Smoking used to be everywhere. The first time I went to the pub – more years ago than I would like to admit – it was a decidedly smoky experience. It seemed like basically everybody at the pub smoked as they drank, to a level that youngsters today would probably find quite shocking.
I quickly found myself among them, holding court on some nonsense topic over a student-priced beer and loosely holding a cigarette as if I was some world-weary story-teller. But soon, things started to change.
First, in 2007, smoking indoors was banned. But then over the next few years, e-cigarettes slowly came onto the scene, and I ended up switching a couple of years after that. The smokers huddled outside despite the typically British weather, while the increasing number of vapers (usually) got to stay inside.
In 2020, this combination has led to a wildly different landscape. If you’re lucky with your local, the vapers will still be allowed indoors, but regardless of house rules, you’ll undoubtedly notice a lot more vapers than there used to be. Meanwhile, the number of smokers is noticeably dwindling.
Seeing the rise of vaping and the apparent displacement of smoking makes you think: will smoking soon be a thing of the past? Is vaping actually killing smoking for good?
In fact, many vaping and tobacco harm reduction advocates insist that you can see it already. As vaping becomes more popular in specific countries, the number of smokers plummets, and it’s kind of easy to see why this would be.
But is this really the case? Can you actually see the impact of vaping on a country’s smoking rate? Or is the relationship a little more complicated than it might seem at first?
We’ve taken a look at the data to try to get to the bottom of what’s going on.
Why it’s Hard to “See” the Impact of Vaping
Before getting into any of the details, it’s important to realise that you can’t just look at a graph of smoking rates, point to a decline as vaping increases and declare success. Countries take a wide range of approaches to reducing the smoking rate, including increasing taxes (as British smokers will be all too familiar with), banning smoking in public places, slapping big warnings and garish images on packs and much more. There has also been a general decline in smoking across much of the world because people know that smoking kills a lot of people.
So if you pick a year that vaping became a “thing” in a specific country, and look at either side of this point on the graph, you won’t really be able to spot anything. Before the point and after the point will show a decline, and no matter how much you try to squint to see an increase in the speed of the decline it won’t really be apparent.
This makes it seem like this is a fools’ errand. But even if you can’t definitively say a specific collection of data “proves” vaping is the thing bringing about the decline in smoking (or even the main thing), there are ways you can narrow down the range of possibilities.
For example, if vaping is more common in young adults than older adults, and then smoking declines more in younger adults, while it doesn’t prove that vaping is responsible, it does make the argument a little stronger. Likewise, if the rate of successful quitting increases when vaping comes onto the scene, it doesn’t discount the impact of other approaches, but it does provide a strong hint that vaping is having an impact.
In short, it’s important to remember that you can’t look at the graph and squint your eyes a bit and declare that vaping is increasing quitting smoking. But with enough data pointing in the same direction, ignoring the most probable conclusion is kind of stupid.
Smoking Rates vs. Vaping Around the World
Before digging down into some parts in more detail, it makes sense to look at the picture of the decline in smoking overall. Of course, this doesn’t include every country in the world – and honestly the choice of countries was a little arbitrary – but it does include places with bans or de facto bans (India, Mexico, Australia and Brazil), more vaping-friendly places like the UK, Germany and France, and places like Sweden and Japan where other forms of harm reduction are popular.
The first thing you’ll notice is that the countries where vaping is banned do have very low smoking rates. Mexico’s, for example, is the lowest out of all the included countries with just 7.6 percent being daily smokers in 2017. Sweden and Brazil are tied for second at 10.1 percent smoking, despite their different approaches to tobacco harm reduction overall. Based on this data (taken from the OECD website but collected from various national surveys), the US is in a better position that India and Australia, but they’re among the countries with the fewest smokers.
However, it’s also worth pointing out that they already had low smoking rates around the turn of the millennium when the modern e-cig didn’t even exist yet. So it isn’t likely that the decision to ban vaping has anything to do with their success.
And as you might expect by this point, the smoking rates for all countries (apart from Greece) are going down. There’s an interesting turning point for Russia in 2009 (and vaping is relatively popular there, too), but generally speaking the trend for all of them seems to have been running for long before vaping came onto the scene.
However, while comparisons like this are kind of useful for an overview, there is no way to know the “counterfactual,” i.e. what would have happened if a country had a different attitude to vaping. You can make comparisons between countries, but ultimately it’s difficult to conclude too much from data like this alone.
Is Smoking Declining Faster than Usual?
