Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024.

BACKGROUND AND AIMS: In March 2024, the UK government announced plans to introduce a Vaping Products Duty that will tax e-liquids based on their nicotine strength. This study examined trends in the nicotine strength of e-liquids used by adult vapers and differences in those currently used across relevant subgroups. DESIGN: Nationally-representative, cross-sectional household survey, July 2016 to January 2024. SETTING: Great Britain. PARTICIPANTS: 7981 adult vapers. MEASUREMENTS: Participants were asked whether the e-cigarette they mainly use contains nicotine (yes/no) and the e-liquid strength (no nicotine, >0-≤ 6, 7-11, 12-19 or ≥20 mg/ml). We also collected information on the main device type used (disposable/refillable/pod), age, gender, occupational social grade, history of ≥1 mental health conditions, smoking status and (among past-year smokers) level of cigarette addiction. FINDINGS: The proportion of vapers in England using high-strength (≥20 mg/ml) e-liquids increased from an average of 3.8% (95% confidence interval [CI] = 2.9-5.0) up to June 2021 to 32.5% (CI = 27.9-37.4) in January 2024 (the vast majority of whom [93.3% in January 2024] reported using exactly 20 mg/ml; the legal limit). This rise was most pronounced among those using disposable e-cigarettes, those aged 18-24 years and all smoking statuses (including never smokers) except long-term (≥1y) ex-smokers. Of those surveyed in 2022-2024 in Great Britain, overall, 89.5% (CI = 88.1-90.8) said they usually used e-cigarettes containing nicotine, 8.7% (CI = 7.5-10.0) used nicotine-free e-cigarettes, and 1.8% (CI = 1.2-2.4) were unsure. The proportion using ≥20 mg/ml was higher among those mainly using disposable (47.9%) compared with pod (16.3%) or refillable (11.5%) devices; never smokers (36.0%), current smokers (28.8%) or recent (<1y) ex-smokers (27.4%), compared with long-term ex-smokers (13.9%); and younger (16-24y; 44.2%) compared with older (≥25y; range 9.4-25.1%) age groups. There were no notable differences across other subgroups of interest. CONCLUSIONS: Use of high-strength nicotine e-liquids in England appears to have increased sharply in recent years. Most adult vapers in Great Britain appear to use e-cigarettes that contain nicotine but different subgroups use different strengths: nicotine strengths tend to be higher among those who mainly use disposable devices and those aged 16-24y, and lower among long-term ex-smokers.

Attitudes And Exposure To Illicit Tobacco In England, 2022.

INTRODUCTION: The UK has achieved reductions in illicit tobacco (IT) market size and share. However, there remains a 17.7% tobacco duty gap, contributing to health inequalities. In January 2024, the UK government announced a new strategy to control IT, along with provision of new funding. METHODS: A representative cross-sectional survey of adults in England ran in April 2022 to evaluate attitudes and exposure to IT. Tobacco smokers were asked questions about encounters with IT, while all participants answered questions on knowledge and perspectives on IT. RESULTS: Of 262 tobacco smokers, 18.3% (95% CI 13.8% - 23.6%) had come across IT in the past year. Men had four times the odds of encountering IT recently than women. Among 1,767 adults responding to questions on IT, two-thirds agreed IT harmed children, and more than half agreed IT was linked to organised crime. Younger adults, smokers and those in lower socio-economic groups were less likely to agree IT was harmful. CONCLUSIONS: Exposure to IT, especially among younger males, remains a concern. While most of the public acknowledge its harm, this is not universal, and some population groups are less likely to do so. IMPLICATIONS: The study highlights persistent exposure to illicit tobacco in England, especially among younger males, and varying perceptions of illicit tobacco harm across socio-economic groups. Tackling illicit tobacco requires collaboration between health and enforcement agencies, independent of the tobacco industry's influence. Strategies should include components that shift demand for illicit tobacco and denormalise its presence in communities, particularly in lower socio-economic areas with higher smoking prevalence.

Impact of E-liquid Packaging on Vaping Product Perceptions Among Youth in England, Canada, and the United States: A Randomized Online Experiment.

INTRODUCTION: Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed. AIMS AND METHODS: A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status. RESULTS: Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids. CONCLUSIONS: Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions. IMPLICATIONS: Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered.

Marketing claims on the websites of leading e-cigarette brands in England.

