Sharp rise in long-term vaping among adults in England, study finds

The number of adults in England who report vaping for more than six months has increased substantially from around one in 80 in 2013 to one in 10 in 2023, finds a study published by The BMJ today.

Much of this increase has occurred since 2021, coinciding with the rapid rise in popularity of disposable e-cigarettes, especially among young adults, including those who had never regularly smoked, the results show.

It was already established that vaping rates have increased substantially in England since new disposable e-cigarettes became popular in mid-2021, particularly among adolescents and young adults, but it was unclear how far this reflected an increase in experimental use versus long-term (more than 6 months), regular use. Little was also known about how the types of products used by long term vapers (more than 6 months) were changing over time.

To explore this further, researchers drew on data for 179,725 adults taking part in the Smoking Toolkit Study, a nationally representative survey that collects detailed data on vaping among adults in England each month.

Between October 2013 and October 2023, participants were asked about use of a range of nicotine products, depending on their smoking status. 

Those who reported vaping for more than six months were considered long term vapers. Details of vaping frequency (daily or non-daily), main type of device used (disposable, refillable, or pod), age, sex, and occupational social grade were also recorded.

Over the study period, the proportion of adults reporting long term vaping increased from 1.3% in October 2013 to 10% in October 2023, with a particularly sharp rise from 2021. This included an increase in long term daily vaping, from 0.6% to 6.7%. 

The increase in long term vaping occurred predominantly among current and former smokers, but a recent rise also occurred among those who had never regularly smoked (from less than 0.5% up to March 2021 to 3% by October 2023).

Growth was also more pronounced in young adults (reaching 23% of 18 year olds v 4.3% of 65 year olds) including among those who had never regularly smoked (reaching 16% of 18 year olds v 0.3% of 65 year olds).

The rate of long term vaping was higher among men than women between June 2015 and December 2022, but by October 2023 the rates were similar between men and women. 

The rate of long term vaping was also consistently higher among those from less advantaged social grades compared with more advantaged social grades.

The researchers also note that half of long term vapers now mainly or exclusively use disposable devices, which has a substantial impact on the environment.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors acknowledge several limitations relating to study design and measures that may have influenced their results.

Nevertheless, they say, long term vaping has noticeably increased among young adults since 2021, including among those who have never regularly smoked, suggesting that disposable e-cigarettes may be leading young adults to establish longer term e-cigarette use. 

This adds weight to calls for tighter regulation of vaping products to reduce their appeal to young people and highlights the urgency of this action, they conclude. 

Such policies must be carefully considered as they may unintentionally discourage smokers from using vaping products to quit smoking. Policies most likely to achieve this balance may be those focused on retail displays, packaging, descriptors and cost.

There are sufficient grounds to prohibit disposable vapes based on their environmental impact alone, but a ban on disposable vapes - or any other single product design - is unlikely to significantly alter vaping rates, given the ease with which the market can adapt, says Canadian researcher David Hammond in a linked editorial. 

Instead of trying to isolate disposable products, he suggests regulations should consider the underlying attributes that attract young people to disposable vapes, including colorful brand imagery and ubiquitous marketing at the point-of-sale.

Removing these attributes may increase the appeal and credibility of vaping as a way to quit smoking among middle-aged and older smokers, he says. Such measures also have the potential to reassure health professionals, many of whom remain skeptical of the benefits of vaping for smoking cessation.