Changes in the use of e-cigarettes to stop smoking among adults following the rise of disposable vapes: a repeat cross-sectional survey 2016–2023 in England

Introduction: Using a representative repeat cross-sectional survey, we investigate how the prevalence of e-cigarette ('vape') use, prescription or specialist support and other (non-prescription or specialist support) methods in smoking quit attempts changed following growth in novel disposable vape use in England. Methods: 8323 adults (≥18 years; 47.5% women; mean (SD) age: 39.2 (15.5)) who smoked-and tried to quit-in the past year, were surveyed between July 2016 and December 2023. Using segmented regressions, we estimated annual trends in smoking quit attempts using (1) a vape, (2) prescription or specialist support and (3) other methods before ('pre-disposables') and after June 2021 ('post-disposables'). In a sensitivity analysis, we modelled changes in each outcome associated with the prevalence of disposable vaping as a continuous variable. Results: During the pre-disposables period, vape use in a quit attempt decreased by 3.1% per year (relative risk (RR)=0.969 (95% CI 0.927 to 1.012)). This trend reversed when disposables became popular (RR=1.20 (95% CI 1.12 to 1.29)), with a relative year-on-year increase in prevalence of 16.5% from June 2021 (from 27.7% in June 2021 to 40.6% in December 2023). Conversely, use of other (non-prescription or specialist support) methods increased by 3.6% per year (RR=1.036 (95% CI 1.01 to 1.06)) before June 2021, before reversing (RR=0.91 (95% CI 0.88 to 0.95)) into a relative yearly decline in prevalence of 5.6% (from 65.4% to 56.6%). Use of prescription/specialist support declined by 12% per year (RR=0.880 (95% CI 0.802 to 0.966)) before June 2021, and there was no apparent change in trend. In aggregate models, for each percentage-point increase in disposable vaping, vape use in a quit attempt (in the subsequent month) rose by ~0.66 percentage points (95% CI 0.05 to 1.26), while use of other methods declined by 0.82 percentage points (95% CI -1.40 to -0.24). Conclusions: Increasing use of disposable vapes in England was associated with increased vape use and decreased use of other (non-prescription or specialist support) methods in smoking quit attempts.