INTRODUCTION: Exposure to electronic cigarette (EC) marketing is associated with EC use, particularly among youth. In England, the Tobacco and Related Products Regulations and Committee of Advertising Practice (CAP) regulate EC marketing to reduce appeal to youth; however, there are little published data on EC marketing claims used online. This study therefore provides an overview of marketing claims present on the websites of EC brands popular in England. METHODS: From January to February 2022, a content analysis of 10 of England's most popular EC brand websites was conducted, including violation of CAP codes. RESULTS: Of the 10 websites, all presented ECs as an alternative to smoking, 8 as a smoking cessation aid and 6 as less harmful than smoking. Four websites presented ECs as risk-free. All mentioned product quality, modernity, convenience, sensory experiences and vendor promotions. Nine featured claims about flavours, colours, customisability and nicotine salts. Seven featured claims concerning social benefits, personal identity, sustainability, secondhand smoke and nicotine strength. Six featured claims about fire safety. Some claimed ECs are cheaper than tobacco (n=5), cited health professionals (n=4) or featured collaborations with brands/icons (n=4). All were assessed by the research team to violate one or more CAP code(s) by featuring medicinal claims (n=8), contents which may appeal to non-smokers (n=7), associations with youth culture (n=6), depictions of youth using ECs (n=6) or media targeting youth (n=5). CONCLUSION: Among 10 top EC brand websites in England, marketing elements that might appeal to youth were commonly identified and CAP code compliance was low.

Association of Fully Branded and Standardized e-Cigarette Packaging With Interest in Trying Products Among Youths and Adults in Great Britain.

Importance: e-Cigarette vaping among youths and adults has increased in Great Britain. The design of e-cigarette packaging may appeal to youths. Regulations that reduce the appeal of e-cigarettes to youths may deter adult smokers from trying e-cigarettes to help them quit smoking. Objective: To examine the association of fully branded and standardized e-cigarette packaging with interest in trying products among youths and adults in Great Britain. Design, Setting, and Participants: In this survey study comprising 2 surveys, the online Action on Smoking and Health Smokefree Great Britain survey collected data between March 25 and April 16, 2021, from a representative sample of 2469 youths (aged 11-18 years) and between February 18 and March 18, 2021, from a representative sample of 12 046 adults (aged ≥18 years). Interventions: A between-individuals experimental design was used to examine participants' perceptions of e-cigarette packs that were digitally altered to remove brand imagery and color. Participants were randomly assigned to view a set of 3 e-cigarette packs from 1 of 3 different packaging conditions: (1) fully branded packs (control), (2) white standardized packs with brand name, or (3) green standardized packs with brand name. Main Outcomes and Measures: Youth participants were asked which product people their age would be most interested in trying, while adult participants were asked which product they would be most interested in trying. All participants could respond "no interest" or "don't know." Logistic regression models tested whether reporting no interest in trying the e-cigarettes differed between the pack conditions. Results: This study included 2469 youths (1286 female youths [52.1%]; mean [SD] age, 15.0 [2.3] years) and 12 046 adults (6412 female [53.2%]; mean [SD] age, 49.9 [17.4] years). Youths had higher odds of reporting no interest among people their age in trying the e-cigarettes packaged in green (292 of 815 [35.8%]; adjusted odds ratio [AOR], 1.37; 95% CI, 1.10-1.71; P = .005) but not white (264 of 826 [32.0%]; AOR, 1.16; 95% CI, 0.93-1.44; P = .20) standardized packaging compared with the fully branded packaging (238 of 828 [28.7%]). Adults had lower odds of reporting no interest in trying e-cigarettes in green standardized packaging (3505 of 4040 [86.8%]; AOR, 0.85; 95% CI, 0.73-0.99; P = .046) but not white packaging (3532 of 4006 [88.2%]; AOR, 1.05; 95% CI, 0.89-1.23; P = .59) compared with branded packaging (3526 of 4000 [88.1%]). Youths who had never vaped (275 of 699 [39.3%]; AOR, 1.34; 95% CI, 1.07-1.69; P = .01) and youths who had never smoked (271 of 676 [40.1%]; AOR, 1.38; 95% CI, 1.10-1.75; P = .006) were more likely to report no interest in trying e-cigarettes in green packaging compared with branded packaging (224 of 688 [32.6%] never vaping; 216 of 662 [32.6%] never smoking). There were no significant differences by vaping or smoking status among adults. Conclusions and Relevance: The findings of this survey study suggest that standardized packaging measures may reduce the appeal of e-cigarettes among youths without reducing their appeal among adults.

Use of tobacco and e-cigarettes among youth in Great Britain in 2022: Analysis of a cross-sectional survey.