So the assumption that just looking at the decline in smoking in some places wouldn’t be too informative is right. It makes it pretty unlikely that vaping is making the situation any worse, but it’s definitely not enough to say its making anything better either.
However, if vaping is helping bring down smoking rates beyond what we’d have expected otherwise, some more detailed analysis might reveal a difference. In particular, looking at country-specific figures, is the decline in smoking faster in recent years than it has been previously?
Based on evidence from the UK and US, it appears that this is happening, but not to a huge degree. For example, when vaping existed in the UK but was much less popular, between 2010 and 2014, regular smoking declined from 20 to 18.1 percent of the population.
From 2014 to 2019, as the percentage of Brits vaping daily increased from 3.7 to 5.7 percent, the number of smokers declined from 18.1 percent to 14.1 percent. This suggests an increase in the rate of the decline of smoking, although it’s still difficult to tie the change directly to vaping.
The picture in the US is much the same. From 2004 to 2008, when essentially nobody in the US vaped, the percentage of smokers declined from 20.9 to 20.6 percent, basically staying the same. From 2009 to 2013, when there will have been the first stirrings of vaping in the US, the smoking rate declined from 20.6 to 17.8 percent. In 2014, the rate of current vaping was 3.7 percent, and this actually decreased to 3.2 percent by 2018. Over this same period, the smoking rate declined from 16.8 to 13.7 percent of the population.
In this case, things are even less clear. The decline in vaping in the most recent years makes it especially difficult to draw any conclusions. The fact that many people have used vaping as a stepping stone to quit nicotine entirely - 2.2 million in the UK alone - also complicates matters.
However, there are other indications of a link between increasing vaping and decreasing smoking.
Does the Age of Quitters Match the Age of Vapers?
The overarching statistics presented so far don’t really paint that clear of a picture. But things get a little more interesting when you break down how smoking rates change with the rise of vaping by age. Because of limitations on the available data, we’re going to continue to focus on the US and UK here.
In the UK, between 2014 and 2019, the biggest increase in vaping was in the 16 to 24 age group, where the number of daily vapers more than doubled. Correspondingly, adults under 24 saw the biggest relative decrease in smoking over the same time period. The challenge with the UK data, though, is that the age groupings are slightly different, so direct comparison isn’t easy.
To address this, the data has been combined so it looks at under 35s and those aged 35 and over (the estimate for the smoking statistics is a little rougher but the figures for the vapers work out similarly using either approach). For under 35s, vaping rates went from around 3.6 percent to 6.6 percent, while smoking rates declined from 23.8 percent to 17.5 percent. For the older group, vaping increased from 3.7 to 5.4 percent, while smoking declined from 16.4 to 13.3 percent.
In short, the rate of vaping in under 35s rose by 3 percentage points, compared to 1.7 for over 35s, and smoking decreased by 6.3 percentage points vs. a 3.2 percentage point decline for over 35s. The rise in vaping was bigger for younger adults and the decline in smoking was bigger too, almost twice as much in both cases. This is a much clearer sign that the drops in smoking correlate with the rise in vaping.
In the US, the comparison is a little easier to make because the ages for both surveys match up perfectly and the result is ultimately the same.
The only age group where vaping increased between 2014 and 2018 was 18 to 24 year olds, where it increased from 5.1 to 7.6 percent. There were small declines in vaping for 25 to 44 year olds and those aged 65 and over, and a drop from 3.5 to 2.1 percent for 45 to 64 year olds. The declines in smoking over the same time period were bigger for younger groups and smaller for older groups.
This doesn’t perfectly match up to the rises in vaping, but it’s very telling that the only group where vaping increased saw a huge decline in smoking from 16.7 to 7.8 percent, while all other groups saw much smaller decreases.
How Do Changes in Vaping Policy Affect Smoking Rates?
Another important source of data regarding the impact of vaping on smoking is what happens when there is a change in the policy or environment surrounding vaping. If vaping is made less appealing by increasing the price or removing flavours, can you see this in the smoking rate? And what happens when the attitude towards vaping moves in the other direction and a country takes a more relaxed approach?
Taxes and Flavour Bans in the US
Some of the best evidence on this point comes from the impact of e-cigarette taxes in the US. Although this obviously isn’t the same as a ban on nicotine-containing e-cigs, it still fills out the picture of the link between vaping and smoking.
One example study looked at the impact of Minnesota’s vaping tax, at 95 percent of the wholesale price. The researchers did this by comparing what happened in Minnesota following the tax increase to what happened in “control” states without such large taxes. The tax came into force in 2013 and the study used data up to 2015. The results show that the tax led to more smoking and less quitting, relative to the control states. The researchers estimate that 32,400 additional smokers would have quit had the tax not been implemented.
