Young people's smoking and vaping behaviour, and comparative perceptions of appeal, imagery and harm, across different vape devices and a tobacco cigarette: findings from UK cross-sectional surveys in 2020 and 2023.

Introduction: After the introduction of a new generation of disposable vapes (e.g., Elf Bar) in the UK in 2021, there was a rapid increase in their use by young people and concern about their availability and marketing. This study examined young people's vaping and smoking between 2020 and 2023, and perceptions of a disposable vape, a tank model and a traditional cigarette, to examine whether disposable vapes may have contributed to the rise in youth vaping. Methods: Online cross-sectional surveys in 2020 (Youth Tobacco Policy Survey Results: Between 2020 and 2023, prevalence of ever smoking reduced from 12.2 to 9.3%, whilst ever vaping increased from 10.1 to 17.5%. Vaping experimentation was not confined to young people who had already tried smoking: in 2023, never smokers accounted for the majority of ever vapers (56.6%). Of those who had tried vaping, disposable vapes were the most commonly used device type, with 72.8% having used a disposable vape the first time they tried vaping. There was an association between having tried vaping and susceptibility to smoke. Disposable vapes were rated more favourably compared with a tank device on 9 of 11 items across appeal, imagery and harm (range adjusted odds ratio (AOR): 1.40-4.16; Conclusion: This study highlights the appeal of disposable vapes to young people. Causality cannot be inferred due to the cross-sectional design of the study, however, positive perceptions of disposable vapes across dimensions of appeal, imagery and harm, may have contributed to trends in youth vaping. Further monitoring of the nicotine market, product marketing, and young people's response is critical, particularly as the market adapts in response to the disposable vapes ban.