INTRODUCTION: Although e-cigarettes can be an effective form of nicotine substitution for adults attempting to quit smoking, their use among children and young people is a concern. Accurate data about this are needed to inform debates over policy and regulation in the UK and elsewhere. METHODS: Using data from an online survey of 2613 youth aged 11-18 years, conducted by the market research company YouGov in March 2022, we present prevalence estimates of e-cigarette and tobacco use. We use logistic regression models to assess differences in e-cigarette use, tobacco use and use of disposable e-cigarettes across a range of covariates including age, sex, tobacco smoking status, social class, and country. RESULTS: Among the 18.0% of those surveyed who reported ever having smoked a cigarette, 83.9% were not regular (at least once per week) smokers and 16.1% were (15.1% and 2.9% of the total sample, respectively). Among the 19.2% of those surveyed who had ever used an e-cigarette, 79.2% were not regular users, while 20.8% were (15.2% and 4.0% of the total sample, respectively). Regular e-cigarette use was more common than regular tobacco smoking (4.0% vs 2.9%). E-cigarette use was more common among those who also smoked tobacco, with 9.0% of never e-cigarette users ever smoking tobacco, compared with 89.4% of regular e-cigarette users. Both smoking and e-cigarette use were associated with increasing age and use by others within the home, but not with social class. Use of disposable e-cigarettes was reported by 53.8% of those who have ever used an e-cigarette, and more common among females than males. CONCLUSIONS: Regular e-cigarette use is now more common than smoking in children and youth, though the majority of this is among those who have also smoked tobacco. Measures to reduce the appeal of both e-cigarettes and tobacco to children and young people are warranted.

Smoking in social housing among adults in England, 2015-2020: a nationally representative survey.

OBJECTIVES: To analyse associations between living in social housing and smoking in England and to evaluate progress towards reducing disparities in smoking prevalence among residents of social housing compared with other housing types. DESIGN: Cross-sectional analysis of nationally representative data collected between January 2015 and February 2020. SETTING: England. PARTICIPANTS: 105 562 adults (≥16 years). PRIMARY AND SECONDARY OUTCOME MEASURES: Linear and logistic regression were used to analyse associations between living in social housing (vs other housing types) and smoking status, cigarettes per day, time to first cigarette, exposure to others' smoking, motivation to stop smoking, quit attempts and use of cessation support. Analyses were adjusted for sex, age, social grade, region and year. RESULTS: Adults living in social housing had two times the odds of being a smoker (ORadj=2.17, 95% CI 2.08 to 2.27), and the decline in smoking prevalence between 2015 and 2020 was less pronounced in this high-risk group (-7%; ORadj=0.98, 95% CI 0.96 to 1.01) than among adults living in other housing types (-24%; ORadj=0.95, 95% CI 0.94 to 0.96; housing tenure-survey year interaction p=0.020). Smokers living in social housing were more addicted than those in other housing types (smoking within 30 min of waking: ORadj=1.50, 95% CI 1.39 to 1.61), but were no less motivated to stop smoking (ORadj=1.06, 95% CI 0.96 to 1.17) and had higher odds of having made a serious attempt to quit in the past year (ORadj=1.16, 95% CI 1.07 to 1.25). Among smokers who had tried to quit, those living in social housing had higher odds of using evidence-based cessation support (ORadj=1.22, 95% CI 1.07 to 1.39) but lower odds of remaining abstinent (ORadj=0.63, 95% CI 0.52 to 0.76). CONCLUSIONS: There remain stark inequalities in smoking and quitting behaviour by housing tenure in England, with declines in prevalence stalling between 2015 and 2020 despite progress in the rest of the population. In the absence of targeted interventions to boost quitting among social housing residents, inequalities in health are likely to worsen.

When is Subnational, Supralocal Tobacco Control "just right"? A Qualitative Study in England.

INTRODUCTION: Subnational, supralocal (or "regional") approaches to tobacco control are often central federal nation tobacco control and can be superfluous for very small nations. However, their relevance to countries with weak intermediate tiers of governance are less clear. This study explores expert and policymaker perceptions on the function, form, footprint, and funding of regional tobacco control (RTC) in England. AIMS AND METHODS: One-to-one semistructured interviews (n = 16) and four focus groups (n = 26) exploring knowledge and perceptions of the past, present, and future of RTC in England were conducted with public health leaders, clinicians, tobacco control practitioners, civil servants, and politicians. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: Participants reported several key functions for RTC, including illicit tobacco control, media campaigns, advocacy, policy development, and network facilitation for local actors. A small minority of participants reported little role for RTC. Broader perceived features of effective RTC included subject expertise, strong regional ties, systems leadership, and a distinctive program of work. Views varied on whether regional programs should be developed nationally or locally, and their optimal footprint. Participants generally agreed stable funding was a prerequisite for success, although there was lesser agreement on funding sources. CONCLUSIONS: Pooling resources at the regional level in countries with weak intermediate tiers of governance may increase reach, cost-effectiveness and impact of campaigns, policy interventions, and advocacy, whilst retaining the ability to tailor approaches to regional populations. IMPLICATIONS: There are likely to be greater funding and governance challenges associated with introducing or strengthening RTC in countries with weak intermediate tiers of governance. Despite this, evidence from England shows it is possible to develop RTC approaches reported as effective by key stakeholders. Possible benefits of regional approaches in this context include cost-effective delivery of illicit tobacco control, media campaigns, advocacy, research, policy development, and coordinated support for local action on tobacco.

