The number of adults vaping in England who have never regularly smoked has increased sharply since 2021, when disposable e-cigarettes first became popular, according to a new study by UCL researchers.
The study, published in Lancet Public Health and funded by Cancer Research UK, estimated that, as of April 2024, about one million adults who had never regularly smoked now vaped in England, a sevenfold increase since 2021, with most of them vaping daily and over a sustained period.
This increase was largely driven by young adults, with an estimated one in seven 18-24-year-olds (14%) who never regularly smoked now using e-cigarettes.
Despite this increase in vaping among people without a smoking history, the researchers found that, among the adult population in England overall, the rise in vaping had levelled off since early 2023.
The study looked at survey data collected between 2016 and 2024 from 153,073 adults (18 and over) in England, of whom 94,107 had never regularly smoked tobacco.
Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: "The public health impact of this substantial rise in vaping among people who have never regularly smoked will depend on what these people would otherwise be doing.
"It is likely that some would have smoked if vaping were not an available option. In this case, vaping is clearly less harmful. However, for those who would not have gone on to smoke, vaping regularly over a sustained period poses more risk than not vaping."
For the study, researchers used data from the Smoking Toolkit Study, an ongoing survey that interviews a different representative sample of adults in England each month.
Survey respondents were classed as "never-regular-smokers" if, when asked what statement about smoking habits best applied to them, they chose the statement "I have never been a smoker (i.e., smoked for a year or more)".
The researchers noted that this population is broader than those who have never smoked a single cigarette and prevalence estimates of vaping among people who have never smoked at all would likely have been lower.
Prior to 2021, the proportion of never-regular-smokers who vaped in England was rare, at an average of 0.5% between 2016 and 2020. This increased to 3.5% by April 2024, equating to about a million vapers. Among these, more than half (an estimated 588,000) were aged between 18 and 24.
The sharpest increase in the never-regular-smokers group was among those classed as the heaviest drinkers (of all ages), of whom 22% vaped. This is compared with 3.0% and 1.3% among those drinking alcohol at low-risk levels or not at all. According to the authors, this suggests vaping may be more common among people who would otherwise have gone on to smoke (as smoking rates are also higher among people who drink more heavily).
Across the period 2021 to 2024, most adult vapers who had never regularly smoked vaped daily, and this increased so that in April 2024, more than four times as many never-regular-smokers reported vaping daily than non-daily (2.9% vs. 0.6%).
The researchers also noted that the profile of vapers who had never regularly smoked had changed since disposable e-cigarettes became popular. In recent years, these vapers tended to be younger, more were women, and more were drinking at increasing or higher-risk levels.
They also tended to have been vaping for longer (in 2023/24, 68% had vaped for more than a year), were more likely to use disposable devices and the highest-strength nicotine e-liquids, and to buy their products from supermarkets/convenience stores.
Senior author Professor Jamie Brown (UCL Institute of Epidemiology & Health Care) said: "These findings are a reminder that action is required to try to minimise vaping among young people who have never previously smoked. However, a balancing act is required to avoid deterring smokers from using e-cigarettes to quit.
"Banning disposables, as the UK Government currently plans, is unlikely to fix the issue as popular brands have already launched reusable products with very similar designs and prices.
"A sensible next step would be to introduce stricter regulation around product appearance, packaging and marketing, as those are less likely to reduce the effectiveness of e-cigarettes for smoking cessation – unlike, for instance, flavour bans. The fact that overall vaping prevalence appears to have levelled off since 2023 may reassure policymakers that it would be reasonable to begin with these measures and assess their impact."
