One million people in England now vape despite never having been regular smokers, a seven-fold increase in just three years, according to research that has prompted alarm among health experts.
Rates of e-cigarette use among adults who had never regularly smoked were stable until 2021, when one in 200 – about 133,000 people – were vapers. However, the proportion has increased sharply to one in 28 in 2024 – 1,006,000 people – a study published in The Lancet Public Health journal suggests.
Separate figures from the Office for National Statistics also published this week show 5.1 million people aged 16 or over in Britain – about one in 10 – use e-cigarettes. Vaping rates were highest among those aged 16 to 24, at 15.8%, the ONS found.
Prof Nick Hopkinson, a respiratory physician and chair of Action on Smoking and Health, said: “Vaping has helped millions of adults quit smoking and is much less harmful than smoking. However, it is not risk-free and high levels of use among young people and growing use among never smokers is a concern.”
Prof Sanjay Agrawal, the Royal College of Physician’s special adviser on tobacco, said “urgent action” was required to tackle the rise in vaping among young people and those who had never smoked.
He said: “While e-cigarettes remain a valuable tool for helping smokers quit, it is essential that their use doesn’t create new public health risks, particularly among children.”
The Lancet study led by UCL found that most of the people now using e-cigarettes who had never regularly smoked were vaping daily and over a sustained period. The dramatic increase was largely driven by young adults, with one in seven 18- to 24-year-olds (14%) in England who never regularly smoked now using e-cigarettes, the researchers said.
They warned that banning disposable vapes, which the government plans to do, was unlikely to fix the problem because some brands had already launched reusable products. Instead, they suggested, there should be stricter regulation to make the products look less appealing.
Prof Jamie Brown, of the UCL Institute of Epidemiology and Health Care and a senior author of the study, said: “These findings are a reminder that action is required to try to minimise vaping among young people who have never previously smoked. However, a balancing act is required to avoid deterring smokers from using e-cigarettes to quit.
“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.
“A sensible next step would be to introduce stricter regulation around product appearance, packaging and marketing, as those are less likely to reduce the effectiveness of e-cigarettes for smoking cessation – unlike, for instance, flavour bans.
“The fact that overall vaping prevalence appears to have levelled off since 2023 may reassure policymakers that it would be reasonable to begin with these measures and assess their impact.”
The Lancet study looked at survey data collected between 2016 and 2024 from 153,073 adults in England, of whom 94,107 had never regularly smoked tobacco. People were classed as never-regular-smokers if they said: “I have never been a smoker (smoked for a year or more).”
Before 2021, the proportion of never-regular-smokers who vaped in England was low, at an average of 0.5% between 2016 and 2020. This increased to 3.5% by April 2024 – just over 1 million vapers. Among these, more than half (an estimated 588,000) were aged between 18 and 24, the study found.
The researchers also found that in recent years people who had never regularly smoked tended to be younger, more were women, and more were drinking at increasing or higher-risk levels.
They also tended to have been vaping for longer, were more likely to use disposable devices and the highest-strength nicotine e-liquids, and bought products from supermarkets or convenience stores.
The lead author, Dr Sarah Jackson of the UCL Institute of Epidemiology and Health Care, said: “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.
“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.”
Separately, a second study published simultaneously in the Lancet Public Health concluded that accelerating measures to eliminate tobacco smoking could help boost life expectancy and prevent millions of premature deaths worldwide by 2050.
A third study also published at the same time in the same journal suggested that banning the sale of tobacco to people born between 2006 and 2010 could prevent 1.2m deaths from lung cancer worldwide by 2095.
In a statement, the Department of Health and Social care said that while vapes can be an effective way for adults to stop smoking, “we have always been clear children and adult non-smokers should not vape . . . The Tobacco and Vapes bill will protect future generations from the harms of tobacco and nicotine, saving thousands of lives and easing pressures on the NHS.”
• This article was updated on 3 October 2024 to include a comment from the Department of Health and Social Care received after publication.
