Rise in vapers using high-strength nicotine products

CIEH panel expert says more research around the impact of vaping on health is essential “to develop a public health intervention strategy…”

Almost a third of vapers (32.5%) used high-strength e-liquids containing 20 mg/ml of nicotine or more in January 2024, a jump from 3.8% on average between July 2016 and June 2021, a UCL study has found.

The biggest increase was among 18–24-year-olds (3.9% to 53.1%) and vapers using mainly disposable e-cigarettes (2.6% to 49%), although rises were seen in older age groups, current smokers and recent ex-smokers. The fraction of vapers using disposables and pod devices unsure about the strength of their nicotine-containing e-liquid has also increased.

Researchers examined how the use of nicotine strengths has changed using survey responses from 7,314 adult vapers in England between 2016 and 2024, plus data from Wales and Scotland between 2022 and 2024.

“Our study shows a sharp increase in the use of high-strength nicotine e-liquids in England since 2021,” said Dr Sarah Jackson, Principal Research Fellow in Behavioural Science and Health, UCL. “Nicotine may be addictive but it is not what causes the great majority of harms from smoking. For smokers trying to quit, vaping with higher-strength nicotine is likely to be more effective, as it satisfies cravings more quickly and provides better relief from withdrawal symptoms.”

Dr Lucy Webb, Reader, School of Nursing & Public Health at Manchester Metropolitan University said: “The study findings indicate that it is young people who are most likely to be using stronger nicotine…they were the population group least likely to be aware of the strength of their vapes. The evidence also suggests that those using disposable vapes are being exposed to higher nicotine content.”

Vapes are considered less harmful than cigarettes and are useful for reducing smoking, Webb continued: “However, while there is no clear evidence of the direct physical harm of the pure nicotine in vapes, it is an addictive substance and therefore changes behaviour.”

Kal Ifegwu, CIEH Public Health Advisory Panel Member said, “The main reasons for vaping among young people who have never smoked or only tried smoking were to “give it a try” (48.8%, 2021 ASH-Y), and “liking the flavours” (37.2%, ITC Youth). There is a lack of research among people who vape and have never smoked to determine long term changes in biomarkers of potential harm and clinically relevant predictors of disease. This is essential to develop a public health intervention strategy with a regulatory framework for enforcement.”

In the spring budget, the government proposed a ban on disposable vapes and announced a Vaping Products Duty from October 2026, with three categories of tax on e-liquid depending on its strength.

“...smokers should not be discouraged from using higher nicotine content vapes, which are likely to be more effective quitting aids.”

Researchers argue this could undermine smokers’ attempts to quit and “may result in people using a lower, cheaper strength and vaping more, as a person with nicotine dependence will alter their behaviour to get the required nicotine dose,” said Dr Sharon Cox, Principal Research Fellow in Behavioural Science and Health, UCL. “It therefore may increase the amount of liquid used and vapers’ exposure to potential toxicants.”

Co-author Deborah Arnott, CEO of Action on Smoking and Health said: “If we are to also ensure that vapes remain an effective quitting tool for adults, smokers should not be discouraged from using higher nicotine content vapes, which are likely to be more effective quitting aids.”