In England, the country that has most aggressively embraced e-cigarettes, authorities have long minimized the effects of e-cigarettes on youth and argued that they were improving public health by attracting smokers or displacing cigarette use. Now Harry Tattan-Birch and colleagues have blown those arguments away. Their May 23, 2024 paper Trends in vaping and smoking following the rise of disposable e-cigarettes: a repeat cross-sectional study in England between 2016 and 2023 published in The Lancet Regional Health: Europe provide strong evidence to support their conclusion, “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”
This conclusion holds across all age groups, with the biggest effect among young adults:
They also found increases in daily e-cigarette use, particularly among young adults, which indicates increasing levels of addiction. This finding is consistent with our research on youth in the US, they found rises in daily vaping and other measures of addiction, indicating that e-cigarettes have become more addictive.
They also found increases in e-cigarette use among people who had never smoked, consistent with evidence from the US that e-cigarettes have expanded the nicotine market.
Based on these findings, Tattan-Birch and colleagues conclude that, “Urgent action is
needed to curb the rise in vaping among people who would otherwise avoid nicotine entirely.”
Being from England, however, they could not completely abandon the assumption that e-cigarettes represent harm reduction: The paper ends saying, “However, policies must avoid signalling that cigarette smoking the most harmful form of nicotine use is a better alternative.” While I agree that health campaigns should not promote the idea that cigarette smoking is “a better alternative,” they should stop basing policy on the outdated assumption that e-cigarettes produce substantially less disease, especially when considering dual use. Dual use, which is common among adult e-cigarette users, is more dangerous than just smoking.
Here is the 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.
The full citation is: Tattan-Birch H, Brown J, Shahab L, Beard E, Jackson SE. Trends in vaping and smoking following the rise of disposable e-cigarettes: a repeat cross-sectional study in England between 2016 and 2023. The Lancet Regional Health: Europe Open Access Published: May 23, 2024 DOI: https://doi.org/10.1016/j.lanepe.2024.100924. It is available for free here.
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