How popular is vaping?

Global vaping or e-cigarette use and sales have risen dramatically since 20111.

Number of global vapers in millions

graph showing number of global vapers

Source: Euromonitor International / BBC /  University of Warsaw & Imperial College London1

A few quick facts

  • In 2019 9% of US 13-14 year olds had vaped nicotine; in 2017 it was only 3.5%4
  • In 2021 7% of UK 11 – 15 year olds had vaped and 30% of 18 years old had vaped; in 2013 only 5% of 11-18 year olds had vaped17
  • Even nicotine free juice often contains nicotine30
  • Vapers often uptake more nicotine that smokers31
  • The global e-cigarette and vape market was valued at US$15bn in 2020 compared with $3bn in 2016 and expected to grow at 28% from 2021 to 202828

Is vaping safe? – 5 Vaping health facts you should know:

1. Vaping is less harmful than smoking but it’s still not safe

It is likely that vaping is less harmful than smoking but it is definitely not harmless. Some people have compared vaping instead of smoking as being like falling from the 10th floor of a building rather than the 20th floor. There is some integrity to this comparison although it’s not a simple consideration.

The World Health Organisation13 has also cited many concerns regarding vaping:

  • The long-term effects are unknown but there is growing evidence of it’s harmful effects29
  • Vaping liquid often contains nicotine even when it says it is nicotine free30.
  • Nicotine is addictive
  • There are many other questionable ingredients contained in the liquid
  • There is no doubt that vaping causes lung issues, makes lungs more vulnerable to infection and disease, heart issues, weakens the immune system and more24, 29 & 33-35

In January 2018, the National Academies of Science, Engineering and Medicine released a consensus study report that reviewed over 800 different studies and concluded that ENDS /e-cigarettes / vaping causes health risks18.

 

 

 

2. Vaping is bad for your heart and lungs

The American Lung Association has stated that the inhalation of harmful chemicals [from vaping] can cause irreversible lung damage and lung disease24.

Vaping liquid contains over 80 chemicals including nicotine, cancer-causing chemicals and toxic heavy metals such as nickel, tin and lead7 all of which are associated with developing lung disease.

When heated the vaping liquid creates ultrafine particles and volatile organic compounds. These can exacerbate conditions such as asthma and emphysema and could lead to a heart attack11, 12.

Popcorn Lung  – A chemical called diacetyl, which although banned in the UK & EU is available in juices worldwide including in US and online, is used to create a buttery flavour such as used in popcorn, custard and sweet dessert flavours. High levels of exposure to diacetyl can lead to the serious lung disease bronchiolitis obliterans also known as “popcorn lung10.

EVALI/VAPIE-cigarette Vaping product use Associated Long Injury (EVALI) is an acute or subacute respiratory illness with damage to the lungs that can be severe and life-threatening20, 21, 22. As of 18 February 2020 there were almost 3,000 hospitalised cases or deaths due to EVALI in US23 most of whom were under 35 years old.

Read full article – Can Vaping Damage the Lungs?

 

 

3. E-cigarettes are just as addictive as traditional cigarettes

E-cigarettes very often contain nicotine and even the juices that say they do not contain nicotine often do30. Furthermore, vaping is often a gateway to the nicotine variety and to smoking (the World Health Organisation estimates that for young people it more than doubles the likelihood of smoking in the future)29. In fact, 99% of the e-cigarettes sold in the USA contained nicotine5 and according to JUUL’s website the nicotine content of one JUUL pod is equivalent to one packet of cigarettes.

In fact e-cigarette users uptake of nicotine can be more than that of smoking because of the concentration of the juice, the power of the device, the ingredients in the juice and the puffing style of the user31. Furthermore, juice manufactures have developed new mixtures that deliver higher levels of nicotine to the user while masking it’s harshness enabling users to have more nicotine32.

Nicotine is a highly addictive substance and in fact it has been reported to be harder to quit than cocaine.

Vaping is therefore addictive due to nicotine just like cigarettes. Given that addicts are capable of increasing the dose of nicotine content – it is likely to be even more so.

Read full article – Is Vaping harder to quit than cigarettes?

 

 

4. E-cigarettes aren’t the best way to quit smoking

Vaping may be less harmful than smoking but it’s still not safe.

The US Surgeon General’s Report on Cessation concluded, “The evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation”36.