Tobacco Retailers' Support for Point-of-Sale Tobacco Control Policies in England: Association Study of Retailers' Perceived Importance of Tobacco Sales, Contact with the Tobacco Industry, and the Perceived Impact of the Policy.

INTRODUCTION: Political acceptability and successful implementation of tobacco control policies at the point of sale may depend on, among other factors, tobacco retailers' level of support for these policies. This study quantified the level of support among small tobacco retailers for four point-of-sale tobacco control policies and its association with three predictors. METHODS: We used cross-sectional telephone survey data (August 2019) of 508 small tobacco retailers in England. Weighted logistic regression analyses examined associations between support for the product display ban, price display ban, minimum pack size, and standardized packaging, and self-reported importance of tobacco sales for a business, contact with the tobacco industry, and the perceived impact of the policy on their overall business. RESULTS: A majority of retailers support minimum pack size (66%), product display ban (65%), price display ban (54%), and standardized packaging (55%). The importance of tobacco sales was not associated with support for the policies. More frequent contact with the tobacco industry was associated with higher odds of support for minimum pack size (OR: 2.01, 95%CI:1.25-3.21), but not with the other three policies. The negative perceived impact of the policies, compared with neutral, was associated with 1.5 to three times lower odds of support for all four policies. CONCLUSION: In England, small retailers' support for the four point-of-sale tobacco control policies varied between 54% and 66%. Support seems unrelated to the perceived importance of tobacco sales, and contact with the tobacco industry, but seems strongly related to the perceived impact of tobacco control policies on their business. IMPLICATIONS: This study shows that small independent retailers' support for point-of-sale (PoS) tobacco control policies is fairly high and that the lack of support voiced by retail trade organizations is not representative of the views of retailers in England. Support rates may be further improved by addressing retailers' perceptions of the impact of policies on their business. Support was not related to retailers' perceived importance of tobacco sales for their business and their contact with the tobacco industry. The industry rhetoric is not supported by our findings, as the majority of small independent retailers in England support tobacco control regulations.

Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England.

AIMS: To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio-demographic profile of those smokers. DESIGN AND SETTING: Nationally representative cross-sectional survey of adults in England conducted between January 2009 and July 2019. PARTICIPANTS: A total of 219 720 adults. MEASUREMENTS: All participants reported their current smoking status and socio-demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio-demographic characteristics relative to non-smokers. FINDINGS: The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21-30. In 2019, 15.6% [95% confidence interval (CI) = 12.8-18.8%] of 18-20-year-olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18-20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40-1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06-1.24 range) and HSI (ORs = 1.05-2.85 range). Compared with non-smokers aged 18-20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1-E (lower social grades) compared with AB (higher social grades) (OR = 1.19-1.83 range). CONCLUSION: Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18-20, who have less motivation to quit.

What does Brexit mean for UK tobacco control?

In January 2020 the UK left the European Union (EU), although a transition period extends EU rules/regulations until the end of 2020 while a longer-term relationship agreement is negotiated. After almost 50 years of membership the UK economy is tightly integrated into that of the EU single market, and many UK laws and regulations have their origins in the EU, including those concerning tobacco. This paper provides an overview of potential implications of Brexit for UK tobacco control. We examine the key areas of the supply, cost, taxation, and regulation of tobacco products, and the impact of commitments in regards to the border between Ireland and Northern Ireland (NI). We find that Brexit provides an opportunity for improved tobacco control with potential for particular enhancements in the areas of taxation and product regulation. However, commitments in regards to NI mean these benefits either won't extend to NI (which will continue to follow EU rules), or could lead to the whole UK having to follow most EU rules/regulations despite no longer being involved in the decision making process. The details of any future deal will be important, especially since virtually all UK tobacco products come from the EU, and hence would be subject to disruption/considerable new tariffs (i.e. taxation on imports) without a trade deal. We conclude that political will by the UK government to secure conditions which protect the UK's world leading tobacco control measures will be key to whether Brexit helps or hinders tobacco control in the UK. In this regards the signs are mixed.

