Two million ex-smokers currently vape in England

About one in five people who have stopped smoking for more than a year in England currently vape, equivalent to 2.2 million people, according to a new study led by UCL (University College London) researchers.

The study, published in the journal BMC Medicine and funded by Cancer Research UK, found that this increased prevalence was largely driven by greater use of e-cigarettes in attempts to quit smoking.

However, the researchers also found a rise in vaping uptake among people who had already stopped smoking, with an estimated one in 10 ex-smokers who vape having quit smoking prior to 2011, when e-cigarettes started to become popular. Some of those smokers had quit for many years before taking up vaping.

The study looked at survey data collected between October 2013 and May 2024 from 54,251 adults (18 and over) in England who reported they had stopped smoking or had tried to stop smoking.

Lead author Dr Sarah Jackson (UCL Institute of Epidemiology & Health Care) said: “The general increase in vaping among ex-smokers is in line with what we might expect, given the increasing use of e-cigarettes in quit attempts. NHS guidance is that people should not rush to stop vaping after quitting smoking, but to reduce gradually to minimise the risk of relapse.

“Previous studies have shown that a substantial proportion of people who quit smoking with the support of an e-cigarette continue to vape for many months or years after their successful quit attempt.

“However, it is a concern to see an increase in vaping among people who had previously abstained from nicotine for many years. If people in this group might otherwise have relapsed to smoking, vaping is the much less harmful option, but if relapse would not have occurred, they are exposing themselves to more risk than not smoking or vaping.”

For the study, researchers used data from the Smoking Toolkit Study, an ongoing survey that interviews a different representative sample of adults in England each month.

The team found that one in 50 people in England who had quit smoking more than a year earlier reported vaping in 2013, rising steadily to one in 10 by the end of 2017. This figure remained stable for several years and then increased sharply from 2021, when disposable e-cigarettes became popular, reaching one in five in 2024 (estimated as 2.2 million people).

The researchers found, at the same time, an increase in the use of e-cigarettes in quit attempts. In 2013, e-cigarettes were used in 27% of quit attempts, while in 2024 they were used in 41% of them.

The increase in vaping prevalence, the researchers reported, was greatest in younger age groups, with more than half (59%) of 18-year-olds who quit smoking more than a year earlier reporting vaping in May 2024, compared to 11% of 65-year-olds.

The increase was also larger among ex-smokers who drank heavily, with more than a third (35%) of the heaviest drinkers who stopped smoking more than a year earlier reporting vaping.

Among ex-smokers who quit smoking prior to 2011, the proportion who reported vaping increased from one in 250 (0.4%) in 2013 to one in 27 (3.7%) in May 2024, equivalent to 212,000 people.

In this group of people who quit smoking prior to 2011, the largest increases in vaping were also found among younger people and heavier drinkers. Ten per cent of 35-year-olds reported vaping compared to 3% of 65-year-olds in this group. Among the heaviest drinkers in this group, 14% reported vaping. The researchers noted there was some uncertainty with these findings, due to a smaller sample size in this group.

Senior author Professor Lion Shahab (UCL Institute of Epidemiology & Health Care) said: “The implications of these findings are currently unclear. Vaping long term may increase ex-smokers’ relapse risk due to its behavioural similarity to smoking and through maintaining (or reigniting) nicotine addiction. Alternatively, it might reduce the risk of relapse, allowing people to satisfy nicotine cravings through e-cigarettes instead of seeking out uniquely harmful cigarettes. Further longitudinal studies are needed to assess which of these options is more likely.”