The European Union’s Scientific Committee on Health, Environmental and Emerging Risks (SCHEER) Opinion on electronic cigarettes concluded, “There is a lack of robust longitudinal data on the effect of electronic cigarettes on smoking cessation. Until such research is available, electronic cigarettes should only be considered to support smoking cessation for a limited time and under supervision” 37.

Furthermore, there is research that suggests that, in some cases, ENDS / vaping could hinder cessation in some individuals by prolonging or increasing addiction to nicotine38.

All the above has led the World Health Organisation to say “ENDS / vaping cannot be recommended as cessation aids” instead it recommends methods with randomised controlled trials that enable smokers to quit nicotine completely29. This is also the advice given by the US Centres for Disease Control and Prevention7.

The World Health Organisation goes on to say that “Randomized controlled trials show that there are proven ways for drug free smoking cessation, for example, intensive behavioural support with individual or group counselling [such as Allen Carr’s Easyway] is one of the effective interventions.”

Quitting nicotine completely may sound a daunting prospect but there is a drug free and clinically proven method called Allen Carr’s Easyway which, as it’s name says, is the easy way to quit nicotine completely.

Stop vaping with Allen Carr’s Easyway

 

 

5. A new generation is getting hooked on nicotine

In 2019, 9% of 13-14 year olds had vaped nicotine; in 2017 it was only 3.5%4. The rapid rise in young vapers  is driven by the slick advertising projecting vaping as sexy, attractive and safe, (reminiscent of smoking adverts of a bygone era) and by the flavours that appeal to young people1. They also don’t realise there is nicotine in the vaping juice5. The use of the word “juice” is a deliberate choice on the part of the manufacturers – the implication is that the liquid is healthy rather than poisonous and addictive.

In addition a number of adults who have never smoked are now vaping, and smokers are combining vaping & smoking, drawn in by the same adverts in the belief that there is a health benefit from reducing their smoking, or that it is just a bit of fun with no harmful effects to vaping. However, vaping liquid contains over 80 chemicals including nicotine, cancer-causing chemicals and toxic heavy metals such as nickel, tin and lead7. When heated the vaping liquid creates ultrafine particles and volatile organic compounds. These can exacerbate conditions such as asthma and emphysema and could lead to a heart attack11, 12. Vaping is less harmful than smoking (but it’s still not safe).

It is worth noting that the single biggest factor to stop teens starting to vape appears to be to raise children in a smoke and vape free home. If the parents smoke or vape it normalises the behaviour in children who particularly when they are young look up to parents as their role models. This increases the likelihood that the child will be taken in by the advertising and go on to vape and smoke25.

In fact the World Health Organisation states that children who vape are more than twice as likely to start smoking28

The numbers, particularly amongst the young, show the risk that a new generation is getting hooked on nicotine.

Read more about Teen Vaping and How to Help Them to Quit

Vaping statistics worldwide

Vaping statistics worldwide

graph showing worldwide vaping stats 2021

A few quick facts

  • Vape liquid or juice contains up to 80 chemicals including nicotine, cancer-causing chemicals and toxic heavy metals such as nickel, tin and lead7
  • In US more young people than adults vape7Read more teen vaping statistics and facts  
  • In 2019 9% of 13-14 year olds had vaped nicotine; in 2017 it was only 3.5%4
  • Only 40% of parents were aware that their children vaped; against 70% for smoking9
  • Around two-thirds of JUUL users aged 15-24 do not know that JUUL contains nicotine5
  • The nicotine content of one JUUL pod is equivalent to one pack of cigarettes6.
  • In 2016 nearly 200 e-cigarette users developed severe lung disease in 22 states across USA Read more about vaping damage to lungs

Top 5 markets for vape products 2020 ($m)

Top 5 markets for vape products 2020

Source: Statista3

Vaping statistics in the UK

UK vaping or e-cigarette use and sales have risen dramatically since 2012.

Number of UK vapers in millions

Graph to show Number of UK vapers in millions 2020

Source: ASH2 & 26

A few quick facts

  • The UK is the second largest market in the world for vape products worth £2.3bn in 20203
  • The age range with the most UK vapers is 35-44 years olds2(in the US it is 18-24 year olds)
  • The most common reason for vaping in the UK is as an aid to quitting smoking (30%)26
  • 77% of vapers use tanks rather than cartridge / JUUL26
  • In 2020, e-cigarette use declined for the first time year on year26
  • The most popular flavour vape juice is fruit (in 2015 it was tobacco)3

Vaping statistics in the US

US vaping or e-cigarette use and sales have risen dramatically since 2012. The graph below shows the growth in teens:

