Vaping in England: 2021 evidence update summary - GOV.UK

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Released on February 23, 2021

©Crown Copyright 2021

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This is the seventh report in a series of independent reports commissioned by the Public Health Agency of England (

) Summarize the evidence related to atomized products to inform policies and regulations.

In an unhealthy environment, smoking remains the single largest risk factor for death and life, and is the main cause of health inequality in England and the rest of the world.

Alternative nicotine delivery devices, such as nicotine aerosol products, can play a key role in reducing the huge health burden caused by smoking.

This report covers the latest evidence on the prevalence and characteristics of e-cigarettes among young people and adults in England, with a particular focus on data that has emerged since 2000


The report also includes the latest evidence on the effect of vaping products on smoking cessation, which has recently been studied in detail in the following literature:

The term "vaporized product" describes e-cigarettes, refill containers and e-liquids.

The term "e-cigarette" refers to a person who frequently uses e-cigarette products and uses "e-cigarettes" as the behavior of using e-cigarette products. These terms do not include the atomization of cannabis or other illegal substances, which is not the subject of this report.

COVID-19 has had a devastating impact on a global scale. As far as this report is concerned, it affects the implementation of routine investigations and may also affect smoking and smoking behavior in England.

The COVID-19 pandemic is the subject of many ongoing studies, and it is too early to evaluate its full impact on e-cigarettes and smoking at the time of writing.

The government issued new regulations,

, To ensure that the UK fulfills its obligations regarding tobacco control and e-cigarette product policies under the EU (Withdrawal of Agreement) Act 2020. The new regulations include a notification mechanism for the sale of e-cigarette products in the UK (new system) and Northern Ireland (previous EU system). These regulations ensure that fees are only paid when the product is notified to the two databases. The government is also reviewing other regulations related to the EU (Exit Agreement) Act 2020.

The UK government has committed to review


) (Administration of nicotine atomized products) to assess whether the regulations have reached their targets before May 20, 2021.

As nicotine-free vaping products are subject to strict control (through

) (Instead of nicotine-containing products), they may need to be reviewed,

. With the advent of other non-tobacco nicotine products (such as nicotine bags), it seems necessary to review the regulations for these products at the same time.

Drug-licensed nicotine vaping products are exempt

There are currently no licensed products in the UK.

It is forbidden to sell vaping products to anyone under the age of 18, and it is prohibited to purchase vaping products to anyone under the age of 18. According to reports, nicotine atomized products (and cigarettes) violated the age of sale. A five-year report on these regulations should be submitted. A loophole in the legislation allows free samples of vaping products to be provided to people of any age.

Between May 20, 2016 (implemented

) And January 5, 2021, the Drugs and Healthcare Products Regulatory Agency (

) Received 231 reports of 618 adverse reactions, which are considered to be related to nicotine-containing vaping products produced by nicotine

. Each report represents one person, and more than one adverse reaction may have been reported. A report does not prove that the reaction is caused by an aerosolized product, but the reporter believes that it may be the cause.

Since May 20, 2016,

According to the report, there were 3 fatal accidents related to vaping products in the UK, and one of them seemed to meet the criteria of "e-cigarette or vaping product use-related lung injury" (EVALI).

Security review

) Concluded that the risk of adverse health effects from the use of e-cigarette products is expected to be much lower than that of cigarettes. The review found that exposure to particulate matter and nicotine may be associated with adverse health effects, and the effects of inhaled flavoring ingredients are uncertain. This

It is also recommended not to smoke but people who smoke may experience some adverse health effects.

A government consultation meeting in 2019 outlined a new goal to be smoke-free in the UK by 2030. It also includes an ultimatum to the industry, requiring that tobacco leaf tobacco be made obsolete by 2030, and smokers quit smoking or switch to risk-reducing nicotine delivery systems, such as e-cigarette products.


Although a new tobacco control plan has been developed for the UK, which is expected to be released in July 2021, the plan sets a goal for 2022.

Establish a smoke-free target for 2030, develop a new tobacco control plan and review

Provide opportunities to review all nebulization (and other nicotine and tobacco) regulations to ensure that they are appropriate and help smokers quit, while managing the risk of ingestion by never-smokers.

As outlined

To achieve smoke-free by 2030 will require more resources, and the legislation proposed by the coalition requires tobacco manufacturers to provide funding for the "Smoke-free 2030 Fund."

England’s next tobacco control plan provides an opportunity to set intermediate smoking targets among different disadvantaged groups.

