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E-cigarettes: an evidence update <br /> <br />3 <br />Contents <br />Foreword 5 <br />Key messages 6 <br />Executive summary 7 <br />1.Introduction 14 <br />Description of e-cigarettes 15 <br />Structure of report 16 <br />2.Methodology 17 <br />Smoking Toolkit Study (STS, University College London) 17 <br />ASH Smokefree GB (adult and youth) surveys 18 <br />Internet Cohort GB survey (King’s College London, University College London) 18 <br />ASH GB Smokers’ survey 2014 18 <br />ITC Policy Evaluation project 18 <br />3.UK policy framework 20 <br />E-cigarette regulations in England: current and proposed 20 <br />4.Prevalence of e-cigarette use in England/Great Britain 26 <br />5.Smoking, e-cigarettes and inequalities 40 <br />Smoking and inequalities 40 <br />E-cigarette use and different social groups 41 <br />E-cigarette use in other disadvantaged groups 43 <br />6.E-cigarettes and smoking behaviour 45 <br />Introduction 45 <br />Use of e-cigarettes while smoking 49 <br />Summary of findings 51 <br />7.Reasons for use and discontinuation 53 <br />Reasons for using e-cigarettes 53 <br />Reasons why trial does not become use 55 <br />8.Harm perceptions 57 <br />Trends in harm perceptions relative to cigarettes over time 58 <br />Harm perception relative to nicotine replacement therapy (NRT) 61 <br />9.E-cigarettes, nicotine content and delivery 63 <br />Background 63 <br />Toxicity of nicotine 63 <br />Review methods 64 <br />Nicotine in ambient air, e-liquid and e-vapour 64 <br />Passive vaping: Nicotine from e-cigarette use in ambient air 64 <br />Nicotine delivery to e-cigarette users 70 <br />Summary of findings 74 <br />10.Safety of e-cigarettes in the light of new evidence 76