% of US teenagers who reported any vaping during the last 30 days

graph showing % of US teenagers who reported any vaping during the last 30 days

Source: University of Michigan Monitoring the Future survey4 & 27

A few quick facts

  • The US is the largest market in the world for vape products worth US$6.2bn in 20203
  • 9% of US adults vape regularly or occasionally14
  • Oklahoma has the highest rate of e-cigarette usage, followed by Louisiana, Nevada, Ohio, Tennessee, and Kentucky5
  • Washington, D.C. has the lowest rate of e-cigarette usage, followed by South Dakota, California, Maryland, and Vermont5
  • The age range with the most US vapers is 18-29 years olds14
  • 73% of vapers use JUUL19
  • The most popular flavour vape juice is fruit15
  • The main reason for vaping is young people being attracted to the flavours and advertising (22%)7, 16

Vaping statistics by age

Vaping statistics vary by country due to the policies and controls in place by the various governments.

Age Profile of US Vapers who vaped in the last week

Age Profile of US Vapers who vaped in the last week

Source: Gallop 8

Age Profile of UK Vapers who vaped in the last week

Age Profile of UK Vapers who vaped in the last week

Source: ASH2

The graphs show clearly that in the US most vapers are young people whereas in the UK it is mainly middle aged people who use electronic cigarettes. The reason for the difference is the strong push in the UK by the authorities to promote vaping as a means of stopping smoking and restrictions on advertising and marketing of vaping.

Health risks exist for vaping and more research is on-going into this area. In the US the authorities make it clear that vaping is not harmless and can contain harmful and potentially harmful substances5.

% of US teenagers who reported any vaping during the last 30 days

graph showing % of US teenagers who reported any vaping during the last 30 days

Source: University of Michigan Monitoring the Future survey4 & 27

% of UK teenagers who reported any vaping during the last 30 days

graph showing % of UK teenagers who reported any vaping during the last 30 days 2021

Source: ASH2, 17

There has clearly been a rapid increase in the number of teens. The marketing aimed to encourage them to start vaping coupled with flavours that appeal to them has lead to this increase. Most teens are unaware that electronic cigarettes contain nicotine[9] or of the health dangers they pose. For more information about teen vaping click the button below:

Read more about Teen Vaping and How to Help Them to Quit

Final Thoughts

The number of people using E-cigarettes has grown dramatically over the last few years many unaware that the vaping liquid contains harmful chemicals including nicotine. The marketing makes it look sexy, fun and safe when the reality is that the products are addictive and can be damaging to health. A new generation is now becoming addicted to nicotine. You may be interested in these articles:

Vaping Around Kids – Is it safe?

Teen Vaping & How to Help Teens to Quit

Vaping While Pregnant – What are the risks?

Can Vaping Damage the Lungs?

References:

