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04 March 2020

New report by King's researchers on vaping in England to inform national policy

The latest Public Health England (PHE) report on vaping, led by researchers from King’s College London, is published today.

Vaping is less harmful than smoking and could play a crucial role in helping people quit.

The report reviews the latest evidence on vaping and smoking among adults and young people in England with a focus on two important sub-groups: smokers with mental health conditions and pregnant women.

Despite the fact that smoking prevalence in England has declined to around 15% of adults, it remains the largest single cause of death and disease in England and is a major driver of health inequalities because smoking is more common among vulnerable and disadvantaged groups. Vaping is less harmful than smoking and could play a crucial role in helping people quit.  

Over the last five years there has been little increase in vaping and the prevalence has remained at between 5% and 7% in adults. 

It is now clear that the deaths and lung injuries in the US in the last year were attributable to vaping tetrahydrocannabinol (THC) oil cut with vitamin E acetate. Both THC and vitamin E acetate are banned in nicotine vaping products in England. Since 2011 there have been a handful of deaths in the UK potentially associated with vaping, but the connection with nicotine containing vaping products has not been established. Compared to the US, nicotine vaping products are regulated very differently in England.

It is no surprise that smokers are confused about the relative risks of smoking and vaping. Indeed, nearly four out of ten adult smokers have not tried vaping, and the majority of these thought vaping was equally or more harmful than regular cigarettes and are therefore unlikely to try vaping. A lot of work remains to be done to correct these misperceptions.

Professor Ann McNeill from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and co-author of the report

Professor Ann McNeill from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and co-author of the report commented: ‘The exact causes of the few deaths in England are still being investigated and understanding any possible role that vaping played in these is vitally important. However, what has not been reported is that over the same time period, since 2011, there have been over 700 thousand deaths from smoking in England..’

Young people and vaping

Around 6 % of 11 to 15 year olds reported that they were currently vaping, which includes occasional vaping i.e. less than once a week. With little change in this figure over the last few years, there are no signs of the ’epidemic’ in youth vaping that has been reported in the US. The majority of regular young vapers were given their vaping products, mostly by friends, but just over a quarter were buying their products from shops, and a similar proportion from the internet.

Current smoking among 11 to 15 year olds is at a record low, at 5%, having halved over the last 10 years. Experimentation with vaping was strongly associated with experience of smoking, and less than 1% of those who had never smoked reported being regular vapers. Subsequent reports will focus on vaping, stopping smoking and the health effects of vaping in young people.

At the moment the UK strategy to minimise the attractiveness of these products to young people appears to be working. Nevertheless, more could be done to prevent children buying cigarettes and vapes.

Dr Robert Calder from the IoPPN and report co-author

The report aimed to summarise research findings on vaping among smokers with mental health conditions and among pregnant women to better understand the uptake of vaping in these groups and its impact on smoking.

Smoking, vaping and mental health conditions

Smoking rates are much higher among those with mental health conditions and vaping could be particularly important at driving their high levels of smoking down. Whilst more research is needed, studies so far show vaping has helped some smokers with mental health conditions to stop or reduce their cigarette intake. However, health professionals working with this group seem ambivalent about the merits of vaping.

Health professionals could do more to support smokers with mental health conditions to quit, as smoking is one of the main causes of their early death and poor health. We don’t yet have any definitive trials of vaping among those with mental illness, but preliminary studies have indicated that vaping has the potential to help this group reduce the harm from smoking tobacco.

Dr Debbie Robson from the IoPPN and report co-author stated

Pregnancy and smoking

Smoking during pregnancy varies greatly, depending on location: the likelihood that a pregnant woman will smoke is 13 times higher if they live in a deprived area. Given the known negative impacts of smoking on birth outcomes and the health of child and mother, it is important to study the impact of vaping on this group.

However, there were no studies  from England on the prevalence of vaping in pregnancy or its impact, although research did indicate that the reasons pregnant women in England vaped were to stop smoking or prevent a return to smoking and to reduce harm to themselves, their baby and others.


Our review found little evidence on the prevalence of vaping among pregnant women or on its effects on smoking or babies’ health, although we are aware such studies are in the pipeline. In the meantime we need to ensure that pregnant smokers, who are very likely to come from vulnerable and disadvantaged groups, have access to the full range of tools to help them to stop smoking.

Dr Leonie Brose from the IoPPN and report co-author


Reference: McNeill, A., Brose, L.S., Calder, R., Bauld, L., and Robson, D. (2020). Vaping in England: an evidence update including mental health and pregnancy, March 2020: a report commissioned by Public Health England. London: Public Health England

In this story

Ann McNeill

Professor of Tobacco Addiction

Debbie  Robson

Senior Lecturer in Tobacco Harm Reduction

Leonie Brose

Reader in Addiction Education and Nicotine Research