Background E-cigarette use is growing worldwide, being used as an aid to quit smoking. Trends and characteristics in E-cigarette use in England are profiled, including the characteristics of never smokers who use e-cigarettes, where the use may be harmful, potentially being a gateway into other drug use.

Methods Using the cross-sectional nationally representative Health Survey for England 2016-2019 (N=32,005 adults aged 16+), multivariable logistic regression was conducted on the odds of ever using e-cigarettes, by age-group, education (Degree or higher (reference)/Other/No qualifications), quintiles of area-deprivation, alcohol drunk on heaviest drinking day (none (reference)/below daily limits/above daily limits/binge), seven geographical regions (reference: London), self-rated health (Very good-good (reference)/Fair-Very bad), and survey-year (reference: 2016). Models were repeated concentrating on groups by smoking status only (current/ex/never smoker). Models examining the risk of being a current user of e-cigarettes will also be assessed. Complex survey design and non-response weighting was applied. Analyses was carried out using Stata 17.

Results The prevalence of e-cigarette use was 20%, 64% among current smokers, 23% among ex-smokers and 5% among never smokers. E-cigarette use increased over time, including among never smokers (4% (95% Confidence Interval (CI) 3-5%) in 2016, compared with 7% (95% CI 6-8%) in 2019). Among all adults, being male (1.17 (95% CI 1.08-1.26)), binge drinking (1.44 (95%CI 1.28-1.63), poorer self-rated health (1.38 (95%CI 1.27-1.51)), living in the Noth West (1.24, 95%CI 1.03-1.51)), North East (1.24, 95%CI 1.03-1.50) and East Midlands (1.40 95%CI 1.15-1.70)) compared with London was associated with greater odds of ever using e-cigarettes. The risk of ever using e-cigarettes was greater among younger-age groups and more recent years. Similar associations were found for the risk of ever using e-cigarettes among current smokers, and ex-smokers (having lower qualifications was also associated with increased use (e.g. 1.79 95%CI 1.44-2.22)). Among never smokers, being male (OR=1.61, 95%CI 1.36-1.91) increased alcohol consumption (e.g. binge (OR=2.44 95%CI 1.89-3.15), lower than a degree (OR=1.23 95%CI 1.00-1.53)), more recent years (2019 (OR=1.93, 95% CI 1.46-2.54)), and younger age was associated with ever using an e-cigarette.

Conclusion E-cigarette use among never smokers remained low, however increased in recent years, and was associated with young adulthood and other risky behaviours. This should be monitored in future years.