Vaping has seen a massive surge in popularity in the UK, particularly in the last five years with more and more smokers making the switch to the less harmful alternative. While overall this is a positive change for public health, there have been concerns surrounding if (and how) this will affect underage use of e-cigarettes. The fact that vaping has really only become mainstream in relatively recent times, government regulators and retailers have had to adapt quickly to do their best to ensure e-cigarettes stay out of underage hands. There’s a lot of information around regarding teenage use, so we’re taking a closer look at the who, why and where as well as looking at how we need to update regulations going forward.
WHAT ARE THE CURRENT PATTERNS WE CAN SEE IN UNDERAGE USE?
ASH (Action on Smoking and Health) have been monitoring underage use of both cigarettes and e-cigarettes since 2013. While vaping has been around since 2005, it wasn’t particularly widely available or popular until 2012 and since then we’ve seen a much bigger increase in adult use. When it comes to teenage use, ASH’s findings came to a few key conclusions:
- As far as vaping awareness goes, an overwhelming majority of 77.7% of teenagers surveyed had never tried vaping at all and 10.5% aren’t even aware of what e-cigarettes are.
- The number of teenagers who have tried vaping has remained relatively consistent, despite their increasing popularity amongst adults. In 2015, 11.6% of 11-17 year olds had tried vaping, with a peak in 2020 of 13.9%, followed by a drop in 2021 to 11.2%.
- Those who had tried vaping were more likely to be in their late teens, with first time use far less common in those under the age of 16.
- Even amongst those at the legal vaping age (18 years old) around 30.1% had tried an e-cigarette. 16 and 17 year olds were less likely again to have tried them, with 23.3% having used an e-cigarette at least once and use amongst 11 - 15 year olds is as low as 6.5%.
- Between 2015 and 2021, there’s been an increase in weekly use from 2.4% to 4.1% amongst 11 - 18 year olds. However, more than once weekly use remains low at 1.5%.
With all of this in mind, it’s also important to note what the perception of vaping is from a teenage perspective. While vaping has been reported as 95% less harmful than smoking by Public Health England for some time now, only 43.8% of 11 to 18 year olds believe that e-cigarettes are safer than smoking. This fact may play an important role in the pathway most teenagers take when it comes to trying vaping in the first place.
WHY ARE TEENS VAPING AND WHERE ARE THEY GETTING THEIR E-CIGARETTES FROM?
By understanding the why (and how) teens are vaping, we can also better understand what it’ll take to discourage underage use and look at where the cracks in regulations are. While teenage use of e-cigarettes has remained relatively low, an important consideration is where they’re getting them from and why they’re trying vaping in the first place.
When surveyed by ASH, the main source teenagers were getting e-cigarettes from (as well as conventional cigarettes) was at the shops. There was also a trend showing it’s still more common for them to be getting cigarettes, with 60% getting their cigarettes from shops like off-licenses compared to 41.9% getting vapes from the same sources.
WHERE THE CONCERN COMES FROM?
If use is still remaining fairly low in the UK, with very little regular use in 11 to 18 year olds, where is the concern coming from? Across the pond in the United States, a growing “vaping epidemic” has been a cause of major concern. However, the ways in which e-cigarettes are regulated in the US is very different from the UK.
The main catalyst behind the popularity of teen vaping in the US came from the release of the Juul. The compact pod kit revolutionised the e-cigarette market given its ease of use and high strength e-liquids. In the States, the Juul offers pods with a 50mg strength, approximately two and a half times stronger than the maximum you can purchase in the UK and EU. The style and design of the kit itself was comparable to a thumb drive, making it easy for teens to fly under the radar at school. Currently, around 1 in 4 teenagers in the US use an e-cigarette on a regular basis. It became so bad that North Carolina’s State Attorney sued Juul for $40 million USD following the accusations they were responsible for the increase in teen vaping.
