As NICE consult on new vaping advice, survey shows 90% of smokers don’t know e-cigs are much less harmful than smoking

25 June 2021

ASH welcomes the launch today of a consultation by NICE on revised tobacco guidance, [1] including updated advice for healthcare professionals on what to say to smokers about vaping. Ralph, aged 59, is a good example of what a difference such support can make.  A smoker since his early teens, he decided to stop smoking during the first lockdown in 2020 having tried to quit before but never succeeded for long. For him e-cigarettes alongside advice from health professionals made all the difference. He started using his e-cigarette before meeting with a stop smoking advisor and they supported his choice and provided him with further medication and support:

“It was really helpful that the stop smoking advisor was supportive when I said I was trying vaping. I’d found a vape with a sealed capsule that worked for me. It doesn’t leak, it’s quite small and unobtrusive and doesn’t produce loads of vapour. It just gives me a little nicotine hit when I need it. It’s not the same as smoking but it does give you something to do with your hands. Vaping’s made the difference for me, after decades of smoking, finally I’ve been able to quit.”

NICE guidance is needed because despite being a proven aid to quitting, more effective than nicotine patches or gum.[2] 30% of smokers have never tried e-cigarettes, equal to around 1.7 million people in England.[3] And only one in ten smokers (12%) surveyed by YouGov for ASH know that e-cigs are much less harmful than smoking. Of the remainder a third (32%) think they’re more or equally harmful, one in four (24%) don’t know and 30% think they’re less harmful, but don’t realise that they are a lot less harmful.[3]

Deborah Arnott, Chief Executive of ASH said:

“With support and encouragement from health professionals more smokers would use an e-cigarette to help them stop, increasing the overall number who successfully quit long-term. This would be another step forward to securing the Government ambition for England to be Smokefree by 2030.” [4]


Misconceptions of risk

Since 2013 the fallacy that e-cigarettes are equally or more harmful than smoking has grown from 7% to 32% in 2021. In reality, e-cigarettes pose much less of a risk to health than smoking [5].

When asked why they have not used an e-cigarette, 10% cite concerns about safety and a further 22% say they are concerned about substituting one addiction for another. Both concerns indicate a misunderstanding of the positive role e-cigarettes can play in helping smokers quit.


Level of use

ASH and King’s College London estimate that in 2021 there are around 3.6 million current vapers in Great Britain. This is the same number as in 2019 following a dip in use to 3.2 million in 2020. The numbers of people vaping have been fairly static in the last few years after a big increase in popularity between 2013 and 2015. [3]


Youth use

While e-cigarettes are now a proven route to quit for adult smokers there have been concerns that young people will use the products as a route into smoking. ASH monitors use annually and will continue to do so, but to date survey findings show low levels of use among 11-17 year olds (the age of sale for e-cigarettes is 18).  Fewer than 1% of 11-17 year olds who have never smoked are currently using an e-cigarette and 3.3% have ever tried them. The overwhelming majority of all 11-17 year olds have never tried an e-cigarette, and this has seen little change since 2015 (in 2015 the proportion was 87.5% of 11-17 year olds and in 2021 it was 88.2%). [6]



Notes to the Editor

Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see:

ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.

ASH staff are available for interview. For more information send an email to or ring Deborah Arnott (Chief Executive, ASH) on 07976 935 987 or Hazel Cheeseman (Director of Policy, ASH) on 07754 358 593.



[1] New guidance on tobacco will be published for consultation from 25th June 2021 – 06 August 2021. Expected publication of final guidance 30 November 2021. For information about the NICE consultation contact / 07973970534

[2] Hajek P, Phillips-Waller A, Przulj D, Pesola F, Myers Smith K, Bisal N, Li J, Parrott S, Sasieni P, Dawkins L, Ross L. A randomized trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine. 2019 Feb 14;380(7):629-37.

[3] Factsheet and detailed survey findings available here. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 10,211 adults. Fieldwork was undertaken between 18th February – 18th March 2021. The survey was carried out online. The figures have been weighted and are representative of all English adults (aged 18+).

[4] Department of Health & Social Care. Advancing our health: prevention in the 2020s – consultation document. Published 22 July 2019.

[5] McNeill A, Brose LS, Calder R, Bauld L & Robson D (2018). Evidence review of e-cigarettes and heated tobacco products 2018. A report commissioned by Public Health England. London: Public Health England.

[6] All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 2513 children aged 11 to 18 (2021 for 11-17 year olds). Fieldwork was undertaken between 25th March – 16th April 2021.  The survey was carried out online. Results have been weighted and are representative of GB children aged 11 to 18.