Two million ex-smokers currently vape in England: study

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 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.

“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,” lead author Dr Sarah Jackson, of the UCL Institute of Epidemiology & Health Care, said.

“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 per cent of quit attempts, while in 2024 they were used in 41 per cent of them.

Senior author Professor Lion Shahab, of 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.”