Increasing numbers of adults say they are vaping for more than six months, according to researchers who compared rates in 2013 in England with those recorded in 2023.

Writing in the latest of The BMJ, which was published yesterday (17 July), Sarah E Jackson, from Department of Behavioural Science and Health at University College London, and colleagues state that rates rose from around one in 80 in 2013 to one in 10 in 2023.

Dr Jackson and her co-authors note that the increase has accelerated since 2021. This coincided 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 clear, they write, that vaping rates increased substantially in England since new disposable e-cigarettes became popular in mid-2021, particularly among adolescents and young adults. But it was less clear how far this reflected an increase in experimental use versus long term (more than six 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, Dr Jackson and her colleagues 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.

From October 2013 to 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 per cent in October 2013 to 10 per cent in October 2023, with a particularly sharp rise from 2021. This included an increase in long term daily vaping, from 0.6 per cent to 6.7 per cent. 

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 per cent up to March 2021 to 3 per cent by October 2023).

Growth was also more pronounced in young adults (reaching 23 per cent of 18-year-olds v 4.3 per cent of 65-year-olds) including among those who had never regularly smoked (reaching 16 per cent of 18-year-olds v 0.3 v 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. Dr Jackson and colleagues also note that half of long-term vapers now mainly or exclusively use disposable devices, which has a substantial impact on the environment.

The growth has been concentrated among people with a history of regular smoking, but an increase has also occurred among those who have never regularly smoked, especially young adults [Sarah Jackson et al]

Caveats and conclusions

As the study was observational in nature, firm conclusions about cause and effect cannot be drawn, 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.

Dr Jackson and colleagues conclude: ‘The prevalence of long term (>6 months) vaping increased substantially among adults in England from 2013 to 2023. Much of this increase occurred from 2021, coinciding with the rapid rise in popularity of disposable e-cigarettes. Half of long term vapers now mainly or exclusively use disposable devices.’

They add: ‘The growth has been concentrated among people with a history of regular smoking, but an increase has also occurred among those who have never regularly smoked, especially young adults.’

To access the research article – titled  Trends in long term vaping among adults in England, 2013-23: population based study doi: 10.1136/bmj-2023-079016 – click 

What attracts young people?

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 David Hammond in a linked editorial. 

Professor Hammond is based at the School of Public Health Sciences, University of Waterloo, Ontario, Canada. He suggests that rather than trying to isolate disposable products, policymakers should consider the underlying attributes that attract young people to disposable vapes, including colourful 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 sceptical of the benefits of vaping for smoking cessation.

To access the editorial – titled The rise of disposable e-cigarettes in England and implications for public health doi: 10.1136/bmj.q1508 – click