Nicotine use rises among young adults in England, but cigarette smoking continues to decline

Overall nicotine use has risen among adults in England since disposable vapes started becoming popular, due to a rapid increase in vaping among young adults coupled with a modest overall decline in smoking, finds a new study by University College London (UCL) researchers.

Importantly, the declines in smoking were most pronounced in age groups with the largest increases in vaping.

The study, published in The Lancet Regional Health—Europe, found that the proportion of 18- to 24-year-olds who vaped had tripled since disposable e-cigarettes entered the market, rising from 9% in May 2021 to 29% in May 2023. Smoking declined from 25% to 21% in this group, and overall nicotine use increased from 28% to 35%.

In the older age groups, there were smaller increases in vaping and smaller or no declines in smoking. For example, vaping prevalence increased from only 5% to 6% among those aged over 45 years old whereas smoking prevalence increased from 12% to 14%.

The rise in vaping was particularly steep among young adults who had never smoked, increasing from 2% to 9%.

The researchers looked at survey responses from 132,252 adults in England between July 2016 and May 2023, comparing trends in the prevalence of vaping, smoking and overall nicotine use (either vaping or smoking) before and after the introduction of popular disposable e-cigarettes in June 2021.

Lead author Dr. Harry Tattan-Birch (UCL Institute of Epidemiology & Health Care) said, "The rapid rise in vaping would be less concerning if smoking rates had come down more rapidly. The overall increase in the use of nicotine shows this has not happened.

"Instead, driven by the arrival of highly popular disposable e-cigarettes, vaping has become much more common among young people, some of whom would likely otherwise have avoided nicotine entirely. Given these findings, the UK government's current Tobacco and Vapes Bill to reduce youth vaping is welcome."

The researchers used data from the Smoking Toolkit Study, an ongoing survey which interviews a different representative sample of 1,700 adults in England each month.

Senior author Dr. Sarah Jackson (UCL Institute of Epidemiology & Health Care) added, "While action is needed to counter the rise in vaping among young people who otherwise would not use nicotine, policies should avoid signaling that e-cigarettes are a worse alternative to smoking tobacco. Vaping may not be risk-free, but smoking is uniquely lethal.

"It is also critical that policies designed to make e-cigarettes less attractive to young people do not inadvertently make these products less effective for helping people to stop smoking. Measures that target vaping products' appearance, packaging, and marketing rather than their flavors and nicotine content may be most effective in striking this balance."