Transitions in smoking and nicotine use from 2016 to 2017 among a UK cohort of past-year smokers

Aims: Recent changes in UK’s tobacco control policy and emergence of e-cigarette use have altered how smokers use nicotine and quit smoking. Research evidence describing these changes mostly focuses on specific types of smokers. To provide a comprehensive view of changing nicotine use patterns, we differentiated a cohort of past-year smokers into latent groups and explored participants’ transitions over time.

Methods: Analysis of an online cohort data from 2857 past-year smokers and vapers from the UK surveyed in June 2016 and followed up in October 2017. Latent transition analysis used information on participants’ smoking, use of e-cigarettes and nicotine replacement therapies (NRT), urges to smoke and last quit attempt to identify latent groups. Participants’ sociodemographic (age, gender, education and income) and smoking (cigarettes smoked per day, motivation to stop smoking and last quit attempts) characteristics between the identified groups were compared using Pearson’s ?2 test and Cramer’s V.

Results: Latent transition analysis differentiated four latent groups of current smokers (heavy and light smokers, smokers using NRT, smokers using e-cigarettes) and two groups of participants who recently quit smoking (abstinent ex-smokers and ex-smokers using e-cigarettes). At both waves, heavy and light smokers who did not use alternative nicotine and had not tried to quit smoking composed nearly half of all participants (50.84% in 2016 and 47.06% in 2017). Probabilities of remaining in the same latent group at follow-up ranged from 75.3% for smokers using e-cigarettes to 86.6% for heavy smokers. Notably, smokers transitioned to ex-smokers’ groups, whose prevalence at follow-up increased by 7.68%, with the majority of participants transitioning to abstinent ex-smokers (+6.29%). Use of alternative nicotine while smoking was associated with higher chances of changing nicotine use pattern at follow-up; among other groups, smokers using NRT decreased the most (-4.89%) and smokers using e-cigarettes were most likely to quit smoking (17.5%). Ex-smokers using e-cigarettes were likely to either quit e-cigarettes and transition to abstinent ex-smokers (9.0%) or relapse to smokers using e-cigarettes (7.1%).

Conclusions: Smokers tended to transition towards quitting smoking, with most abstaining from nicotine altogether. Use of e-cigarettes alongside or instead of smoking has increased slightly, but nearly half of past-year smokers continued smoking without having tried to quit or reduce harm with alternative nicotine products.