UK Health Security Agency News and Media

23 Feb 2021

Evidence suggests vaping better than nicotine replacement therapy for stopping smoking in England

At a time when the number of vapers in England is plateauing, incorrect perceptions of relative risks of vaping compared to smoking could be discouraging smokers from trying a vaping product to quit

Public Health England’s seventh independent report on vaping in England, carried out by researchers at King’s College London, is published today (Tuesday 23 February 2021).

  • Nicotine vaping products were the most popular aid (27.2%) used by smokers trying to quit in England in 2020
  • It is estimated that in 2017 over 50,000 smokers stopped smoking with the aid of a vaping product who would otherwise have carried on smoking
  • 38% of smokers in 2020 believed that vaping is as harmful as smoking and 15% believed that vaping is more harmful
  • Using a vaping product as part of a quit attempt in local stop smoking services had some of the highest quit success rates (between 59.7% and 74% in 2019-20).[1]

The report takes an in depth look at the latest evidence on the effectiveness of nicotine vaping products in helping people to stop smoking. The report also provides an update on the use of nicotine vaping products among young people and adults and examines the data on people’s perception of risk.

COVID-19 is likely to have had an impact on smoking and vaping behaviours in both adults and young people but it is still too early to assess the full effect of the pandemic, with much of the data examined in this report being pre-pandemic.

In England in 2020, nicotine vaping products were the most popular aid used by smokers trying to quit with 27.2% of smokers using a vaping product compared with 18.2% using nicotine replacement therapy (NRT) products such as patches and gum and 4.4% using the prescription medicine varenicline.[2]

Evidence over the years suggests that as the use of vaping products in quit attempts increases, the number of successful quits in England also increases. It is estimated that in 2017 over 50,000 smokers stopped smoking with the aid of a vaping product who would otherwise have carried on smoking.[3] Data from systematic reviews  since PHE’s 2018 report show that vaping products were significantly more effective for helping people stop smoking than NRT.

Those using a vaping product as part of their quit attempt in local stop smoking services  have some of the highest quit success rates (between 59.7% and 74% in 2019-20).[4]

Vaping has plateaued in adults and young people since the last PHE report (March 2020).

Around 4.8% of young people (aged 11-18 years) reported vaping at least once a month, the same as last year, and most of these were either current or former smokers (only 0.8% of young people who had never smoked currently vape). Smoking prevalence among young people (including those who smoked sometimes or more than once a week) was 6.7% in March 2020, similar to March 2019 (6.3%).[5] The law bans the sale of smoking and vaping products to under 18s but age of sale violations are being reported.

Similar to last year, around 6% of adults are current vapers, equating to about 2.7 million adult vapers in England. Smoking prevalence continues to fall and is between 13.8% and 16% depending on the survey. Vaping prevalence was between 17.5% and 20.1% among current smokers, around 11% among former smokers and between 0.3% and 0.6% among never smokers.[6] The proportion of vapers who also smoke (“dual users”) has declined since 2012.

There are still concerns around increasing misperception of the relative risk caused by vaping products compared to smoked tobacco. In 2020, 38% of smokers believed that vaping is as harmful as smoking and 15% believed that vaping is more harmful.[7] This is out of line with expert reviews from the UK and US concluding that using regulated nicotine vaping products is far less harmful than smoking.

Professor John Newton, Director of Health Improvement at Public Health England, commented on the report:

“Smoking is still the leading preventable cause of premature death and disease – killing almost 75,000 people in England in 2019.[8] The best thing that a smoker can do is to stop smoking completely and the evidence shows that vaping is one of the most effective quit aids available, helping around 50,000 smokers quit a year.

“Thousands more could have quit except for unfounded safety fears about e-cigarettes. The evidence has been clear for some time that, while not risk free vaping is far less harmful than smoking. For anyone who smokes, particularly those who have already tried other methods, we strongly recommend they try vaping and stop smoking, ideally with additional support from their local stop smoking service for the very best chance of quitting for good.”

PHE’s advice remains that smokers should switch to vaping products to help them quit smoking, but non-smokers should not take up vaping. Vaping products contain significantly less harmful chemicals than cigarettes but are not without some risks.

PHE has commissioned a full review of the evidence on the safety of vaping products, which will be published next year in 2022. King’s College London are working with a number of different researchers from the UK and US (including some who contributed to the National Academies of Sciences, Engineering and Medicine’s e-cigarette report in in 2018) to conduct this review.

Professor Ann McNeill, Professor of Tobacco Addiction at King’s College London, and lead author of the report said:

“Our report draws together findings from randomised controlled trials, stop smoking services and population studies and concludes that nicotine vaping products are an effective way of successfully quitting smoking.  

“What is concerning is that smokers, particularly those from disadvantaged groups, incorrectly and increasingly believe that vaping is as harmful as smoking.  This is not true and means fewer smokers try vaping.

