Jackson, Sarah; Brown, James; Kock, Loren; Shahab, Lion; (2024) Prevalence and uptake of vaping among people who have quit smoking: a population study in England, 2013-2024. medRxiv.org: Rochester, NY, USA.

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Abstract

BACKGROUND: Vaping prevalence has increased rapidly in England since 2021. This study estimated trends between 2013 and 2024 in vaping among ex-smokers, overall and among those who did not use e-cigarettes to support their quit attempt. METHODS: Data were collected via nationally-representative, monthly cross-sectional surveys in England, October-2013 to May-2024. We analysed data from 54,251 adults (≥18y) who reported having tried to stop smoking in the past year or having stopped smoking more than a year ago. Logistic regression estimated associations between time and e-cigarette use. FINDINGS: Across the period, there were increases in the use of e-cigarettes to support attempts to stop smoking (from 26.9% [24.0-30.0%] in October-2013 to 41.4% [37.7-45.2%] in May-2024), in current vaping among ≥1y ex-smokers (1.9% [1.5-2.5%] to 20.4% [18.7-22.2%]), and in late uptake of vaping after smoking cessation (i.e., current vaping among people who quit smoking before e-cigarettes started to become popular in 2011; 0.4% [0.2-0.8%] to 3.7% [2.8-4.9%]). These increases were non-linear, with much of the change occurring since mid-2021, and were greatest at younger ages (e.g., current vaping among ≥1y ex-smokers reached 58.9% among 18-year-olds vs. 10.7% among 65-year-olds). INTERPRETATION: Vaping prevalence increased substantially among adult ex-smokers in England over the past decade, particularly at younger ages. While this is likely to have been largely driven by increased use of e-cigarettes in quit attempts and continued use thereafter, there was also evidence of increased uptake of vaping among those who had been abstinent from smoking for many years. FUNDING: Cancer Research UK. EVIDENCE BEFORE THIS STUDY: We searched PubMed up to July 2024 using the following search terms (“e-cigarette∗” OR “vap∗”) AND (“trend*”) AND (“ex-smok*” OR “former smok*” OR “quit smok*” OR “smoking status”) AND (“adult*”) AND (“England” OR “Great Britain” OR “United Kingdom”). The search returned 13 results, of which four reported on changes in the prevalence of current vaping among adults who have stopped smoked. The first documented an increase in current vaping among >1y ex-smokers between 2010 and 2013 (from 0.3% to 2.7%). The second indicated the prevalence of current vaping among ≥1y ex-smokers rose further in subsequent years (from 3.3% in 2014 to 10.4% in 2019) and also reported an increase among people who quit smoking before e-cigarettes started to become popular in 2011 (from 0.8% in 2014 to 2.1% in 2019). The third reported a substantial increase in the proportion of ≥1y ex-smokers who were vaping with disposable e-cigarettes between 2021 and 2023 (from 0.0% in January 2021 to 4.1% in August 2023). The fourth reported an increase in long-term (>6 month) vaping among ≥1y ex-smokers between 2013 and 2023 (from 1.4% in October 2013 to 16.2% in October 2023), with much of this increase occurring since 2021. ADDED VALUE OF THIS STUDY: This study shows the proportion of adult ex-smokers in England who vape increased substantially between 2013 and 2024. As of May 2024, there were around 2.2 million adult vapers in England who had stopped smoking. There were also increases in the use of e-cigarettes in attempts to quit smoking and in the uptake of vaping among people among people who quit smoking before e-cigarettes started to become popular. These increases were non-linear, with much of the change occurring since mid-2021, and were greatest at younger ages. IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE: Since disposable e-cigarettes were introduced to the market in 2021, there has been a sharp increase in vaping among ex-smokers. While this is likely to have been largely driven by increases in people using e-cigarettes as a smoking cessation aid and continuing to vape beyond their successful quit attempt, there was also evidence of increased uptake of vaping among those who had been abstinent from smoking for many years. COMPETING INTEREST STATEMENT: JB has received unrestricted research funding from Pfizer and J&J, who manufacture smoking cessation medications. LS has received honoraria for talks, unrestricted research grants and travel expenses to attend meetings and workshops from manufactures of smoking cessation medications (Pfizer; J&J), and has acted as paid reviewer for grant awarding bodies and as a paid consultant for health care companies. All authors declare no financial links with tobacco companies, e-cigarette manufacturers, or their representatives.

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