The UK Government uses the Annual Population Survey (APS) as its official smoking estimate.

APS only captures cigarette smoking and may miss some non-daily use. Our findings suggest that relying solely on APS data could overstate reductions in smoking.

Although smoking prevalence is now similar across regions of GB, there is variation in cigarette consumption among adults who smoke.

Mean cigarettes smoked/day and % smoking >20/day:
🟡Highest in North East and Scotland
🟡Lowest in London and South West

academic.oup.com/ntr/advance-...

Likewise, the spike in e-cig use did not lead to a sustained increase in the population burden of nicotine dependence, which is now at a historically low level.

However, dependence symptoms increased over time among those only using e-cigs.

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Our results show no evidence of a gateway effect from vaping to smoking at the population level: despite a sharp rise in e-cigarette use in 2019, use of cigarettes and other combustible tobacco products continued to fall and in 2023 were lower than ever.

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While dependence symptoms were consistently highest among cigarette users, they were increasingly prevalent among those using only e-cigarettes after 2017.

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The overall burden of nicotine dependence was substantially lower, but showed a similar pattern, with a peak in 2019 and a notable reduction by 2023.

Even when we re-estimated dependence to account for potential underreporting by students using e-cigs only.

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Our new analysis, using NYTS data up to 2023, shows the proportion of high-school students using any nicotine product in the past 30 days peaked at 31.4% in 2019 and has since fallen steeply to a record low of 12.5% in 2023.

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This raises questions as to what has happened to the population burden of nicotine dependence among young people, in the context of decreased prevalence of vaping, but potentially increased dependence among those who vape.

Since 2019, the vaping landscape has changed.

Vaping prevalence among young people has fallen substantially.

But newer products using nicotine salts e-liquids deliver nicotine more efficiently, potentially leading to increased dependence among the remaining pool of vapers.

In a previous study that analysed NYTS data up to 2019, we found increases in vaping among US high-school students did not appear to have been accompanied by a similar increase in the population burden of nicotine dependence.

onlinelibrary.wiley.com/doi/10.1111/...