Another study looked at the impact of cigarette taxes on vaping rates and vice-versa. This argues that the two products are “economic substitutes,” in that higher cigarette taxes increase vaping and higher vaping taxes increase smoking. They estimate that a tax of $1.65 per ml of e-liquid in the US would lead to a 1 percent increase in the number of adults who smoke cigarettes each day.
A more recent study takes a look at the impact of the flavoured e-liquid ban in San Francisco on flavoured tobacco use, as well as more generally. While the ban did reduce the use of flavoured tobacco products (as you would expect), the results also show it led to increases in cigarette smoking. Before the ban, the rate of smoking among 18 to 24 year olds was 27.4 percent, but after it increased to 37.1 percent. There was also a small increase among 25 to 34 year olds, although (unlike for the younger adults) this wasn’t statistically significant.
New Zealand is a particularly interesting case because, much like Australia, e-cigarettes were effectively outlawed there up until the government turned around on the issue in 2017. Although government surveys show some vapers in 2015, it’s unlikely there were many at all before then.
The data shows that from 2015/16 to 2018/19, the number of vapers increased from 0.9 to 3.2 percent of the population, around a 3.5-fold increase. In the four years from 2011 to 2015, smoking went from 16.3 to 15 percent of the population, while in the next four years, during the increase in vaping, smoking went from 14.2 to 12.5 percent. So for the time when vaping was pretty rare, there was a 1.3 percentage-point decrease, while during the increase in vaping there was a 1.7 percent decrease. In short, the rate of decline increased as vaping came onto the scene.
Increase in Success Rate for Quit Attempts
Another interesting sign is the increase in the chance of success for smokers who attempt to quit in recent years. In short, the hypothesis is that vaping’s effectiveness – or even just the general appeal – for smokers makes it more likely that quit attempts will be successful across the whole population.
This has been shown in the UK through a study from Jamie Brown and Robert West, using data from the Smoking Toolkit Study collected between 2007 and 2017. This amounts to over 18,000 participants in total, and the results were pretty clear. Despite some fluctuation, the rate of successful quit attempts increased from a low of 13.4 percent in 2010 to a maximum of 19.8 percent in 2017, which was significantly higher than the average for the previous 10 years.
This is a clear sign of the impact vaping is having on the smoking rate. If the quit rate had been the same as previously, the smoking rate wouldn’t have declined as much as it did. You could argue that this isn’t related to the availability of e-cigarettes, but with no other substantial changes in the quitting landscape in that time, it’s not a particularly convincing argument.
You can also look at the practical experience of e-cig friendly stop smoking services. For example, when Leicester Stop Smoking found that when people used vaping to try and quit smoking, they were 20% more likely to be successful than people who didn't use electronic cigarettes.
On top of this, data from the Smoking Toolkit Study shows that vaping has been the most popular method of quitting smoking in the UK since 2013, so it’s highly likely that this is the cause of the change in success rates.
Is Smoking Dying?
So even if you can’t just look at smoking rates around the world and see the impact of vaping, there are many indications that vaping is the main reason for the difference. But is smoking really on the way out?
This is a really hard question to answer. England, for example, intends to be smoke-free by 2030, partially dependent on the availability of vaping products. But about 14 percent of adults in the UK still smoke, and even though this is a big decrease compared to say, 1990, when 30 percent of adults smoked, it’s still a big figure. If – and this is a big “if” – smoking continues to decline at this same speed, it would take until around 2037 for it to be completely eliminated. At the same speed, we could reach a smoking rate of 5% by 2031, but even that isn’t a sure thing.
The good news is that smoking is certainly on the way out, but the bad news is that estimates of the date of its demise might be a little too optimistic. It’s not that the goal is unachievable; it’s more that it’s far from clear that current trends will continue until smoking is gone. There is a possibility of “hardening,” where the remaining smokers after all these declines are the ones who struggle to quit the most (or want to the least). This is just one possibility of many that could disrupt such goals.
On top of that, “killing” smoking will require substantial investment in support for smokers and a decidedly rational approach to THR. If more countries move towards vaping bans, for instance, it’s hard to imagine things staying quite so rosy.
So maybe the news of smoking’s demise is premature, but the rise of vaping is teaching us many important lessons. And the most important is pretty simple: if you make safer alternatives to smoked tobacco available, people will use them.
We can only hope that governments around the world see the potential in tobacco harm reduction before it’s all but crushed under the weight of over-caution and strict regulations.