Non-smokers shunning e-cigarettes

Behind the Headlines

Monday April 28 2014

E-cigarettes is currently largely a self-regulated industry

There are now over 2 million ‘vapers’ in the UK

“E-cigarette users have tripled to 2 million since 2012,” The Guardian reports. This is just one of the findings from a survey by anti-tobacco public health charity Action on Smoking and Health (ASH). It also showed there is little evidence that non-smokers are using e-cigarettes, although this could change in the future.

These headlines are triggered by a new factsheet on the usage of electronic cigarettes (e-cigarettes) published by ASH.

The research has found that non-smokers are not taking up the e-cig habit, although it is too early to be complacent. The data only spans the 2010 to 2014 period, meaning that longer-term smoking trends are unknown. As e-cigarettes are a relatively modern phenomenon, it is impossible to predict with any certainty what long-term effects they may have on smoking habits.


E-cigarettes – the new fashion accessory?

There is increasing evidence that e-cigarettes are being marketed as a fashion accessory. If you live in London, you may have noticed buses plastered with advertisements saying that “Smoking is so last season”.


This is concerning, as such marketing could lead young people, especially young women, to take up the habit.


It also suggests that the current position of e-cigarettes not being a gateway to nicotine addiction could quickly change.

Who are ASH?

Action on Smoking and Health (ASH) was established in 1971 by the Royal College of Physicians. It is a campaigning public health charity that works to eliminate the harm caused by tobacco.

ASH produces a variety of published material for companies and governments, as well as bulletins and newsletters.

Today’s publication on e-cigarettes coincides with the day the Advertising Standards Authority (ASA) consultation on the advertising of electronic cigarettes closes.

The consultation concerned proposals to introduce new rules for the advertising of e-cigarettes, including measures to protect young people, address concerns over the indirect promotion of tobacco products via e-cigarettes and prohibiting health or medical claims. 


Is nicotine safe?

No. It is certainly safer than most substances found in cigarettes, many of which are known to cause cancer. Also, for nicotine to have a poisonous effect on the body, you would need to ingest substantial amounts; you would probably need to plaster your body with nicotine patches before significant poisoning occurred.


However, this does not mean it is safe. Even small doses of nicotine can cause an increase in blood pressure, which can be dangerous, especially in people that already have pre-existing conditions.


The most important factor is that nicotine is highly addictive. The difference between e-cigarettes and traditional nicotine replacement therapies (NRTs), such as patches and gums, is that there is no exit-strategy for e-cigarettes.


A course of NRT is designed to wean you off nicotine forever, by reducing the dosage. No such option is available for e-cigarettes – claims that manufactures are selling the products for altruistic reasons are debatable.

Why was the survey commissioned?

ASH has commissioned a series of surveys to monitor e-cigarette use in adults in recent years (2010, 2012 and 2013). In March 2013, an additional survey of children aged 11 to 18 was conducted. Using these findings and applying them to the most recent population data, ASH estimated the prevalence of electronic cigarette usage in Great Britain. These findings are summarised in their newly-released factsheet.

Each adult survey (2010, 2012 and 2013) recruited around 12,00 adults aged over 18, whereas the March 2013 survey recruited just over 2,000 children aged 11 to 18.

The aim of the surveys and factsheet was to assess use of, and attitudes towards, e-cigarettes among smokers, non-smokers and ex-smokers.


What are the main findings?

Some of the more headline-grabbing findings included:

  • ASH estimated 2.1 million adults in the UK currently use electronic cigarettes.
  • About one third of users are ex-smokers and two-thirds are current smokers.
  • The number of current smokers who had tried e-cigarettes rose dramatically, from 8.2% in 2010 to 51.7% in 2014. Current use of e-cigarettes among adult smokers rose from 2.7% to 17.7% over the same period.
  • The main reason given by current smokers for using the products was to reduce the amount they smoke. Ex-smokers reported using e-cigarettes to help them stop smoking altogether.
  • Regular use of e-cigarettes amongst children and young people was reported to be rare and was confined almost entirely to those who currently or had previously smoked.
  • Just over a third (35%) of British adults believed e-cigarettes were good for public health, while around a quarter (22%) disagreed.
  • The survey conducted in 2014 found that e-cigarette use amongst never smokers remains “negligible”. Only 1.1% of people who had never smoked had ever tried e-cigarettes, and virtually none continue to use them.


Are there any uncertainties or safety concerns around e-cigarettes?

E-cigarettes are a relatively new technology and are not subject to the same regulations as tobacco smoking. There is still a debate surrounding whether they are helpful or harmful overall, and how they should be regulated in the future in the absence of any definitive evidence.

Some argue the devices may be an effective way for current smokers to reduce their exposure to the harmful effects of tobacco smoking while still satisfying their nicotine addiction, potentially helping them to reduce tobacco smoking or quit altogether.

Others are concerned that the product may act as a “gateway device” – enticing non-smokers into the world of nicotine addiction and potentially increasing their chances of trying tobacco smoking later on.

In the past, there have been reports that the nicotine vapour alone might be harmful, but this specific example was inconclusive.

There are additional concerns that the widespread use of e-cigarettes may re-normalise smoking and that this may, in turn, increase the uptake of tobacco smoking in young people, which has been declining steadily alongside the increasing stigmatisation of smoking.

From 2016, e-cigarettes will be regulated as aids to quit smoking, meaning they will be subject to tighter controls, to ensure the products are safe and effective.

Analysis by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

Links to the headlines

E-cigarette users have tripled to 2 million since 2012, study finds. The Guardian, April 28 2014

Two million now puff on e-cigarettes: Number using devices trebles in two years. Daily Mail, April 28 2014

E-cigarette users in UK have 'tripled' since 2010. BBC News, April 28 2014

E-cigs ‘cleared of being route into smoking’. Metro, April 27 2014

E-cigarette use 'has tripled in two years'. ITV News, April 28 2014

Further reading

Action on Smoking and Health. Use of electronic cigarettes in Great Britain (PDF, 4.2Mb). April 2014

Action on Smoking and Health. Electronic cigarettes (PDF, 2.4Mb). March 2014


How helpful is this page?

Average rating

Based on 12 ratings

All ratings

4  ratings
0  ratings
0  ratings
0  ratings
8  ratings

Add your rating

What is Behind the Headlines?

What is Behind the Headlines?

We give you the facts without the fiction. Professor Sir Muir Gray, founder of Behind the Headlines, explains more...

Follow us on Twitter

Join more than 160,000 who follow @NHSChoices for the latest and best health news and lifestyle advice

Call to make 5 a day fruit and veg into '7 a day'

Recent research suggests that eating seven portions of fruit and vegetables is associated with a lower risk of dying from heart disease and cancer. Should we all be eating more?

News analysis: E-cigs to be regulated

E-cigarettes are to be regulated as a quit-smoking aid from 2016. But are they safe, and do they work?

Stop smoking

Help with quitting, including what your GP can do, local services and nicotine replacement therapies