In part 1 of our series on the future of e-cigarettes, we brought you information about Public Health England’s Evidence-Based Review and in part 2, we expanded on nicotine content, emissions and delivery via e-cigs. In this article, we will compare the similarities in smoking rates between the United States and England to help answer the question of how PHE’s report could affect the vaping industry in the U.S.

Smoking Rates: The United States vs. England

The smoking rates in the U.S. compared to England are strikingly similar. The percentage of smokers in England verses the U.S. only varies by about 2%, while social factors also play a huge role. For example, the majority of England’s remaining 8 million smokers comes “from more disadvantaged groups in society, including those with mental health problems, on low income, the unemployed and the offenders”. According to the Centers for Disease Control and Prevention (CDC), the same goes for the U.S. as stated in their most recent report, “Current cigarette smoking is higher among persons living below the poverty level than those living at or above this level.” One of the theories behind these statistics is “the chronic stress of poverty drives unhealthy behaviors.” Former smokers all know first-hand the impact stress can have on smoking habits, so it’s no wonder why those with stressful living conditions are more likely to smoke; Regardless of social factors, smoking is still the number one cause of preventable death in both England and the United States; thus, health organizations must explore all possible avenues for aiding smokers in kicking the habit.

Smoking Rates in England

A key component to Public Health England’s review is the Smoking Toolkit Study based out of University College London. This study, which consists of monthly cross-sectional household interviews of adults aged 16 and over, has been collecting information on smoking and smoking cessation in England since November, 2006, with a new nationally representative sample of about 1,800 respondents collected each month. Here is a chart of the findings in regard to smoking cessation in England:

As you can see, the rate of e-cig usage as a smoking cessation aid has been skyrocketing in England since 2012 and has been the number 1 quitting aid since 2013. This information was enough for Public Health England to take a closer look at electronic cigarettes to determine their future role as an approved smoking alternative in an effort to ensure they are providing smokers with the most successful tobacco alternatives.

Smoking Rates in the U.S.

While there is some information available regarding smoking rates in the U.S., there is currently no information regarding the rates of smoking cessation aids that includes electronic cigarettes. According to Rob Burton, White Cloud’s Director of Corporate and Regulatory Affairs, the UK is ahead of the U.S. in terms of research when it comes to electronic cigarettes. He states this is partly due to the fact that the UK has been more open to electronic cigarettes than the U.S. This proves true in the fact that a chart similar to the one above comparing the use of e-cigs to the currently approved smoking alternatives in the U.S., such as nicotine gum and patches, is basically non-existent. So in an effort to compare the rate of e-cig use for smoking cessation in the United States, let’s take a look at the smoking trends over the last 50 years.

As of this year, the percentage of smokers in the U.S. is just over 15%, according to the latest National Health Interview Survey by the Center for Disease Control (CDC). This is a huge deal compared to the U.S. smoking rate in 1965, which was nearly half of the population at 42%! Smoking rates have steadily decreased over the last 50 years; however, there was a stall in the decline between 2004 and 2009 when smoking rates remained at or above 20% of the population. Since then, smoking rates have undergone a dramatic decline, as shown in the chart below:

Current Smoking

FIGURE 8.1. PREVALENCE OF CURRENT CIGARETTE SMOKING AMONG ADULTS AGED 18 AND OVER:

United States, 1997 – March 2015

NOTES: Data are based on household interviews of a sample of a sample of the civilian noninstitutionalized population. Current cigarrete smokers were defined as those who had smoked more than 100 cigarettes in their lifetime and now smoke every day or some days. The analyses excluded persons with unknown cigarettes smoking status (about 2% of respondents each year).

DATA SOURCE: CDC/NCHS, National Health Interview Survey, 1997 – March 2015, Sample Adult Core component. 

• For January – March 2015, the percentage of adults aged 18 and over who were current cigarette smokes was 15.2% (95% confidential interval = 13.98% – 16.32%), which was lower than the 2014 estimate of 16.8%.
• The prevalence of current cigarette smoking among U.S. adults declined from 24.7% in 1997 to 15.2% in January – March 2015.

As indicated in the chart above, there was a huge drop in smoking rates between 2009 and 2010, which was also the biggest decline in comparison to the last 50 years. This is enough to raise questions about what contributed to this sudden decline. Is it really just a coincidence that smoking rates in the U.S. saw the biggest decline in history shortly after electronic cigarettes started gaining popularity? The even bigger question is: will >Public Health England’s findings affect the FDA’s Deeming Regulations in the U.S? According to Rob Burton, “It could and it really should. The FDA must base decisions on scientific evidence, and the UK’s report is all based on scientific evidence.” To prove that point even further, Public Health England’s evidence review was based on scientific research from around the world, even though the focus was on England.

Electronic Cigarettes Are Not Tobacco

One of the biggest issues with the FDA’s proposed regulations of electronic cigarettes is the idea that e-cigs should be in the same category as tobacco. As we learned in the breakdown of PHE’s Evidence-Based Review, scientific evidence continues to suggest that e-cigs are much safer than smoking. While we do agree there should be some regulations for electronic cigarettes in terms of keeping them out of the hands of minors and making sure e-liquids are contained in childproof packaging, as well as ensuring e-cig devices are approved for safety and no unnecessary harmful ingredients find their way into e-liquids; we also feel that regulating e-cigs in the same way as tobacco is not the answer. As Rob Burton states, “Electronic cigarettes are not tobacco—they contain an ingredient derived from the tobacco plant, but the delivery of this ingredient via electronic cigarettes does not require the burning and inhalation of tobacco leaves, along with the thousands of other harmful chemicals found in a tobacco cigarette.”

When asked about the FDA’s proposal to regulate e-cigs in the same category of tobacco, Rob went on to say, “Electronic cigarettes should not be taxed in the same manner as tobacco cigarettes. If e-cigs are 95% less harmful than tobacco, as concluded and stated in the PHE report, then why tax them as tobacco when the end goal of tobacco harm reduction is to help smokers move away from tobacco?” This is definitely an important question for policy makers and health organizations to keep in mind, as well as the fact that cost also plays a significant role in terms of smokers making the switch to e-cigs. Therefore, if e-cigs are taxed in the same manner as tobacco, then an important advantage of making the switch is taken away from smokers in search of a successful alternative.

Related: White Cloud Responds to FDA Regarding Proposed Rule

The New Future of Electronic Cigarettes

As electronic cigarette research continues to accumulate and point towards positive results, it has become quite obvious the original idea that e-cigs are a fad that will eventually fade away is long gone. With the first official recognition of their potential as a successful smoking cessation aid, it has become apparent that e-cigs are here to stay. As more and more smokers continue to successfully make the switch from tobacco to electronic cigarettes, we believe the future of electronic cigarettes will one day be summed up into one simple word—FREEDOM.