Juul didn’t get to the UK until 2018, on the tail end of the spike in teenage use in the US. With tighter regulations surrounding age verification, maximum nicotine strength and public perception, the UK never reached the same critical level of underage use our neighbours across the pond did. However, the ripple effect travelled across to the UK and in many ways gave us more of an opportunity to preemptively anticipate the best ways to regulate underage e-cigarette use.
THE NORTH VS. THE SOUTH
One trend worth noting in the UK is the North/South divide. Whilst according to ASH regular vaping amongst teens remains relatively low, the NHS has found that e-cig use is much more prevalent in the north than the south. In Yorkshire, local councils have found small hotspots with a high concentration of teen vaping. When surveying 15 year olds, they found throughout Yorkshire and Humber, 10% vaped once a week while 12% vaped “occasionally”. This is a fairly stark contrast with London and the southeast, reporting less than 3% of 15 year olds as being regular e-cigarette users.
COVID-19 AND VAPING
In 2020, the world was enveloped by the COVID-19 pandemic. The UK saw the highest quit attempts in decades, with smokers becoming more concerned over the influence of the virus on their lungs. ASH reported 41% of quit attempts were motivated by the virus given that smoking put them at higher risk of suffering more severely due to impaired lung health.
Along with this, there was a downward trend in teenage use in 2021. In fact, the number of teenagers having tried vaping dropped below 2015 rates to 11.2%, down 2.7% from 2020. Another trend worth noting was the quit rates in younger smokers in the UK during 2020. Typically, people of all ages and generations quit at fairly consistently rates as each other. However, ASH reported that smokers under 30 were more than twice as likely to have quit smoking because of COVID-19 than those over 50. Whether this trend will follow amongst vapers remains to be seen.
VAPING VS. SMOKING
While there has been an increase in weekly e-cig use amongst 11 - 18 year olds (sitting at 2.4% in 2015 and 4.1% in 2021), those using e-cigs more than once a week is still as low as 1.5% in 2021. Of those teenagers surveyed by ASH who are vaping regularly, 43.5% are also current smokers and 14.1% are ex-smokers. Just 0.7% of regular e-cig users had never smoked before. This indicates there’s a distinct trend between cigarettes and vaping and that more often than not, those regular users started out with conventional cigarettes. Of the underage users trying vaping for the first time, less than a quarter (29.3%) vaped without having ever smoked a cigarette as of 2021, up from 18.3% back in 2014.
Nearly half (49.3%) of 11 to 18 year olds are trying vaping just to see what it’s like and 16.7% were motivated to try them because their friends were. Only 1.2% are motivated by the fact that they think it “looks cool” and as far as access goes, only 1.1% were motivated to use e-cigarettes because they were easier to get their hands on than cigarettes.
So, despite the overall increase in e-cigarette use in the UK, the uptake in underage users still remains low with consistent use even lower. So, while they may be giving vaping a go, it’s not becoming a habit without first having a cigarette-driven habit.
THE LEGAL SIDE
As with the purchase of conventional cigarettes and alcohol, the legal age to purchase and use an e-cigarette is 18 years. Despite this, teenagers have still been able to buy e-cigarettes from a range of venues including high street shops, street markets and from online stores. The penalty for selling either cigarettes or e-cigarettes with nicotine containing vape juices is currently a £2,500 fine.
Having laws in place to prevent underage access to nicotine-containing products is important for a number of reasons, not the least of which has to do with brain development. While physically you look and feel more or less like an adult by 18, your brain doesn’t finish developing until around 25 years of age. While your brain is still undergoing changes, it’s not only more prone to becoming addicted to nicotine but can also have that development adversely affected by nicotine too.
E-CIGARETTE MARKETING AND LOOPHOLES IN CURRENT REGULATIONS
While age checking should be the standard, the way in which e-cigarettes are marketed and displayed may need revising to discourage teens from seeking them out in the first place. While e-cigarettes and e-liquids currently require a nicotine warning, they all have unique branding and come in a range of colours, bottle shapes and with unique imagery. When asking about branding, 40% of teenagers expressed a preference for certain vaping products while only 32% had a preference when they had generic packaging. Perhaps similarly to the now very neutral packaging that all cigarettes have, removing or reducing the imagery and branding from vaping products may help discourage teen use.
