for her support in producing this document.89
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E-cigarettes an evidence update A report commissioned by Public Health England

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