Changes in the use of e-cigarettes to stop smoking among adults following the rise of disposable vapes: A repeat cross-sectional survey 2016-23 in England

Aims : To estimate how the prevalence of e-cigarette (“vape”) use, and less effective methods in smoking quit attempts, changed following the widespread availability of novel disposable vapes to the market in England. Design: Nationally representative monthly repeat cross-sectional survey. Setting: England. Participants: 8,323 adults (≥18 years; 47.5% women; mean [SD] age: 39.2 [15.5]) who smoked - and tried to quit - in the past year, surveyed between July 2016 and December 2023. Measurements: Using segmented regression analysis, we estimated annual trends in smoking quit attempts using i) a vape, and ii) less effective methods (i.e. without using vapes, prescription medication or specialist support) before (“pre-disposables”) and after June 2021 (“post-disposables”). In a sensitivity analysis we modelled the changes in each outcome associated with the prevalence of disposable vaping as a continuous variable rather than an abrupt interruption in June 2021. Findings: During the pre-disposables period, the use of vapes in a smoking quit attempt decreased by 3.1% per year (relative risk [RR]=0.969 [95% CI 0.927 to 1.012]). However, this trend reversed when disposables became popular (RR=1.20 [1.12 to 1.29]), with a relative year-on-year increase in prevalence of 16.5% from June 2021 onwards (from 27.7% in June 2021 to 40.6% in December 2023). In contrast, the use of less effective methods in smoking quit attempts increased by 3.6% per year (RR=1.036 [1.01-1.06]) before June 2021, after which the trend reversed (RR=0.91 [0.88 to 0.95]) and there was a relative yearly decline in prevalence of 5.6% (from 65.4% to 56.6%). In the sensitivity analysis, for each 1 percentage-point increase in disposable vaping prevalence, the prevalence of vape use in a quit attempt (in the subsequent month) rose by an estimated 0.66 percentage points (95% CI 0.05 to 1.26), while use of less effective methods declined by 0.82 percentage points (-1-40 to -0.24). Conclusions: The rise in the use of disposable vapes in England was associated with increased vape use and decreased use of less effective methods in smoking quit attempts.