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E-cigarettes: an evidence update <br /> <br />39 <br />who now use EC and have stopped smoking altogether. EC use among long-term ex- <br />smokers is considerably lower than among recent ex-smokers. Current EC use among <br />never smokers is very low, estimated to be 0.2%. The prevalence of EC use plateaued <br />between 2013-14, but appeared to be increasing again in 2015. <br /> <br />Youth: Regular EC use among youth is rare with around 2% using at least monthly and <br />0.5% weekly. EC use among young people remains lower than among adults: a minority <br />of British youth report having tried EC (~13%). Whilst there was some experimentation <br />with EC among never smoking youth, prevalence of use (at least monthly) among never <br />smokers is 0.3% or less. <br /> <br />Overall, the adult and youth data suggest that, despite some experimentation with EC <br />among never smokers, EC are attracting few people who have never smoked into <br />regular use. <br /> <br />Trends in EC use and smoking: Since EC were introduced to the market, cigarette <br />smoking among adults and youth has declined. In adults, overall nicotine use has also <br />declined (not assessed for youth). These findings, to date, suggest that the advent of <br />EC is not undermining, and may even be contributing to, the long-term decline in <br />cigarette smoking. <br /> <br />Policy implications <br />o Trends in EC use among youth and adults should continue to be monitored using <br />standardised definitions of use. <br /> <br />o Given that around two-thirds of EC users also smoke, data are needed on the <br />natural trajectory of ‘dual use’, ie whether dual use is more likely to lead to <br />smoking cessation later or to sustain smoking (see also Chapter 6). <br /> <br />o As per existing NICE guidance, all smokers should be supported to stop smoking <br />completely, including ‘dual users’ who smoke and use EC. <br />S <br />