Smokers who have not tried alternative nicotine products: a 2019 survey of adults in Great Britain.

AIMS: Switching from smoking to using nicotine replacement therapy (NRT), electronic cigarettes (e-cigarettes) or heated tobacco products can reduce tobacco-related health risks. However, not all smokers in Great Britain have tried these products. This study aimed to identify and describe smokers who have never tried alternative nicotine products. METHODS: We analysed cross-sectional survey data of smokers (n = 1777) from a representative adult sample from Great Britain. The online survey was run in March 2019. The proportion of smokers who had never used alternative nicotine products was measured. A multivariate logistic regression assessed the association between never having used alternative nicotine products and sociodemographic and smoking characteristics and motivation to stop smoking. RESULTS: One in four smokers (27.8%, 95% CI 25.8-29.9%) had never tried NRT, e-cigarettes or heated tobacco products. These smokers were more commonly from Black and Minority than White ethnic groups (AOR = 1.55; 95% CI 1.02-2.31), were more likely to smoke up to 10 versus more cigarettes per day (AOR = 1.52; 95% CI 1.14-2.03) and to report low versus moderate or high motivation to stop smoking (AOR = 1.79; 95% CI 1.20-2.74). CONCLUSION: Light smokers, those unmotivated to stop and smokers from Black and Minority ethnic groups are less likely to have ever tried alternative nicotine products. Different approaches are needed to facilitate harm reduction and smoking cessation among these groups of smokers.

Long-term evaluation of the rise in legal age-of-sale of cigarettes from 16 to 18 in England: a trend analysis.

OBJECTIVE: To assess the long-term impact of the increase in age-of-sale of cigarettes from 16 to 18 in England in October 2007. METHODS: Data were collected between November 2006 and September 2018 on 252,601 participants taking part in a nationally representative survey of adults aged 16+ in England, the Smoking Toolkit Study (STS). We assessed the impact of the introduction of the increase in age-of-sale on prevalence of ever smoking, current smoking, and quit attempts, among 16-17 year olds compared with 18-24 year olds. RESULTS: Following the increase in age-of-sale, there was a declining trend in ever smoking that was greater among 16-17 year olds than 18-24 year olds (OR 0.990 versus OR 0.993; p = 0.019). Data on current smoking were insensitive to detect a difference between the age groups in a step-level change or change in trend following the increase in age-of-sale (Bayes factors (BFs) 0.75 and 2.10). Data on quit attempts were also insensitive to detect a change in trend (BF 0.71), and despite a greater step-level decline among those aged 16-17 (OR 0.311 versus OR 0.547, p = 0.025), quit attempts remained higher among those aged 16-17. Secondary analysis indicated that post-policy change, trends in current and ever smoking were linear for 16-17 year olds but quadratic for 18-24 year olds (slowing decline). CONCLUSION: There is some evidence from an assessment of long-term trends in the Smoking Toolkit Study that the increase in legal age-of-sale of cigarettes in England was associated with a greater long-term decline in ever smoking among those aged 16-17 compared with those aged 18-24.

Stop Smoking Practitioners' understanding of e-cigarettes' use and efficacy with particular reference to vapers' socioeconomic status.

Introduction: We have undertaken four online surveys of Stop Smoking Service (SSS) practitioners in England, between 2011 and 2016, in order to enhance our understanding of e-cigarettes: a fast moving new phenomenon. It is important to understand whether e-cigarettes can ameliorate or exacerbate health inequalities given that smoking is one of the most serious causes of excessive mortality and morbidity among disadvantaged groups globally. Aims: To update findings of previous surveys and examine socioeconomic status differences in e-cigarette use and efficacy. Methods: Analysis was undertaken of electronic surveys, particularly, the most recent 2016 survey (n = 514) and 2015/16 SSS client routine monitoring data. Results: SSS practitioners were becoming more positive about e-cigarettes: 42% agreed that e-cigarettes were a good thing compared with 15% in 2011. Reported use of e-cigarettes among SSS clients was low (about 3%) despite higher quit rates (63% of clients reported being quit at four week follow-up, compared with 51% overall). Where socioeconomic differences in e-cigarettes' efficacy for quitting were identified, affluent and working smokers were advantaged. Conclusions: Low use of e-cigarettes by clients and practitioner opinions suggest that further education of SSS staff is needed if they are to adopt the current service recommendations about e-cigarettes.