A recent study published in the British Medical Journal examined trends in long-term vaping among adults in England between 2013 and 2023.

Study: Trends in long term vaping among adults in England, 2013-23: population based study. Image Credit: Elena Belodedova / Shutterstock.com

Recent trends in e-cigarette use

Electronic cigarettes are effective for smoking cessation and are considered to be less harmful than conventional cigarettes; however, e-cigarettes are not risk-free, especially for non-smokers. Countries continue to struggle to regulate e-cigarettes to aid smokers in quitting while preventing uptake among non-smokers.

In England, e-cigarettes were widely used by smokers for quitting and rarely by young people and non-smokers. However, a rise in vaping among adolescents and young adults has been observed over the past several years due to the increased availability of disposable devices. Thus, further research is needed to understand the long-term health and environmental effects of increased vaping, particularly among non-smokers and young people.

About the study 

Data were obtained from the Smoking Toolkit Study, a monthly cross-sectional survey of adults in England, using random probability and simple quota sampling. The survey includes nationally representative data on smoking prevalence, sociodemographic characteristics, and cigarette use. In-person interviews were replaced by telephone interviews beginning in April 2020 due to coronavirus disease 2019 (COVID-19) pandemic restrictions.

The analysis included data between October 2013 and October 2023, focusing on adults 18 years of age and older. Long-term vaping was defined as current vaping for more than six months. Vaping frequency was recorded and distinguished between daily and non-daily use.

The main types of devices used were categorized as refillable, disposable, or pod. Smoking status was determined based on current and past smoking habits, while sociodemographic characteristics included gender, age, and occupational social grade.

Logistic regression analysis was used to examine trends in long-term vaping. These trends were also stratified by smoking status, age, gender, and occupational social grade. Segmented regression and sensitivity analyses were also performed.

Study results 

During the study period, 197,266 adults 18 years of age and older in England were surveyed. After excluding 17,541 participants from months where vaping duration was not assessed, the final sample included 179,725 participants, 125,751 of whom provided data on the type of vaping device used between July 2016 and October 2023. 

Throughout the study period, long-term vaping surged from 1.3% to 10% among adults. This increase was non-linear, as it rose from 1.3% to 3.3% between October 2013 and July 2017, remained stable until August 2019, then sharply increased, especially from late 2021 until reaching 10% by October 2023.

Segmented regression analysis indicated that this rise coincided with the growing popularity of disposable e-cigarettes. Before June 2021, long-term vaping increased by 11.3% each year; however, following the widespread availability of disposable devices, this periodic form of vaping rose to 38.6% yearly.

From an equal proportion of 0.6% in October 2013, daily vaping reached 6.8% by October 2023, while non-daily vaping rose modestly to 1.6%. Among never-smokers, the increase in daily vaping of 1.5% was more significant than non-daily vaping at 0.6%. Detailed frequency data indicated a reduction in less frequent vaping and an increase in vaping 12 or more times daily.

In July 2016, most long-term vapers used refillable devices, with few using disposables, 2.5% and 0.1%, respectively. By October 2023, similar proportions of the study population used refillable and disposable devices, 4.6% and 4.9%, respectively.

Long-term vaping with disposable devices rose from 0.1% before 2021 to 4.9% by October 2023. Refillable device usage increased from 2.5% to 4.6%, whereas pod device usage increased from 0.3% to 1.0%.

Among 6,173 long-term vapers, 9.3% also used various non-combustible nicotine products. When these participants were excluded from the sensitivity analysis, slightly lower prevalence estimates were observed at 9.1% before 2021 compared to 10% in October 2023.

Long-term vaping primarily increased among current and former smokers and among non-smokers, from less than 0.5% before 2021 to 3% by October 2023. The prevalence of long-term vaping significantly increased among younger adults to 22.7% by October 2023 compared to 4.3% of 65-year-olds. This pattern persisted, even after adjusting for psychological distress.

An initially higher prevalence of long-term vaping was observed among men, which equalized by October 2023 at 10.1% and 9.9% for men and women, respectively. Long-term vaping was consistently higher among those of less advantaged social grades, with similar time trends. The increase in long-term vaping with disposable devices showed similar patterns across age, gender, smoking status, and social grade.

Conclusions 

Long-term vaping of six months or more rose significantly between 2013 and 2023 from 1.3% to 10% of adults, respectively. This increase in vaping frequency was primarily attributed to increased daily vaping and the rising popularity of disposable devices.

Initially, most long-term vapers used refillable devices; however, the use of disposable devices surged from 2021.

The rise was particularly notable among young adults, non-smokers, and 18-year-olds. Long-term vaping was also higher among less advantaged groups and initially more prevalent among men; however, by 2023, vaping rates were similar among both genders.

Taken together, the study findings raise concerns about the environmental impacts associated with widespread vaping, as well as the need for balanced regulations to support smoking cessation while mitigating youth uptake.