A new study conducted by researchers at University College London (UCL) has revealed a startling rise in the number of adults vaping in England who have never regularly smoked.
Published in The Lancet Public Health, the study estimates that by April 2024, around one million adults in England who had never been regular smokers were now vaping, representing a sevenfold increase since 2021, when disposable e-cigarettes first gained popularity.
The findings, which have sparked renewed discussions about public health policy, suggest that this surge is largely driven by younger adults.
Approximately one in seven 18-24-year-olds (14%) who have never smoked regularly now use e-cigarettes, with many vaping daily over a prolonged period.
While the overall rise in vaping in England appears to have plateaued since early 2023, the sharp increase in use among non-smokers has raised concerns about the long-term health implications.
The Study’s Scope and Key Findings
The UCL study analyzed survey data from the Smoking Toolkit Study, an ongoing survey that has collected responses from 153,073 adults in England since 2016.
Of these respondents, 94,107 had never regularly smoked. The researchers classified respondents as “never-regular-smokers” if they selected the statement “I have never been a smoker (i.e., smoked for a year or more)” when asked about their smoking history.
Prior to 2021, the number of never-regular-smokers who vaped was minimal, averaging 0.5% between 2016 and 2020. However, by April 2024, this figure had risen to 3.5%, equating to roughly one million people.
Among them, more than half (an estimated 588,000) were aged 18 to 24. This substantial rise coincides with the growing popularity of disposable e-cigarettes, a trend that has reshaped the profile of vapers in England.
Lead author Dr. Sarah Jackson, from the UCL Institute of Epidemiology & Health Care, said the findings highlight the complexities of vaping’s public health impact.
“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,” Jackson said.
“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.”
Young Adults Leading the Surge
The study identified young adults as the demographic most responsible for the rise in vaping among non-smokers. An estimated 14% of 18-24-year-olds who had never regularly smoked were vaping by April 2024.
This age group has also been at the forefront of the shift towards daily vaping, with more than four times as many never-regular-smokers reporting daily vaping (2.9%) compared to non-daily use (0.6%).
Dr. Jackson noted that the increasing prevalence of vaping among this age group raises important questions about the long-term impact of e-cigarettes on a population that has not been exposed to smoking.
“For young adults who might never have smoked, daily vaping over time introduces a new set of health risks. While e-cigarettes are less harmful than smoking, they are not risk-free, particularly for those using high-strength nicotine products over an extended period,” she said.
The Role of Alcohol Consumption
The study also uncovered a correlation between vaping and alcohol consumption. Among adults who never regularly smoked, those who drank heavily were significantly more likely to vape. In fact, 22% of the heaviest drinkers vaped, compared to 3% of those drinking at low-risk levels and 1.3% of non-drinkers.
This association mirrors trends in smoking, which is more prevalent among heavy drinkers. The researchers suggest that for some, vaping may serve as an alternative to smoking, particularly among individuals who would have otherwise picked up cigarettes.
However, for those who would not have smoked in the first place, the increase in vaping among heavy drinkers represents a public health concern.
Changing Profile of Vapers
Since 2021, when disposable e-cigarettes became widely available, the profile of vapers who never regularly smoked has evolved.
Vapers in this category are increasingly younger, more likely to be women, and more likely to consume alcohol at increasing or higher-risk levels. Additionally, many of these vapers have been using e-cigarettes for longer periods.
By 2023/24, 68% of never-regular-smokers who vaped had been doing so for over a year. Disposable devices and the highest-strength nicotine e-liquids were particularly popular among this group, with most purchasing their products from supermarkets and convenience stores.
Senior author Professor Jamie Brown of UCL’s Institute of Epidemiology & Health Care expressed concern over these findings, emphasizing the need for stricter regulation of e-cigarette products.
“These findings are a reminder that action is required to try to minimize vaping among young people who have never previously smoked,” he said.
Policy Implications and Government Response
The UK Government is already considering measures to address the rising prevalence of vaping among non-smokers, particularly the younger population.
A proposed ban on disposable e-cigarettes is one potential step, but Professor Brown cautioned that this alone may not solve the issue.
“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,” he said.
Instead, Brown and his colleagues suggest a more comprehensive approach, including stricter regulations around product appearance, packaging, and marketing.
These measures, they argue, are less likely to deter smokers from using e-cigarettes as a smoking cessation tool but may help curb the appeal of vaping among non-smokers.
“The fact that overall vaping prevalence appears to have leveled off since 2023 may reassure policymakers that it would be reasonable to begin with these measures and assess their impact,” Professor Brown added.
The government’s plan to tackle youth vaping has been a topic of ongoing debate. Some experts argue that flavor bans, similar to those implemented in the US, could help reduce the appeal of vaping to young people.
However, others caution that such bans could also discourage smokers from using e-cigarettes as a means to quit smoking, potentially doing more harm than good.
The Public Health Debate
The rise in vaping among never-regular-smokers presents a dilemma for public health officials.
On one hand, e-cigarettes have been shown to be an effective tool for smoking cessation, reducing the harm caused by traditional tobacco products.
On the other hand, the growing use of e-cigarettes among people with no history of smoking introduces a new set of health risks.
While vaping is generally considered to be less harmful than smoking, it is not without its dangers. Long-term use of e-cigarettes, particularly those containing high levels of nicotine, has been linked to respiratory and cardiovascular issues.
Furthermore, the impact of e-cigarettes on young people’s health and well-being remains an area of concern, particularly given the rising number of teenagers and young adults who are taking up vaping.
The UCL study’s findings underscore the need for a balanced approach to regulating e-cigarettes—one that acknowledges their potential benefits for smokers while addressing the risks they pose to non-smokers, particularly young adults.
As the government moves forward with its plans to regulate vaping, it will need to strike a careful balance between encouraging smokers to quit and preventing non-smokers from developing a potentially harmful habit.
Conclusion
The UCL study paints a complex picture of vaping in England. While the overall prevalence of vaping appears to have stabilized, the sharp increase in use among non-smokers—particularly young adults—raises important questions about the future of e-cigarettes and their role in public health.
As the government considers new regulations, it will need to carefully weigh the benefits of vaping as a smoking cessation tool against the potential risks posed to non-smokers.
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