There is also an urgent need to review the lack of medically licensed products.

The areas of concern outlined in the Convention need to be studied.


The report used two surveys to obtain information about smoking and smoking among young people in England:

In order to obtain information about adult smoking in England, the report used the following 4 types of survey information:

The 2019 Annual Population Survey (APS) is used to estimate smoking prevalence.

In order to determine the available evidence for quitting and reducing smoking through e-cigarettes, we conducted a systematic review of the existing peer-reviewed literature.

NHS Digital data is used to provide information on smoking cessation services in England between April 2019 and March 2020.


Provides information on suspected adverse events of e-cigarette products from May 2016 to January 2021.

The data reported in this chapter was collected in September 2019 (from

Survey) and March 2020 (extracted from

Polls). Therefore, the conclusions in this chapter do not consider the potential impact of COVID-19 on young people’s e-cigarettes and smoking.

Survey data (11 to 18 years old) shows:

Survey data (16 to 19 years old) shows:

According to the socio-economic status of the 11 to 18-year-old age group, in social grades A, B, and C1, the estimated prevalence of smoking and smoking among the dominant population is higher than that of the disadvantaged population (7.1% , 5.3% in a smoking state). Social grades C2, D and E (5.7% for smoking and 3.5% for smoking).

Most young people who have never smoked have never smoked. 0.8% to 1.3% of young people who have never smoked are current smokers.

Most current smokers are former smokers or current smokers.

The main reasons for vaping are:

Among 11 to 18-year-old children, 11.9% claimed that they did so to quit smoking.

More 11 to 18-year-olds who tried e-cigarettes said:

The storage tank model is a reusable and rechargeable toolkit. Users can use it to replenish liquids. It is currently the most popular e-cigarette product model. 49.1% of the 11 to 18-year-old children currently using e-cigarettes use this model. The usage rate of models with pre-installed ink cartridges has increased from 17.6% in 2019 to 34.2% in 2020.

Among the current vapers, fruit flavors are the most popular. Followed by menthol/mint, and then "chocolate/dessert/sweet/candy" flavors.

Although e-cigarettes between the ages of 11 and 17 are sold to under 18, and agent purchases are illegal, three-quarters of e-cigarettes still purchase their e-cigarette products.

Among current and former smokers between the ages of 11 and 18, less than half (43.0%) reported always using nicotine-containing vaping products – 17.3% always used nicotine-free products. Three-fifths (61.3%) of 16 to 19-year-old children who had smoked in the past 30 days used nicotine in their current products. 17.3% said their products were nicotine-free.

The most common nicotine intensity used by young people aged 16 to 19 who had smoked in the past 30 days was less than 20 milligrams per milliliter (mg/mL) (54.0%). One-fifth (19.6%) of the participants did not know the strength of their nebulizer, 18.0% of the participants used a concentration of 20mg/mL or more, and 6.6% of the participants used a concentration of 40mg/mL or more .

Among the 16 to 19-year-olds who smoked in the past 30 days, more than half (56.6%) currently use nicotine salts, 30.6% do not use nicotine salts, and 12.8% are unsure.

Among the 16 to 19-year-olds who smoked in the past 30 days, more than half (58.2%) were not obsessed with the fog, but 38.5% said they were obsessed a little or very obsessed.

About one-fifth (18.4%) of 11 to 18-year-old e-cigarettes experience the urge to use e-cigarettes almost all the time or all the time.

The proportion of 11 to 18-year-olds who believe that smoking is less harmful than smoking has dropped from 66.7% in 2015 to 43.3% in 2020.

Among people between 11 and 18 years of age, the current use of heated tobacco products is very small (0.5%). Among 16 to 19-year-olds, 2.6% have used nicotine sachets (half used in the last month), and 4.1% have used smokeless tobacco (one-third used in the last month) Over smokeless tobacco).

In recent years, smoking and smoking rates among young people in the UK seem to have remained unchanged and should continue to be closely monitored.

There is a need to improve the enforcement of the sales age regulations for e-cigarettes (and smoking).

Misunderstandings about the relative harm of smoking and smoking should be resolved.

More research is needed on the significant differences in the prevalence of smoking and smoking in different socioeconomic groups between young people (higher in the dominant population) and adults (higher in the disadvantaged population).

More research is needed on the addictiveness of different types and intensities of nicotine atomized products among young people and the extent to which they use illegal products.

