England: Increased trend in long-term vaping among adults

A study[1] A recent study published in the British Medical Journal analysed trends in vaping among adults in England between 2013 and 2023. Over the period studied, the prevalence of vaping over time increased from 1.3% to 10%.

Long-term vaping was defined as use of these products for 6 months or more at the time of the survey. Data were obtained from the Smoking Toolkit Study, a monthly cross-sectional survey conducted in England among people aged 16 and over. Based on random sampling, an adjustment was made incorporating socio-demographic and geographic representativeness quotas and concerned exclusively adults aged 18 and over. The final sample included 179,725 participants.

Increase in consumption fuelled by the arrival of disposable e-cigarettes in England

Throughout the study period, lifetime vaping increased from 1.3 % to 10 % among adults, with no significant difference between men and women. This increase was not linear, increasing from 1.3 % to 3.3 % between October 2013 and July 2017. Prevalence then remained stable until August 2019, then increased sharply, especially from late 2021, to reach 10 % in October 2023. Segmented regression analysis indicates that this increase coincides with the arrival and increasing popularity of disposable e-cigarettes (puffs) in England. Prior to June 2021, lifetime vaping was increasing by 11.3 % per year; However, after the widespread adoption of disposable devices, long-term vaping consumption increased by 38.6% per year.

Long-term vaping with disposable devices increased from 0.1 % in 2021 to 4.9 % in October 2023. Use of open and refillable devices increased from 2.5 % to 4.6 %, while use of pod devices increased from 0.3 % to 1% of the adult population over the same period. For the authors, this indicates that many vapers continue to use disposable devices long-term, rather than switching to refillable devices.

The authors warn that long-term vaping with disposable e-cigarettes can also have a substantial environmental impact: because these products are designed for single use, they generate more waste than refillable vaping products, namely rechargeable devices and pods.

Young adults more likely to report being long-term vapers

According to the study, the prevalence of long-term vaping increased more rapidly among younger adults than older adults after 2019, with 22.7% of 18-year-olds reporting long-term vaping compared to 4.3% of those aged 65 and older. A similar trend was observed among those who had never smoked regular cigarettes regularly: 16.1% of 18-year-olds compared to 0.3% of those aged 65 and older were long-term vapers but had never smoked.

The study also found that the increase in vaping over time was mainly among current and former smokers of tobacco products.[2], excluding heated tobacco. The proportion of current smokers who vape over time increased from 4.8 % to 23.1 % between 2013 and 2023. For recent ex-smokers (who quit less than a year ago), this proportion is respectively 5.7 % in 2013 and 36.1 % in 2023. For longer-term ex-smokers (who quit more than a year ago), 1.4 % vaped in 2013 and this proportion is 16.2 % in 2023. However, an increase is also observed among people who have never regularly smoked tobacco products, excluding heated tobacco, since the prevalence of vaping in this population increased from 0.1 % in 2013 to 3 % in 2023.

Daily vaping over a longer period of time

The study data also suggest that an increasing number of long-term users are daily users. There were 0.6% daily users in 2013, then 3% in 2021 and 6.8% in 2023. This finding also concerns more than two-thirds of those who have never smoked regularly. In other words, the authors emphasize that consumption increases over time but that it is also more frequent. However, this progression between 2021 and 2023 coincides with the popularization of disposable devices.

A previous British study[3] had also shown that the arrival of disposable vaping devices in 2021 had led to a higher use of high-nicotine vaping products among adult vapers in Great Britain. The number of vapers using products containing 20mg/ml of nicotine or more increased from 6.6% on average between June 2021 to 33% in January 2024. Almost one in two vapers (47.9% of vapers) using high-nicotine devices mainly use disposable devices.

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[1] Jackson SE, Tattan-Birch H, Shahab L, Brown J. Trends in long term vaping among adults in England, 2013-23: population based study BMJ 2024; 386:e079016 doi:10.1136/bmj-2023-079016

[2] Manufactured cigarettes, rolled cigarettes, pipes, hookahs

[3] Jackson SE, Brown J, Shahab L, Arnott D, Bauld L, Cox S. Nicotine strength of e-liquids used by adult vapers in Great Britain: A population survey 2016 to 2024. Addiction. 2024. https://doi.org/10.1111/add.16576