  1. Euromonitor international https://www.euromonitor.com/smokeless-tobacco-and-vapour-products and Estimation of the Global Number of Nicotine Vapers T. Jerzyński Warsaw University & G Stimson Imperial College doi.org/10.21203/rs.3.rs-480786/v1
  2. ASH Use of e-cigarettes (vaporisers) among adults and young people in Great Britain https://ash.org.uk/wp-content/uploads/2019/09/Use-of-e-cigarettes-among-adults-2019.pdf and https://ash.org.uk/wp-content/uploads/2021/02/YouthEcig2020.pdf
  3. Statista E-Cigarettes https://www.statista.com/outlook/50040000/100/e-cigarettes/worldwide#market-marketDriver
  4. The New England Journal of Medicine : Trends in Adolescent Vaping, 2017–2019 October 10, 2019 N Engl J Med 2019; 381:1490-1491 DOI: 10.1056/NEJMc1910739 https://www.nejm.org/doi/full/10.1056/NEJMc1910739
  5. Centres for Disease control and Prevention https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html
  6. Willett JG, Bennett M, Hair EC, et al Recognition, use and perceptions of JUUL among youth and young adults. Tobacco Control Published Online First: 18 April 2018. doi: 10.1136/tobaccocontrol-2018-054273
  7. US Department of Health and Human Services. E-cigarette Use Among Youth and Young Adults: A Report of the Surgeon Generalpdf icon[PDF – 8.47MB]. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. Accessed July 27, 2018. https://www.cdc.gov/tobacco/data_statistics/sgr/e-cigarettes/pdfs/2016_sgr_entire_report_508.pdf
  8. July 2018 Gallup poll https://news.gallup.com/poll/237818/young-people-adopt-vaping-smoking-rate-plummets.aspx
  9. Parental Awareness of Youth Tobacco Use and the Role of Household Tobacco Rules in Use Prevention Tsu-Shuan Wu and Benjamin W. Chaffee Pediatrics October 2020, e20194034; DOI: https://doi.org/10.1542/peds.2019-4034 
  10. NHS: Flavouring found in e-cigarettes linked to ‘popcorn lung’ https://www.nhs.uk/news/heart-and-lungs/flavouring-found-in-e-cigarettes-linked-to-popcorn-lung/
  11. Fuoco, F.C.; Buonanno, G.; Stabile, L.; Vigo, P., “Influential parameters on particle concentration and size distribution in the mainstream of e-cigarettes,” Environmental Pollution 184: 523-529, January 2014
  12. Grana, R; Benowitz, N; Glantz, S. “Background Paper on E-cigarettes,” Center for Tobacco Control Research and Education, University of California, San Francisco and WHO Collaborating Center on Tobacco Control. December 2013.
  13. Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS) World Health Organisation August 2016 https://www.who.int/fctc/cop/cop7/FCTC_COP_7_11_EN.pdf?ua=1&ua=1
  14. What Percentage of Americans Vape? Gallup https://news.gallup.com/poll/267413/percentage-americans-vape.aspx
  15. Wang TW, Neff LJ, Park-Lee E, et al. E-cigarette Use Among Middle and High School Students — United States, 2020. Morbidity and Mortality Weekly Report, 2020;69.
  16. Goniewicz ML, Gupta R, Lee YH, et al. Nicotine levels in electronic cigarette refill solutions: a comparative analysis of products from the United States, Korea, and Poland. Int J Drug Policy. 2015;26(6):583–588.
  17. ASH Use of e-cigarettes among young people in Great Britain ASH-Factsheet-Youth-E-cigarette-Use-2019 & Use-of-e-cigarettes-among-young-people-in-Great-Britain-2021
  18. National Academies of Science, Engineering and Medicine Public Health Consequences of E-Cigarettes Report – https://www.nap.edu/resource/24952/012318ecigaretteConclusionsbyEvidence.pdf
  19. Electronic cigarette sales in the United States, 2013-2017. King BA, Gammon DG, Marynak KL, Rogers T. 2018;320:1379–1380
  20. Pulmonary illness related to e-cigarette use in Illinois and Wisconsin – preliminary report. Layden JE, Ghinai I, Pray I, et al. N Engl J Med. 2019 
  21. CDC clinician outreach and communication activity. [Nov;2019 ];CDC Clinician outreach and communication activity, August 2019. Available at: https://emergency.cdc.gov/newsletters/coca/081619.htm (Accessed on August 21, 2019 2019. https://emergency.cdc.gov/newsletters/coca/081619.htm
  22. Vaping Associated Lung Injury (EVALI): An Explosive United States Epidemic G Salzman, M Alqawasma, H Asad Mo Med. 2019 Nov-Dec; 116(6): 492–496. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913849/#:~:text=As%20of%20November%205%2C%202019,deadly%20in%20the%20United%20States.
  23. Centres for Disease Control & Prevention – Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
  24. American Lung Association: The Inhalation of Harmful Chemicals Can Cause Irreversible Lung Damage and Lung Disease https://www.lung.org/quit-smoking/e-cigarettes-vaping/impact-of-e-cigarettes-on-lung
  25. Parental Awareness of Youth Tobacco Use and the Role of Household Tobacco Rules in Use Prevention Tsu-Shuan Wu and Benjamin W. Chaffee Pediatrics October 2020, e20194034; DOI: https://doi.org/10.1542/peds.2019-4034 
  26. Use of e-cigarettes (vapes) among adults in Great Britain ASH October 2020, https://ash.org.uk/wp-content/uploads/2020/10/Use-of-e-cigarettes-vapes-among-adults-in-Great-Britain-2020.pdf 
  27. University of Michigan Monitoring the Future vaping survey 2021 Richard Miech; Adam Leventhal; Lloyd Johnston Pediatrics October 2020, JAMA Pediatr. 2021;175(2):185-190; DOI: 10.1001/jamapediatrics.2020.5667 
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  33. Skotsimara G, Antonopoulos AS, Oikonomou E, Siasos G, Ioakeimidis N, Tsalamandris S et al. Cardiovascular effects of electronic cigarettes: a systematic review and metaanalysis. European Journal of Preventive Cardiology. 2019;26(11):1219–1228.
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