Trends in use of e-cigarette device types and heated tobacco products from 2016 to 2020 in England

Abstract

This study examined use trends of e-cigarette devices types, heated tobacco products (HTPs) and e-liquid nicotine concentrations in England from 2016 to 2020. Data were from a representative repeat cross-sectional survey of adults aged 16 or older. Bayesian logistic regression was used to estimate proportions and 95% credible intervals (CrIs). Of 75,355 participants, 5.3% (weighted = 5.5%) were currently using e-cigarettes or HTPs, with the majority (98.7%) using e-cigarettes. Among e-cigarette users, 53.7% (CrI 52.0-55.1%) used tank devices, 23.7% (22.4-25.1%) mods, 17.3% (16.1-18.4%) pods, and 5.4% (4.7-6.2%) disposables. Tanks were the most widely used device type throughout 2016-2020. Mods were second until 2020, when pods overtook them. Among all e-cigarette/HTP users, prevalence of HTP use remains rare (3.4% in 2016 versus 4.2% in 2020), whereas JUUL use has risen from 3.4% in 2018 to 11.8% in 2020. Across all years, nicotine concentrations of ≤ 6 mg/ml were most widely (41.0%; 39.4-42.4%) and ≥ 20 mg/ml least widely used (4.1%; 3.4-4.9%). Among e-cigarette/HTP users, ex-smokers were more likely than current smokers to use mod and tank e-cigarettes, but less likely to use pods, disposables, JUUL and HTPs. In conclusion, despite growing popularity of pods and HTPs worldwide, refillable tank e-cigarettes remain the most widely used device type in England.

Figure 1

Use of different e-cigarette device types and heated tobacco product use among adult heated aerosolized nicotine delivery system (HANDS) users in England from 2016 to 2020. Shaded bands represent 95% CrIs. Trends would be the same with a denominator of all adults rather than only HANDS users, as overall prevalence of HANDS use was stable from 2016 to 2020 (Supplementary Fig. S2). Some people reported using JUUL but not pods. When these individuals were considered pod users, there was a more pronounced rise in pod use from 19.5% in 2019 to 30.4% in 2020.

Figure 2

Nicotine concentration used in e-cigarettes by adult e-cigarette users in England from 2016 to 2020. Shaded bands represent 95% CrIs. Trends would be the same with a denominator of all adults rather than only e-cigarette users, as overall prevalence of e-cigarette use was stable from 2016 to 2020 (Supplementary Fig. S2).