The data reported in this chapter comes from 4 different surveys. Most of the data comes from

, The collection time is from January 2020 to October 2020,

The survey was collected in February 2020 and March 2020. Other data will be collected in 2019.

According to the survey, the smoking rate among adults in England continues to decline, between 13.8% and 16.0%, which is equivalent to approximately 6 to 7 million smokers.

According to sociodemographics, there are some differences in smoking rates, for example, smoking rates are higher among adults in more vulnerable groups. There are also differences between the two surveys. The most significant is the smoking rate of young people (24.1%

Compared to 10.8%

(Applicable to teenagers between 18 and 24 years old).

In all populations, the smoking rate is lower than the smoking rate, and continues to remain at about 6% (between 5.5% and 6.3%), which is equivalent to about 2.7 million adult smokers in England.

There are certain differences in smoking rates and smoking status among different social population groups. use

The data shows that 7.2% of men in northern England, 7.7% of the population, and 7.6% of the population of C2, D, and E social classes are passing away. The smoking rate of current smokers is between 17.5% and 20.1%, former smokers are about 11%, and never smokers are between 0.3% and 0.6%. Approximately 10% of long-term smokers (quit smoking for more than 1 year) will smoke, compared with 24% of long-term smokers (quit smoking less than 1 year).

Since 2012, the proportion of vapers who also smoke has dropped from 74% to 38%

And increased from 92% to 51%

Polls. The difference may be due to different definitions of smoking status.

Among adults who have ever smoked, more than half (57.4%) of never-smokers have tried once or twice, and 6.1% have smoked every day. Among people who have ever smoked, more than half (56.3%) of former smokers and approximately 30% of current smokers smoke every day.

Among long-term smokers who have smoked for a long time, the proportion of using nicotine replacement therapy has declined (

)-Between 2013 and 2020, the proportion of used e-cigarette products is getting higher and higher.

At present, the proportion of e-cigarettes that have been used for more than 3 years is increasing (23.7% in 2018, 29.3% in 2019, and 39.2% in 2020). The percentage of new incumbent Vapers with a time limit of less than one month by 2020 is 2.6% (5.5% in 2018 and 5.1% in 2019). Most people who used e-cigarettes in the past stopped using them after 6 months or less (59.9% in 2020).

The most common reasons for vaping are

The subjects of the survey are: quit smoking (29.7%), quit smoking (19.4%) or reduce smoking (11.2%). inside

According to a survey in 2019, 52.8% of vapers currently say that they have started to quit smoking.

Most vapers (about 75%) use tank models.

Less than 5% of the use rate is lower than the legally permitted strength (nicotine greater than 20mg/mL). The use of non-nicotine liquids may be more common among vapers in social classes C2, D, and E.

Since starting to use e-cigarettes, just over half of e-cigarettes (51%) have reported reducing the strength of the nicotine liquid they use. Only 1.1% of people who have just started to use non-nicotine liquids have started to use atomized nicotine.

Fruit (31.6%), tobacco (25.2%) and menthol/mint (20%) are the most popular flavors among vapers.


In a survey of adults with a history of smoking and smoking, smokers tended to believe that they dislike smoking more than smoking. However, among dual users of smoking and smoking and users of disposable devices or nicotine salts, smoking is more addictive than smoking.

Compared with smoking, the knowledge and evidence of the harm caused by smoking are increasingly inconsistent. This

The investigation found:

Among smokers in social classes C2, D, and E, the misunderstanding is more obvious.

By 2020, the proportion of adults in England who use heated tobacco products is estimated to be 0.3%, and that of nicotine pouches is 0.5%.

With the passage of time, the proportion of people who use e-cigarettes for a long time is increasing, so further research on this group is needed.

As suggested in previous reports, in this series and in

, Should support all smokers to quit smoking completely, including dual smokers.

More emphasis needs to be placed on how best to communicate evidence of relative harm to smokers so that they can consider offering them all options to quit smoking completely.

Smoking is more common among the more disadvantaged adult groups in society. This reflects the smoking rate, and research should continue to explore the impact on health inequality.

The addictiveness of different types of e-cigarette products, the type and flavor of nicotine used in e-cigarettes should be further studied.

The following are the main findings of the national representative survey data (


Using e-cigarette products is the most common help for people trying to quit smoking. By 2020, in the past 12 months, 27.2% of people have used e-cigarette products to quit smoking. In contrast, used

Over-the-counter or prescription drugs (2.7%), and the use of varenicline accounted for 4.4% of patients.