When it comes to e-cigarettes, unlike conventional cigarettes, they don’t need to be hidden from view in shops. A study done on the impact of banning open displays showed a direct correlation between removing cigarettes from view and a decrease in youth uptake:
“Both partial and full implementation of a display ban were followed by a reduction in smoking susceptibility among adolescents, which may be driven by decreases in brand awareness.”
There’s also a current loophole which doesn’t prohibit handing out nicotine-containing e-cigarettes to anyone, even if they’re underage. The reason being that, while e-cigarettes do contain nicotine, they’re not classified as tobacco products meaning they aren’t subject to the Tobacco Advertising and Promotion Act “prohibition of free distribution” rules.
EXTERNAL FACTORS - INCLUDING SOCIAL MEDIA
Another factor to consider is social media. The regulations surrounding actual advertising are fairly rigid, prohibiting paid promotion on TV, radio, online through social media or email marketing or through sponsored posts. In the States, following the peak of the vaping epidemic, Juul deleted their social platforms entirely and in 2019, the US made it illegal to sell or market to under-21s. What this doesn’t factor in is non-paid for promotions.
Platforms like Instagram, Facebook and Twitter expose teenagers to marketing on an almost constant basis. While many pages will express an 18+ only rule, without having either age verification for teens signing up to these apps or some sort of regulation on the kinds of posts allowable, they’ll continue to be exposed to e-cigarettes online.
Another app that’s widely used by teens is of course TikTok. TikTok is a 12+ rated app and is incredibly popular amongst teenagers. The video hosting platform has a growing trend, particularly in the US of accounts promoting the sale of Elf Bar devices and the likes of Geek bars, a similar pod-style device. They offer to package them up discreetly, often shipping the devices with other cloaking products like clothing. This black market style of selling e-cigarettes is difficult to police and without heavy intervention from the app itself, it’s a trend that will likely persevere.
WHAT WE CAN DO TO REDUCE TEEN VAPING
While teenage use is relatively low, making the most of the fact it’s still a relatively novel concept is key in keeping underage use as low as possible. There’s a number of ways in which we can collectively work on reducing underage e-cigarette use. Educating teens on the risks of nicotine-containing products on young brains is one path that’s worth taking. However, teenagers will tend to experiment regardless and as such, reducing their exposure to these products is also a necessity.
The UK currently has a smoke-free goal of 2030 and as a part of this are considering raising the legal age to use tobacco products to 21. While this may be helpful in theory, they run the risk of isolating the inbetween age bracket. Without quit-support for those who already use e-cigs or smoke regularly may lead to more issues with counterfeit and illegal sales with those aged 18 - 21.
Rather, considering regulating the way in which vaping products are displayed in places like convenience stores and gas stations as well as a Challenge 25 policy may be more helpful. Options like 1account, a digital age verification platform, would solve this issue for both in-person and online sales. The premise of it is simple but has a lot of potential in making age verification more reliable and a lot easier. These kinds of platforms require a valid proof of photo identification like a passport or driver's license which in turn can also help reduce counterfeit ID’s and borrowed ID use when purchasing regulated goods. It’s free for people to use and even those without a photo ID can use things like their debit card or electoral roll to prove they’re over 18. It also provides the same verification capabilities online as well, meaning whenever a customer is purchasing remotely rather than in store, they can still use 1account to have their age verified.
Despite what we see in the media and in contrast with the trends in the United States, the trend we’re seeing with teenage use is that, whilst there is some uptake in minors, overall teenage use remains low. Typically, teenage use stems more from smoking than picking up an e-cigarette without ever having tried cigarettes before too. The responsibility first and foremost is upon businesses selling vaping products as well as updating laws relating to giving out e-cigarette products for free. Maintaining existing regulations, enforcing them correctly and improving age verification across both retail and online stores is key to keeping this figure as low as possible.