Trends in single and multiple non-combustible nicotine product use: a population study in England.

Introduction: Non-combustible nicotine products are commonly used and are used alone or in combination. This study aimed to provide up-to-date estimates of the prevalence of single and multiple non-combustible nicotine product use among adults in England in 2023 and to estimate trends between 2013 and 2023.

Methods: Data were drawn from repeated cross-sectional surveys of adults (≥18y) in England conducted between January 2013 and December 2023. Single non-combustible nicotine product use was defined as current use of one of: nicotine replacement therapy (NRT), e-cigarettes, nicotine pouches, or heated tobacco products. Multiple use was defined as current use of two or more of these products. We used logistic regression to estimate monthly time trends in the prevalence of single and multiple product use across the study period and provided descriptive data by smoking status and sociodemographic characteristics.

Results: The proportion of adults using any single non-combustible nicotine product increased non-linearly from 5.4% (95%CI=5.1-5.9) in January 2013 to 14.3% (13.6-15.0) in December 2023. The prevalence of multiple non-combustible nicotine product use was 0.7% (95% CI 0.6-0.9) in January 2013 and stable until 2020 before increasing to 1.4% by December 2023 (95% CI 1.2-1.7). Most single and multiple non-combustible nicotine product users were individuals who currently (44.7% [43.1-47.6] and 70.6% [64.2-76.1], respectively) or had formerly smoked (41.2% [39.1-43.4 and 25.5% [19.4-31.5).

Conclusion: Use of non-combustible nicotine products has increased substantially among adults in England over the past decade. While most use only one product, a growing minority (predominantly individuals who currently smoke) use multiple non-combustible nicotine products.

Implications: Over recent years, the proportion of adults in England reporting single and multiple non-combustible nicotine product use has risen, with the prevalence of single product use almost tripling and multiple product use doubling. It will be important to continue monitoring product use patterns as the market continues to evolve rapidly. There is also a need for further research to understand how different patterns of non-combustible nicotine use may affect people's motivation to stop smoking or success in quitting.