Trends in vaping and smoking following the rise of disposable e-cigarettes: a repeat cross-sectional study in England between 2016 and 2023

Abstract

Background: There has been a rapid rise in disposable (single-use) e-cigarette vaping among young adults in England since June 2021 (leading to a planned ban on these products). We examined how this has affected population trends in current (i) vaping, (ii) tobacco smoking, and (iii) inhaled nicotine use.

Methods: We used data from a nationally-representative monthly repeat cross-sectional survey of adults (≥18) in England (n = 132,252; July-2016-May-2023). Using interrupted time-series analyses (segmented logistic regression), we estimated yearly trends in current tobacco smoking, vaping, and inhaled nicotine use (smoking and/or vaping) before ('pre-disposables') and after June-2021 ('post-disposables'), stratified by age group (18 to 24, 25 to 44, 45 and over). We also examined trends in daily use and in vaping among never-smokers.

Findings: Pre-disposables, vaping and smoking prevalence had been stable or declining across all age groups. However, post-disposables, the odds of current vaping increased by 99% per year among 18 to 24-year-olds (odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.71 to 2.31), compared with 39% (OR = 1.39; 95% CI = 1.26 to 1.52) in 25 to 44-year-olds and 23% (OR = 1.23; 95% CI = 1.12 to 1.35) in those aged 45 or older. Smoking rates continued to decline - albeit modestly - in 18 to 24-year-olds (OR = 0.88, 95% CI = 0.77 to 1.00) and 25 to 44-year-olds (OR = 0.93, 95% CI = 0.86 to 1.00), but increased among those aged 45 or older (OR = 1.12, 95% CI = 1.05 to 1.20). As a result, post-disposables, the overall prevalence of inhaled nicotine use increased across all age groups. Trends were similar for daily use, but post-disposables increases in vaping were greatest among people who had never regularly smoked (e.g., 18 to 24-year-olds: OR = 2.50, 95% CI = 1.82 to 3.43).

Interpretation: Since disposable vapes started becoming popular in England, historic declines in nicotine use have reversed. Now, nicotine use appears to be rising, driven primarily by sharp increases in vaping among young people. Smoking declines have been most pronounced in age groups with the largest increases in vaping.

Funding: Cancer Research UK.

Keywords: ENDS; Electronic nicotine delivery systems; Single-use; Tobacco; Vaping.

Fig. 1

Prevalence of (A) current and (B) daily disposable vaping among adults in England by age, October 2020 to May 2023. Lines represent weighted point estimates from logistic regression including an interaction between age and month (modelled non-linearly using restricted cubic splines with four knots), while shaded areas represent 95% confidence intervals. Points represent weighted monthly prevalence estimates. The vertical dotted line shows the assumed interruption separating pre- and post-disposable periods. Disposable vaping was not measured in May, June, or August 2022 and daily disposable vaping was only measured quarterly from April 2022 onwards.

Fig. 2

Prevalence of current inhaled nicotine use, smoking and vaping pre and post the rapid growth of disposable vaping in England by age, July 2016 to May 2023. Points represent weighted (unmodelled) quarterly prevalence estimates. Lines represent weighted point estimates from a set of logistic regressions, stratified by age and product, with pre- and post-disposables trends modelled linearly. A 0/1 indicator variable was also added as a covariate to account for effects of COVID-19 including the change in modality from face-to-face interviews before to telephone after March 2020, and pre-pandemic lines and points are adjusted to account for this change. The vertical dotted line shows the assumed interruption separating pre- and post-disposable periods.