Vaping - understanding prevalence and trends among adults and children: research

Appendix

This appendix contains information on and links to the studies included in this document. The sources included are:

• The Smoking Toolkit Study
• The Scottish Health Survey
• Opinions and Lifestyle Survey
• ASH SmokeFree GB Survey
• Understanding Society
• Health Survey for England
• Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)
• Health and Wellbeing Census
• ASH Smokefree GB Youth Survey
• Growing Up in Scotland (GUS)
• Health Behaviour in School Aged Children (HBSC) (Scotland)
• The Student Health and Wellbeing Survey

Smoking Toolkit Study

The Smoking Toolkit Study (STS) is run by the Institute of Epidemiology & Health Care of UCL. It is funded by Cancer Research UK, the National Institute for Health and Care Research (NIHR) and the Society for the Study of Addiction (SSA).

STS consists of monthly cross-sectional household interviews of representative samples of UK adults aged 16+. Initially limited to England, the study expanded to include Scotland and Wales in October 2020. Approximately 1700 adults in England, 450 adults in Scotland and 300 adults in Wales complete the survey each month.

STS includes detailed questions on smoking and smoking cessation. Questions on vaping pertain to prevalence and dual use, but also characteristics and sources of e-cigarettes.

Current use is derived from answers to the following questions:^[14]

• Current smokers are asked:

1. Which, if any, of the following are you currently using to help you cut down the amount you smoke?

2. Do you regularly use any of these in situations when you are not allowed to smoke?

3. Can I check, are you using any of the following either to help you stop smoking, to help you cut down or for any other reason at all?

• Everyone else is asked:

1. Can I check, are you using any of the following at all for any reason?

If participants answer to one or several of these that they used e-cigarettes, they are considered current e-cigarette users.

This document makes reference to the tables 'Prevalence of e-cigarette and heated tobacco product use' and 'Proportion of daily-e-cigarette and NRT users who are smokers' which can be accessed on the Smoking Toolkit dashboard for Scotland, and those for England and Wales. Some of the data included in this report is unpublished and kindly provided by the STS team.

Scottish Health Survey

The Scottish Health Survey (SHeS) is a survey series commissioned by the Scottish Government Health Directorates. It has been carried out annually since 2008 and prior to this was carried out in 1995, 1998, and 2003.

SHeS has been designed to yield a representative sample of the general population living in private households in Scotland. Due to disruption to the survey at the onset of the pandemic, the survey data collected in 2020 was published as experimental statistics and is not comparable with the time series.

SHeS aims to provide regular information on aspects of the public's health, such as the occurrence of certain health conditions, the prevalence of certain risk factors, and differences between regions and subgroups of the population.

Questions on vaping included in the SHeS ask participants whether they have used e-cigarettes or vaping devices (now, ever or never) and, if so, how often. The survey also includes a question on dual use.

Reports and supplementary tables are accessible via the Scottish Government website.

This document makes reference to Chapter 7 of the SHeS 2021 (figure 7F – Current e-cigarette use by age and sex – and to the related supplementary tables – J69, 577, J70, J71, J89, 597, J90, J91, J26, J27).

The SHeS dashboard provides additional data, such as confidence limits. These can be obtained by clicking on the 'Trends' tab, selecting 'Smoking' as a topic, 'E-cigarette use' as an indicator, 'Currently using' as a category, 'Age'/'SIMD quintile'/'Equivalised income' as breakdown, and finally ticking the box for 'Show/hide 95% confidence limits'.

Opinions and Lifestyle Survey

The Opinions and Lifestyle Survey (OPN) is a currently fortnightly cross-sectional sample survey run by the Office for National Statistics. It provides data for the whole UK. The sample size is about 2000/2500 participants (aged 16 years and older) per period.

OPN covers a range of topics relating to health, including Covid-19, cost of living and shortage of goods.

The survey asks questions on vaping. Before March 2020, respondents were asked whether they currently used an e-cigarette or vape. This included both "daily" and "occasional" use. In March 2020 the survey question changed to ask respondents about frequency. To compare current users with previous years, figures have been summed for daily and occasional users.

This document makes reference to the December 2021 report (Figure 6 on the Proportion of current vapers between 2014 and 2020), the December 2022 report and the datasets on e-cigarette use in Great Britain (tables 1a: 2020 to 2021, 1c: 2014 to 2017 and 2a: 2020 to 2021).

