A decade-long study reveals a sharp rise in vaping among ex-smokers, particularly younger adults, fueled by disposable e-cigarettes and changing social trends.

Study: Prevalence and uptake of vaping among people who have quit smoking: a population study in England, 2013-2024. Image Credit: Shutterstock AI

In a recent study published in the journal BMC Medicine, researchers at University College London investigated the prevalence and patterns of vaping among ex-smokers in England from 2013 to 2024. The study examined the trends in vaping uptake relative to smoking cessation, with a focus on nuanced factors like age, social factors, alcohol consumption, and vaping behaviors. The research also evaluated the timing and reasons behind vaping adoption among former smokers.

Background

Electronic cigarettes or e-cigarettes were introduced in the United Kingdom (U.K.) in 2008 and gained prominence as a smoking cessation tool after 2011. These devices mimic smoking behaviors and effectively deliver nicotine, making them a popular choice for smokers who are attempting to quit tobacco smoking.

By 2014, over a quarter of the attempts to quit smoking in England involved e-cigarettes, with their use steadily increasing among ex-smokers. Evidence from various studies suggests that e-cigarettes are significantly less harmful than traditional cigarettes, although uncertainties about their long-term health effects remain.

Research showed that while many ex-smokers begin vaping during their attempts to quit tobacco smoking and continue afterward, others take up vaping long after they have quit smoking. In recent years, there has been a surge in disposable e-cigarettes, particularly among younger individuals, coinciding with broader market dynamics and social trends. These developments raise questions about their impact on public health and smoking relapse rates.

About the Study

In the present study, the researchers utilized data from the Smoking Toolkit Study, an ongoing nationally representative monthly survey of adults in England. Data were collected from October 2013 to May 2024 from over 54,000 participants who reported recent smoking cessation attempts or had quit smoking over a year ago.

The researchers conducted face-to-face surveys until April 2020 and then transitioned to telephone interviews due to the coronavirus disease 2019 (COVID-19) pandemic. The participants were classified by smoking status and assessed for vaping habits. While the study provides valuable insights, the authors note that certain subgroups, such as recent ex-smokers, had small sample sizes, limiting the precision of specific estimates.

The key outcomes assessed in the study included current vaping among ex-smokers, use of e-cigarettes during attempts to quit tobacco smoking, and vaping uptake after smoking cessation.

Furthermore, distinctions were made for ex-smokers who quit recently, those who quit before e-cigarettes became popular in 2011, and those using vaping products without prior cessation attempts. The study also collected data on sociodemographic characteristics, such as age, gender, and occupational social grade, as well as on alcohol consumption and vaping characteristics.

Alcohol intake was categorized using the AUDIT-C score, which reflects a range from low-risk to potentially dependent levels. Vaping characteristics included device type, frequency of use, nicotine strength, and purchase source.

Statistical analyses employed logistic regression to model non-linear trends over time. The researchers also conducted subgroup analyses to examine differences in vaping prevalence by age, gender, and alcohol consumption.

Additional sensitivity analyses addressed variations in sampling periods, focusing on recent and late vaping uptake. The results were compared across specific subpopulations to assess how changes in vaping patterns relate to sociodemographic and behavioral factors.

Results

The study found that vaping prevalence among ex-smokers in England increased significantly from 2013 to 2024, with notable differences based on age and alcohol consumption levels.

Initially, fewer than 2% of ex-smokers reported vaping in 2013. By 2024, this number rose to 20.4% among those who had quit tobacco smoking over a year ago. The data highlighted non-linear trends, with much of the increase occurring after 2021, likely linked to the rise of disposable e-cigarettes.

The researchers noted that the uptake of vaping was particularly pronounced among younger individuals, with rates as high as 58.9% in 18-year-olds compared to 10.7% in 65-year-olds.

Furthermore, among those who attempted to quit smoking, e-cigarette use during quit attempts grew from 26.9% in 2013 to 41.4% by 2024.

In addition to sustained vaping following attempts to quit smoking, there was also evidence of late uptake. Vaping among individuals who quit smoking before e-cigarettes became mainstream increased from 0.4% in 2013 to 3.7% in 2024, particularly among younger adults and those with higher alcohol consumption levels. However, the researchers caution that wide confidence intervals in these subgroup analyses introduce some uncertainty.

Notably, the timing of these trends aligned with broader market shifts, such as the popularity of disposable e-cigarettes post-2021. Additionally, sociodemographic patterns suggested that individuals from less advantaged social grades and those with higher alcohol consumption were more likely to vape.

Gender differences were minimal, although male ex-smokers showed slightly higher prevalence rates. The authors emphasized that while vaping appears to support smoking cessation, its role in relapse prevention versus unintended harm remains unclear.

The study highlighted a shift in vaping device preferences, with increased use of disposables and high-strength nicotine products from 2013 to 2024. Over time, ex-smokers who vaped tended to report longer durations of smoking abstinence and sustained vaping habits, underscoring a gradual accumulation of long-term vaping among this group.

Conclusions

To summarize, the study reported a substantial rise in vaping prevalence among ex-smokers in England over the past decade, especially among younger adults.

The findings suggest a dual dynamic: while e-cigarettes support smoking cessation, increased late uptake among long-term quitters raises concerns about potential unintended health consequences, such as exposure to harm or increased risk of relapse.

The researchers emphasize the importance of evaluating vaping’s role in relapse prevention versus its potential risks. They call for targeted public health policies to address the diverse needs of different demographic groups and further research to clarify vaping’s impact on smoking behaviors.