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Vaping: Good news and bad news

The number of e-cigarette users in Great Britain declined by 400,000 between 2019 and 2020, according to new research by the public health charity Action on Smoking and Health (ASH).

 While in 2019 there were 3.6m British vapers (an increase of 700,000 against 2018), in 2020 the number has fallen to 3.2m – the first time the figure has gone down since ASH started its yearly study in 2012.

 The charity attributed the fall to a mistaken belief that vaping is as harmful as smoking. CEO Deborah Arnott said: “About a third of smokers have never even tried an e-cigarette and less than 20% are currently using one. If many more smokers could be encouraged to give e-cigarettes a go, the latest evidence indicates that many more might successfully quit.”

 More than half (58.9%) of British vapers are ex-smokers, while only 100,000 have never smoked, the survey found. Dual users represent 38.3% of the vaping population in 2020, down from a 2014 high of 65.1% and continuing a falling trend.

 In 2012 a total of 76.1% of respondents said they had never tried an e-cigarette. In 2020, this figure was down to 31.4%.


 Change in public perception


In previous years, around half the smokers surveyed believed that vaping was “less or a lot less harmful” than traditional cigarettes. Last year 48% had this perception, but in 2020 the number had dropped to 39%.


“The likely driver for this change in public perception is the impact of the media coverage of an outbreak of serious lung injury to vapers in the US,” the ASH study said.


Among all e-cigarette users, the three main reasons for vaping were as an aid to quitting smoking (30%), followed by preventing relapse (20%) and to cut down on the number of cigarettes smoked (11%).


According to the report, the most popular products for all vapers are tank systems, used by 77% of vapers, followed by pods (19%) and disposable e-cigs (2%). Vype (20%), Blu (17%), Logic (10%) and Juul (10%) were reported to be the most popular brands for pod users in Great Britain. ECigIntelligence estimates that there are 3.6m vapers in the UK, around 10% more than the ASH figure for Great Britain, which includes England, Scotland and Wales but not Northern Ireland.

The survey was carried out in February and March, before the lockdown and other restrictions caused by the COVID-19 outbreak.


Effective for quitting


At around the same time as the ASH survey was published, however, a review of the scientific literature concluded that e-cigs do have a value in smoking cessation.


Nicotine e-cigarettes can be more effective than other more traditional methods in helping smokers to quit the habit for at least six months, the latest Cochrane review of the subject concluded.

 Cochrane, an independent international medical research charity based in London, said nicotine-containing e-liquids “may not be associated with serious unwanted effects” and that they work better than either nicotine-free e-cigarettes or behavioural support alone.


The report, “Electronic cigarettes for smoking cessation”, reviewed evidence from 50 studies from around the world, representing a total of more than 12,000 participants. It concluded that there was “moderate-certainty evidence” that quit rates are higher among people using nicotine-containing e-cigs than those using a nicotine replacement therapy (NRT).

According to the Cochrane Tobacco Addiction Group, if six people in 100 quit smoking using NRT, ten in 100 would quit with nicotine-containing e-cigs. Lead author Jamie Hartmann-Boyce of the Nuffield Department of Primary Care Health Sciences at the University of Oxford, says there is now evidence that nicotine-containing e-liquids “are likely to increase the chances of quitting successfully compared to nicotine gum or patches”.


Although they researchers say they are “moderately confident” of the role of vaping products to help smokers quit, they advise that results might yet change as further evidence becomes available.


Unwanted side-effects


The report says reliable evidence is needed to be confident, especially about the effects of newer types of e-cigarettes “that have better nicotine delivery”. Hartmann-Boyce told ECigIntelligence this was a reference to “Juul and other relatively new e-cigarette designs or devices”.


There is uncertainty on whether there is a difference between how many unwanted effects occur with nicotine e-cigarettes compared to those that are nicotine-free. “We did not detect any clear evidence of harm from nicotine e-cigarettes, but the longest follow-up was two years and the overall number of studies was small,” the report says.

 It adds that nicotine e-cigarettes may cause unwanted side-effects, such as throat or mouth irritation, headaches, coughing and nausea, which reduce over time as people continue vaping.


The review considered randomised controlled trials (RCTs) and randomised crossover trials, in which smokers were allocated randomly to either e-cigarette use or a control group. Studies were considered only if they reported at least six months’ abstinence from cigarettes and/or data on adverse events or other markers of safety at one week or longer.

The Cochrane review shows the potential of vaping products as a tool to quit smoking as against other popular quitting methods such as NRT and this new research could help guide policy.

The organisation said there are currently 20 trials under way and that it will be looking for newly published evidence every month from December.


“It is important that the review continues to provide up-to-date information to people who smoke, healthcare providers and regulators about the potential benefits and harms of electronic cigarettes,” Hartmann-Boyce said.


Photo credit: Zaya Odeesho 


About ECigIntelligence


ECigIntelligence is the leading provider of detailed global market and regulatory analysis, legal tracking, and quantitative data for the e-cigarette, heated tobacco and combustible-alternatives sector worldwide. Customised research and consultancy are also available. 


We offer tools to navigate the complex market and regulatory landscape through independent, analytical and actionable data insights, in-depth country reports, regulatory trackers and legal analysis.


We also publish for the global CBD sector, and our site covers products such as heated tobacco and snus.