What are e-cigarettes?

Electronic cigarettes (e-cigarettes), also known as ‘vapes’ are devices that enable the user to inhale nicotine. They work by heating and vaporising a solution that contains nicotine, glycerine and sometimes flavourings. Inhaling nicotine from an e-cigarette is referred to as vaping.

Since vaping involves no burning, there is no smoke produced and hence no tar or carbon monoxide, which are two of the most toxic products of smoking. The vapour from e-cigarettes has been found to contain some potentially harmful chemicals but these are at much lower levels than they are in conventional tobacco smoke. The Evidence review of e-cigarettes and heated tobacco products 2018: executive summary from Public Health England tells us that one assessment concluded that the cancer potencies of e-cigarettes were largely under 0.5% of the risk of smoking. But there have been some studies with adolescents suggesting respiratory symptoms among e-cigarette experimenters. 

While there are some public health concerns over the uptake of e-cigarettes by non-smokers, many doctors believe that they can help smokers quit or reduce their tobacco consumption. In fact, they may begin to be prescribed on the NHS to help people stop smoking. In 2021, Australia made it illegal to possess and use nicotine vaping products without a prescription.

Prevalence

From the ONS bulletin Adult smoking habits in the UK: 2021:

• In 2021, 4.9% of survey respondents reported that they were currently daily users of an e-cigarette, which is an increase from 3.8% in 2020, although not statistically significant. 
• A further 2.8% reported using an e-cigarette occasionally, which is an increase from 2.6% in 2020, although not statistically significant. 
• This equates to around 4 million vapers in the population of Great Britain.
• As seen in previous years, a higher proportion of men reported vaping daily or as an occasional user (9.7%) compared with women (5.7%) in 2021.

Vaping among young people:

The NHS report Smoking, Drinking and Drug Use among Young People in England, 2021 (2022) found that e-cigarette use (vaping) among pupils has increased to 9%, up from 6% in 2018. Around 1 in 5 (21%) 15-year old girls were classified as current e-cigarette users.

And according to a 2021 report into vaping from PHE:

• Smoking prevalence (including those who smoked sometimes or more than once a week) in March 2020 was 6.7% (compared with 6.3% in March 2019) and has changed little since 2015 when it was 7.1%
• There was little change in levels of vaping over the last few years with current vaping (at least once per month) prevalence being 4.8% in March 2020, the same as in March 2019
• Smoking prevalence is at 6.2% (defined as smoking more than 100 cigarettes in their life and having smoked in the past 30 days)
• Current vaping prevalence is at 7.7% (defined as vaping on more than 10 days in their lifetime and having vaped in the past 30 days)

Based on the socioeconomic status of 11 to 18 year olds, the estimates for smoking and vaping prevalence were higher among more advantaged groups in social grades A, B and C1 (7.1% for smoking, 5.3% for vaping) than for more disadvantaged groups in social grades C2, D and E (5.7% for smoking, 3.5% for vaping).

Most young people who had never smoked had also never vaped. Between 0.8% and 1.3% of young people who had never smoked were current vapers.

The main reasons for vaping were to:

• “give it a try”
• “for fun/I like it”
• “liking the flavours”

Of the 11 to 18 year olds who vaped, 11.9% reported doing so to quit smoking.

Most current vapers were either former or current smokers.

While it is illegal to sell vapes to people under 18, there is a loophole that allows the vaping industry to give free samples of vapes to children. To combat the rise in teenagers using vapes the government has decided to clamp down on this and close the loophole.The government also announced that there will be a review into banning the vaping industry selling ‘nicotine-free’ vapes to under 18s (No more free vapes for kids, May 2023).

Worldwide

A study published in Addiction in 2022 analysed 2015–2018 information from 47 countries found that

•  approximately 1 in 12, or 8.6%, of adolescents reported vaping in the past 30 days
• 1 in 60, or 1.7%, had vaped more than 10 days in the past month
• countries with higher tobacco taxes tended to have higher adolescent vaping.

Vaping and smoking cessation:

• Using a vaping product is the most popular aid used by people trying to quit smoking. In 2020, 27.2% of people used a vaping product in a quit attempt in the previous 12 months. This compares with 15.5% who used NRT over the counter or on prescription (2.7%), and 4.4% who used varenicline.
• Vaping is positively associated with quitting smoking successfully. In 2017, over 50,000 smokers stopped smoking with a vaping product who would otherwise have carried on smoking.
• Prescription medication and licensing NRT for harm reduction were also positively associated with successfully quitting smoking. This shows how important it is for people who smoke to have access to a wide choice of cessation aids.
• The extensive use of vaping products in quit attempts compared with licensed medication suggests vaping products may reach more people who smoke and so have more impact than NRT and varenicline.
• In April 2023 the government announced a new ‘Swap to stop’ scheme where 1 in 5 smokers in England will be given a vape starter kit and behavioural support to help them quit.

Pros and cons of vaping

Vaping can help people give up smoking, and vaping is much less harmful. A 2019 study studied 886 smokers given nicotine replacements to help them give up smoking, 18% of the vapers in the group were no longer smoking after a year, compared with 9.9% of those using other means (such as gum or patches). 

Disposable vapes are popular because they are cheap and accessible, however research commissioned by Material Focus, identified that 1.3 million single-use vapes are thrown away every week, per annum this is enough to cover 22 football pitches. Over 50% of single-use vapes are thrown away rather than recycled. This clearly has an environmental impact, especially as the vapes contain batteries that should be recycled.

Further reading

How bad is vaping and should it be banned?
A review of more than 100 sources on tobacco harm reduction, vaping prevalence and health effects, and what other countries are doing in response.

Vaping in England: evidence update February 2021
This update looks at the prevalence of vaping among young people and adults. It also reviews research literature on vaping among pregnant women and people with mental health conditions | PHE, UK

Burning Issues: The Global State of Tobacco Harm Reduction 2020
The central theme of this report, enshrined in many international treaties, is the universal right to health, including for those who for whatever reason continue to engage in risky behaviours. Harm reduction refers to a range of pragmatic policies, regulations and actions which either reduce health risks by providing safer forms of products or substances, or encourage less risky behaviours. Harm reduction does not focus primarily on the eradication of products or behaviours | KAC, UK

Updated July 2023