ASH SmokeFree GB survey

The ASH Smokefree GB Survey is an annual representative survey of UK adults aged 18 and over. The survey is carried out online by YouGov and is commissioned by Action on Smoking and Health (ASH) and funded by a combination of the British Heart Foundation, Cancer Research UK and the Department of Health and Social Care.

In 2010, the survey started including questions on e-cigarette. Questions on vaping ask participants about awareness of e-cigarettes, use and frequency, attitudes towards vaping, dual use, and main source and type of product used.

Sample size varies by year but is around 12,000 (13,088 in 2022).

This document makes reference to the 2022 report (Table 1: Number of e-cigarette users in Great Britain from 2012 to 2022, Figure 1: Smoking status among current adult e-cigarette users in Great Britain 2013-2022 and Figure 2: E-cigarette use among current adult cigarette smokers in Great Britain 2013-2022).

Understanding Society

Understanding Society is the UK Household Longitudinal Study which offers a long-term perspective on how life in the UK is changing over time. It started in 2009 and interviewed around 40,000 households on: family life; income, wealth and expenditure; education and employment; civic participation; health, wellbeing and health behaviours.

Understanding Society has a large sample of around 10,000 people for each birth cohort per decade from the 1940s onwards, and approximately 17,000 children who have been born into the Study since the year 2000. It includes an Ethnic Minority Boost sample and an Immigrant and Ethnic Minority Boost sample.

Parents or care-givers included in the sample can answer questions about children in the household who are up to age 10. Children aged 10-15 have their own questionnaire with questions formulated for their age group.

Understanding Society is one of the most stable longitudinal studies in the world. The study follows sample household members as they move to new households and form new families. In the last wave of data collection over 95% of participants who participated in the previous wave continued to take part in the survey.

The survey asks participants about vaping and frequency.

This document makes reference to the data tables for adults and data tables for youth on e-cigarette use. Some inclusions in this document are not published and were kindly provided by the Understanding Society survey team.

Health Survey for England

The Health Survey for England (HSE) is a series of annual surveys that monitor trends in health and care. Each survey in the series includes core questions, with modules of questions on specific issues that vary from year to year.

The HSE started in 1991 and covers the adult population aged 16+ living in private households. Since 1995, children aged 2 to 15 have been included, and from 2001 infants aged under 2. In some years, the core sample has been augmented by a boosted sample from a specific population subgroup, such as minority ethnic groups, older people or children.

The current questions about e-cigarette use were asked between 2016 and 2021. Participants were asked whether they had 'ever used an electronic cigarette or any other vaping device'. Interviewers offered further clarification if necessary. Those who indicated ever use were asked whether they used e-cigarettes or vaping devices at all nowadays.

This document makes reference to the 2021 report (Table 7: Prevalence of current e-cigarette use by age and sex, and Table 8: E-cigarette use by cigarette smoking status) and to the associated adults' health related behaviours tables (tables 7, 8 and 9).

Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS)

The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) is part of a long-established series of national surveys on substance use. These were carried out jointly in Scotland and England between 1982 and 2000. Since 2002, Scotland developed its own, more tailored survey, which ran approximately every two years until 2018.

SALSUS involved secondary school pupils in Scotland (S2 around age 13 and S4 around age 15) in Local Authority and independent schools. The sample size varied (21,559 eligible pupils participated in 2018). Local level results (Health Board, Local Authority, and Alcohol and Drug Partnership) are available for every second survey, i.e. every 4 years.

Together with other lifestyle-related matters, SALSUS asked about smoking, drinking and drug use, and included questions on e-cigarettes use and frequency.

This document makes reference to the 2018 report (Figure 2.10: E-cigarette use among 13 year olds by smoking status and year 2015-2018, and Figure 2.11: E-cigarette use among 15 year olds by smoking status and year 2015-18).

Data are derived from the following question:^[15]

Now read the following statements carefully and cross the box next to the one which best describes you:

• I have never used an e-cigarette
• I used to use e-cigarettes but don't use them anymore
• I have tried an e-cigarette once
• I have tried e-cigarettes a few times
• I use e-cigarettes sometimes, but no more than once a month
• I use e-cigarettes once a week or more

Health and Wellbeing Census

The Health and Wellbeing Census has been undertaken for the first time by Local Authorities in Scotland between October 2021 and June 2022. It aims to provide local and national information on children and young people's health and wellbeing, including attitudes to school and aspirations, neighbourhood and life at home, physical and mental health, experience of bullying, substance use and relationships and sexual health.

Findings from the Census are experimental statistics which are undergoing development. The results are not weighted to be nationally representative.