“The goal for 2030 is to be smokefree in England. The development of a new Tobacco Control Plan and this year’s review of the Tobacco and Related Products Regulations 2016 is an opportunity to  ensure that the regulations  around vaping are appropriate and help smokers to quit while not attracting people who have never smoked.”

 

[1] NHS Digital Statistics on NHS Stop Smoking Services in England April 2019 to March 2020

[2] UCL Smoking Toolkit Study, 2020

[3] Beard et al. Association of prevalence of electronic cigarette use with smoking cessation and cigarette consumption in England: a time–series analysis between 2006 and 2017. Addiction, 2019. 115(5): p. 961-974.

[4] NHS Digital Statistics on NHS Stop Smoking Services in England April 2019 to March 2020

[5] ASH YouGov Smokefree GB Youth Survey, 2020

[6] UCL Smoking Toolkit Study, 2020, ASH YouGov Smokefree GB Adult Survey, 2020, ONS Opinions and Lifestyle Survey, 2019

[7] UCL Smoking Toolkit Study, 2020

[8]NHS Digital Statistics on Smoking, England 2020

Contact Information

Georgia Featherstone
Georgia.Featherston@phe.gov.uk

Notes to editors

Notes to editors

 

Background

The full 2021 report: https://www.gov.uk/government/publications/vaping-in-england-evidence-update-february-2021

E-cigarette report collection: https://www.gov.uk/government/collections/e-cigarettes-and-vaping-policy-regulation-and-guidance

The Tobacco Control Plan for England: https://www.gov.uk/government/publications/towards-a-smoke-free-generation-tobacco-control-plan-for-england

Tobacco and Related Products Regulations 2016: https://www.legislation.gov.uk/uksi/2016/507/contents 

Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment: https://cot.food.gov.uk/

US National Academies of Sciences, Engineering, and Medicine Public Health Consequences of E-Cigarettes (January 2018): https://www.nap.edu/catalog/24952/public-health-consequences-of-e-cigarettes

UCL Smoking Toolkit Study: http://www.smokinginengland.info/

ASH YouGov Smokefree GBAdult Survey2020:  https://ash.org.uk/information-and-resources/fact-sheets/statistical/use-of-e-cigarettes-among-adults-in-great-britain-2020/ 

ONS Opinions and Lifestyle Survey 2019: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2019/relateddata

ASH YouGov Smokefree GB Youth Survey 2020: https://ash.org.uk/information-and-resources/fact-sheets/statistical/use-of-e-cigarettes-among-young-people-in-great-britain-2020/

NHS Digital Statistics on NHS Stop Smoking Services in England, April 2019 to March 2020: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-nhs-stop-smoking-services-in-england/april-2019-to-march-2020

NHS Digital Statistics on Smoking, England 2020: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2020/part-1-smoking-related-ill-health-and-mortality

 

Further quotes

Ailsa Rutter OBE, Director of Fresh said:

“We welcome this report which adds to both the evidence base and feedback from ex-smokers that switching over completely to vaping can help smokers to successfully quit. We are however concerned that some smokers are being scared off from trying vaping from misperceptions about relative harm, or might stop because they aren’t sure how to maximise their potential.  The time has come for all health care professionals in particular to provide accurate information to smokers about the risks of continuing to smoke and to positively encourage them to stop including trying vaping as part of their options. Smoking remains the key driver of health inequalities and we must do all we can to help reduce rates across all groups, and that should include the role of harm reduction”.

Deborah Arnott, Chief Executive of ASH, said,

“Rightly, since e-cigarettes emerged as an alternative to smoking, the government has sought to strike a balance between helping smokers to quit and protecting children. As ASH research included in the report for PHE shows, e-cigarette use among 11-18 year olds has to date remained low, but on the downside their potential as an adult quitting aid has not been fully realised. As we strive to achieve a smokefree nation by 2030 more needs to be done to support adult smokers who could benefit from switching to do so, while eliminating loopholes in the laws which could be used to promote products to teenagers.”

Michelle Mitchell, Cancer Research UK’s Chief Executive, said:

“E-cigarettes are a still relatively new product – they aren’t risk-free as we don’t yet know their long-term impact. We strongly discourage people who haven’t smoked from using them, particularly young people. But research so far shows that vaping is less harmful than smoking tobacco and, as this report emphasises, can help people to stop smoking. The long-term effects of e-cigarettes are unknown, but the long-term harms of tobacco are indisputable.

“Support from stop smoking services remain the most effective way to help people quit for good. Services can help people find the tool that works for them, e-cigarette or otherwise, and give them the best chance of reducing their risk from tobacco.”

 

About Public Health England

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About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience

King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2020) and among the oldest in England. King’s has more than 31,000 students (including more than 12,800 postgraduates) from some 150 countries worldwide, and some 8,500 staff. 

The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited outputs (top 1% citations) on mental health than any other centre (SciVal 2019) and on this metric we have risen from 16th (2014) to 4th (2019) in the world for highly cited neuroscience outputs. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain.

www.kcl.ac.uk/ioppn @KingsIoPPN