Vaping is positively correlated with successful smoking cessation. In 2017, more than 50,000 smokers stopped using aerosol products to smoke, otherwise they will continue to smoke.

Prescription drugs and licensing

Harm reduction is also positively correlated with successful smoking cessation. This shows how important it is for smokers to obtain a wide range of smoking cessation aids.

Compared with licensed drugs, the widespread use of nebulized products for smoking cessation attempts indicates that nebulized products may attract more smokers and therefore have a greater impact than

And varenicline.

The following are the main findings from the English cessation service data.

Between April 2019 and March 2020, 221,678 quit dates and a cessation service were set, 114,153 (51%) of which resulted in self-reported cessation 4 weeks after the quit date.

Vaporized products were used in 5.2% of smoking cessation attempts. This can be used either alone or at the same time as the vaping product, or after the use of licensed drugs.

Consistent with the findings in our previous report, the quit rate was highest (74%) when quit attempts involved people using a licensed drug and an e-cigarette product.

People who used nebulized products and licensed drugs at the same time (60.0%) had similar smoking cessation rates when using nebulized products alone (59.7%) and valerine alone (59.4%).

In every region of the UK, the exit rate of using e-cigarette products is higher than any other method. It ranges from 49% in the Southwest to 78% in Yorkshire and the Humber.


A survey of clues to tobacco control found that only 11% of local governments stopped smoking services in order to provide aerosolized products to some or all of those trying to quit smoking.

The following main findings come from systematic review data. This includes data from 6 systematic reviews and meta-analysis, and 4 randomized controlled trials (

) And 13 non-random studies published since 2007

Three systematic reviews and meta-analysis of medium to high quality including 15

The effect of smoking on smoking cessation or smoke reduction was evaluated.

Three systematic reviews consistently found that nicotine-containing aerosol products are more effective in helping people to quit smoking than in smoking cessation.

. Two non-randomized studies support this finding, which reported that people who use smoking cessation services have a higher rate of quitting compared to people who have used e-cigarette products.

Results of meta-analysis

Whether aerosolized products that use nicotine are more effective than products that do not use nicotine or behavioral support is still inconclusive. However, when excluding studies with a high risk of bias,

It is suggested that atomized products containing nicotine are more effective.

The withdrawal rate of non-randomized study participants was set at 7% to 36% among participants with clinical symptoms (including mental illness, drug abuse, or HIV/AIDS), and 11% to 62% among non-clinical participants. It is important to note that most of these non-randomized studies are single groups before and after the study, and therefore inherently biased.

a lot of

The information contained in the systematic review is outdated and the nicotine intensity is low. In most studies, tobacco flavor is the most common e-liquid flavor offered, and participants did not choose flavors. Do not

And only one non-randomized intervention study included aerosol products containing nicotine salts.

Studies have shown that smoking in 2017 caused thousands of smokers to stop smoking, similar to estimates in previous years.

Compared with the 2018 review, there is stronger evidence in this year's report that nicotine atomized products can effectively quit smoking and reduce smoking.

As suggested

Combining vaping products (the most popular source of support used by people trying to quit smoking in the general population) and smoking cessation service support (the most effective type of support), it should be an option that everyone who wants to quit smoking can choose from smoking.

Local authorities should continue to fund and provide smoking cessation services, and all smoking cessation services should use e-cigarette products in a consistent manner.

Further research is needed to assess whether smokers who use smoking cessation services and e-cigarette products are different from smokers who use the service and other smoking cessation aids.

It is necessary to further study the barriers and contributing factors of the use of vaping products as part of the smoking cessation service in support of smoking cessation services.

Research is needed, including new e-cigarette products with better nicotine delivery capabilities.

As we stated in the previous report, strict inclusion and exclusion criteria

This means that they are not suitable for many people in the real world, nor are they suitable for the general population who smoke or use electronic cigarettes. These ones

Strict adherence to specific interventions (for example, type, dose, duration, and frequency) is required, which also does not reflect what is happening in real life.

Vaping technology has become more and more complex and diverse, and vape people have become more heterogeneous. Therefore, new flexible methods for conducting observational research and

User trials are required (for example, trial and error of different types of e-cigarette products in order to change preferences over time).

McNeill, A., Brose, LS, Calder, R., Simonavicius, E. and Robson, D. (2021). Vaping in England: Evidence update in February 2021, including vaping for smoking cessation: report commissioned by the British

. London:

Ann McNeill, Leonie Brose, Robert Calder, Erikas Simonavicius, Debbie Robson.

King's College London.

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