In 2021/22, 16 of the 32 Local Authorities took part in the Census, with an overall response rate of 58.3%. This decreased with stages (especially for S4-S6). Response rate was 61% for S2 pupils (16,688 responses) and 45.3% for S4 pupils (11,738 responses).

S2 and S4 pupils were asked about vaping and frequency in the main survey through the following question:

How often do you use e-cigarettes / vapes at present?

• Every day
• At least once a week, but not every day
• Less than once a week
• I do not use e-cigarettes / vapes
• Prefer not to say

ASH SmokeFree GB Youth Survey

The ASH Smokefree GB Youth Survey is an annual survey of a representative sample of 11-18 year olds in Great Britain which has been running since 2013. The survey is carried out online by YouGov and is commissioned by Action on Smoking and Health (ASH) and funded by a combination of the British Heart Foundation, Cancer Research UK and the Department of Health and Social Care.

Since 2021, the analysis in the factsheet focuses on 11-17 year olds to present a clearer picture of underage use.

Questions on vaping ask participants about awareness of e-cigarettes, use and frequency, attitudes towards vaping, dual use, and main source and type of product used.

This document makes reference to the 2022 report and the following figures:

1. Use of e-cigarettes by GB youth 2013-2022

2. Level of use of e-cigarettes GB youth 2014-2022

3. Use of e-cigarettes by tobacco smoking status GB youth 2022

4. Ever use of e-cigarettes by age GB youth 2013-2022

5. Current use of e-cigarettes by age GB youth 2013-2022

6. Order of use between tobacco cigarettes and e-cigarettes, GB youth who had tried an e-cigarette 2014-2022

7. Ever use of cigarettes and e-cigarettes over time GB youth 2013-2022.

Growing Up in Scotland

Growing Up in Scotland (GUS) is a longitudinal study following the lives of young people in Scotland from their early years and childhood, into adolescence and beyond. The study is funded by the Scottish Government and carried out by ScotCen Social Research.

GUS uses data collected from Birth Cohort 1 (BC1), a nationally representative sample of 5217 children living in Scotland when they were 10 months old and who were born between June 2004 and May 2005.

Two reports have been published. The first report, Growing up in Scotland: life at age 12, draws on data collected from 3419 families in 2017/18 when the children were aged 12. The second report, Life at age 14: initial findings from the Growing Up in Scotland study, is based on data collected from 2,943 families in 2019/20, when participants were aged 14. Both reports present data on vaping.

This document makes reference to these publications (including the graph on Proportion of children who ever tried alcohol, a cigarette or an e-cigarette by gender in the report Growing up in Scotland: life at age 12, and Figure 34 on Whether young people had tried smoking, drinking alcohol or drugs in the report Life at age 14: initial findings from the Growing Up in Scotland study).

Health Behaviour in School-aged Children (HBSC) Study (Scotland)

The Scottish Health Behaviour in School-aged Children (HBSC) study is part of a larger cross-national study investigating the health and wellbeing of school children and the social contexts in which they are growing up. This is a collaboration with the World Health Organisation (WHO) covering 44 countries in Europe and North America.

The Scottish HBSC is carried out by the Child and Adolescent Health Research Unit at the University of St Andrews and is funded by Public Health Scotland (PHS). Data collection started in 2014.

The survey is conducted every four years. The sample for each country consists of around 1500-2000 participants aged 11, 13 and 15.

The HBSC survey covers a wide range of health and social topics about physical activity, eating and dieting, oral health, smoking, alcohol consumption, self-reported health and symptoms, and more. The latest survey for school year 2017/18 asked about use of vapes in the previous 30 days.

This document makes reference to the 2018 publication, including Figure 12.5: Ever used e-cigarette and Figure 12.6: Used e-cigarette in past month.

Student Health and Wellbeing Survey

The Student Health and Wellbeing Survey is run by the School Health Research Network (SHRN). It collects data on 11 to 16 year olds' health behaviours in participating schools in Wales.

The survey is undertaken every two years and evolves at each iteration, with core items retained and others removed or reinstated in line with policy needs and research interests.

In 2019/20 the sample size was just under 120,000 pupils. The survey asked participants whether they had ever tried e-cigarettes and frequency of use.

This document makes reference to the 2021 publication and Figures:

8.14: Percentage who have ever tried e-cigarettes by year group and family affluence

8.15: Percentage who have ever tried e-cigarettes by year group and gender

8.18: Percentage who use e-cigarettes at least weekly by year group and family affluence

8.19: Percentage who use e-cigarettes at least weekly by year group and gender.