Vaping in England: an evidence update including vaping for smoking cessation, February 2021 A report commissioned by Public Health England Authors Ann McNeill, Leonie Brose, Robert Calder, Erikas Simonavicius, Debbie Robson King’s College London 1 Vaping in England: an evidence update including vaping for smoking cessation, February 2021 Contents Acknowledgements ...................................................................................................................... 6 Suggested citation .................................................................................................................... 6 Conflict of interest statement ........................................................................................................ 7 Acronyms and abbreviations ........................................................................................................ 8 Executive summary .................................................................................................................... 10 Aim of the report ..................................................................................................................... 10 Methods .................................................................................................................................. 12 Vaping among young people .................................................................................................. 13 Vaping among adults .............................................................................................................. 15 Effect of vaping on smoking cessation and reduction ............................................................. 17 1. Introduction ............................................................................................................................ 21 1.1 Objective of the report ...................................................................................................... 21 1.2 Terminology ...................................................................................................................... 21 1.3 Vaping products................................................................................................................ 21 1.4 A note on COVID-19 ......................................................................................................... 22 1.5 Current vaping regulations in England .............................................................................. 22 1.6 Products notified to the MHRA ......................................................................................... 23 1.7 MHRA Yellow Card scheme ............................................................................................. 24 1.8 Age of sale ....................................................................................................................... 27 1.9 Medicinal nicotine vaping products ................................................................................... 28 1.10 Advertising ...................................................................................................................... 28 1.11 UK government strategies, consultations and relevant commissioned work .................. 29 1.12 A Roadmap to a Smokefree 2030 .................................................................................. 32 1.13 Other consultations and legislative updates ................................................................... 32 1.14 National Institute for Health and Care Excellence: guideline .......................................... 33 1.15 Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment: safety review .................................................................................................... 33 1.16 Selected international developments .............................................................................. 34 1.17 Structure of the report ..................................................................................................... 37 1.18 Conclusions .................................................................................................................... 38 2 Vaping in England: an evidence update including vaping for smoking cessation, February 2021 1.19 Implications..................................................................................................................... 39 2. Methods ................................................................................................................................. 40 2.1 Survey data used .............................................................................................................. 40 2.2 Systematic literature review .............................................................................................. 44 2.3 Other data sources ........................................................................................................... 44 3. Vaping among young people ................................................................................................. 46 3.1 Objective .......................................................................................................................... 46 3.2 Surveys ............................................................................................................................ 46 3.3 Smoking and vaping prevalence among young people in England .................................. 47 3.4 Reasons for vaping ........................................................................................................... 54 3.5 Order of first use ............................................................................................................... 58 3.6 Vaping products................................................................................................................ 61 3.7 Flavours ............................................................................................................................ 62 3.8 Source and place of purchase .......................................................................................... 66 3.9 Nicotine ............................................................................................................................ 68 3.10 Perceived addiction ........................................................................................................ 71 3.11 Urges to vape ................................................................................................................. 75 3.12 Harm perceptions ........................................................................................................... 78 3.13 Other nicotine products .................................................................................................. 80 3.14 Summary of findings ....................................................................................................... 84 3.15 Implications..................................................................................................................... 85 4. Vaping among adults ............................................................................................................. 87 4.1 Objective .......................................................................................................................... 87 4.2 Surveys ............................................................................................................................ 87 4.3 Smoking and vaping prevalence among adults in England .............................................. 89 4.4 Vaping by smoking status ................................................................................................. 96 4.5 Use of selected other products ....................................................................................... 103 4.6 Nicotine product use by former and never smokers ....................................................... 104 4.7 Vaping frequency by smoking status .............................................................................. 108 4.8 Smoking status of vapers ............................................................................................... 109 4.9 Vaping, smoking and socio-economic status .................................................................. 114 4.10 Duration of use ............................................................................................................. 118 3 Vaping in England: an evidence update including vaping for smoking cessation, February 2021 4.11 Reasons for vaping ....................................................................................................... 120 4.12 Vaping products ............................................................................................................ 123 4.13 Flavours ........................................................................................................................ 133 4.14 Perceived addiction ...................................................................................................... 136 4.15 Urges to vape ............................................................................................................... 140 4.16 Harm perceptions ......................................................................................................... 143 4.17 Summary of findings ..................................................................................................... 146 4.18 Implications..................................................................................................................