Increased Vaping Use – An epidemic in the young and next generation of insured lives?

Introduction

As SCOR celebrates the 10th anniversary of our publication SCORacle, it’s fitting that we report on a subject that appeared in our very first edition back in November 2014 yet remains as ever very topical, e-cigarettes (e cigs) /vaping.

Over the last 10 years, we have been true to our word, keeping you, our audience informed of developments and news on e-cigarettes /vaping usage as well as looking at potential risks as we all learned more on published research.

From the 1st edition of SCORacle, we delved into the considered use of e-cigarettes to be a safe method of smoking cessation, following up in May 2016 by focussing on Popcorn Lung and Vaping. In December 2018 we provided an update on latest figures at that time on who were using e-cigarettes and vaping, and again in December 2019 posed the question whether we were any clearer on the risks they present.

This latest edition highlights the increased wave of usage in the young and particularly for those that have never been regular smokers. It also briefly looks at the latest government approach, touches on some of the associated risks with vaping and what potential future implications this all may have for underwriting and claims.

The latest figures on usage

The good news is that latest Office for National Statistics (ONS) figures advise smoking rates among UK adults have been falling over the past decade. They advise 12%, or six million people are smoking in 2023.

However, on the downside, they show e-cigarette or vape use continues to rise, particularly in the young, with estimates that 16–24-year-olds were more likely to use an e-cigarette than any other age group (16%). Additionally, the use of vapes had risen most since 2022, among 25–34-year-olds. Their findings advise about 5.1 million people in the country used a vape or e-cigarette in 2023.

The risks of smoking are well documented with cigarettes containing nicotine and other dangerous chemicals that attribute towards diseases such as cancer, stroke, lung disease and heart disease to name a few.

The role of using e-cigs to help smokers quit is an important one and acknowledges that for those that smoke, e-cigs are considered much less harmful than inhaling tobacco smoke from cigarettes. The NHS advise that smoking claims circa 75,000 lives a year (in 2019 there were 74,800 deaths attributed to smoking among adults aged 35 and over) so, if smoker rates are decreasing this can only be a good thing.

Young adult non smokers

The concerning rise though is in young adults that have started vaping despite not being regular smokers, with estimates that this is around one million. This is a sharp increase in previous years with disposable vapes having been around since 2021.

The rise is driven mostly by young adults - with about one out of every seven 18-24-year-olds who never regularly smoked now using e-cigarettes.

A study published in the Lancet Public Health journal showed that in 2023–24, 55·6% of never-regular-smokers who vaped reported vaping daily; 81·7% had been vaping for 6 months or more. The most used devices in 2023–24 were disposables (50·2%) and the most used e-liquids contained 20 mg/mL or more nicotine.

What is also more worrying is seeing a trend in even younger lives now experimenting with vaping, to the point that we are now seeing an epidemic in youth vaping among children.

Despite it being illegal to sell vapes or e-cigs to children, according to a You Gov survey for Action on Smoking and Health (ASH) there is a rise in 11- to 17-year-olds experimenting with vaping from 7.7% in 2022 up to 11.6%. About 15% of 16 to 17-year-olds and 18% of 18-year-olds are current vapers, it suggests.

Disposable vapes (used once and discarded), often brightly coloured containing nicotine, come in an assortment of flavours with gimmicky marketing brand names, are the most popular products, which can be purchased virtually everywhere, from as little as £5 each.

E-cigs and vaping were never an intended use or alternative use for those that have never previously smoked.

Government action

The government has announced that the sale of single-use disposable vapes will be banned in England and Wales from 1st June 2025. Scotland will also now align to this date. The intention is to protect children’s health and help prevent environmental damage.

The Department for Environment, Food, and Rural Affairs (DEFRA) said vape usage in England has grown by more than 400% between 2012 and 2023, with almost 10% of the British public now buying and using the products. The ban is only on disposable vapes and does not apply to rechargeable or refillable devices.

Disposable vapes are harmful to the environment as they are difficult to recycle and can end up in landfill, with batteries leaking waste like battery acid, lithium and mercury.

The UK market is already ’flooded’ with illegal disposable vapes, so a major concern is the ban will significantly fuel a rise in even more illegal sales. Stricter legislation and procedures for retailers to follow will be introduced.

This measure is separate to government plans to introduce further actions to tackle smoking health risks by ending smoking by banning the sale of cigarettes to anyone born after January 2009.

The risks of vaping

It is still widely reported that e-cigs are safer than traditional cigarettes, for those that smoke. They have helped thousands of people stop smoking by removing the dangerous and toxic tobacco smoke from their habit but what about the harm and risk for those who have never smoked?

More research is still needed on people who vape, but they could still be harmful in the long term and research is still in its early stages. It is known though that e-cigarette vapour which is inhaled can still contain smaller amounts of chemicals, including nicotine, which carry risks. But research is gathering pace. This includes effects for cardiovascular/respiratory function and other disease processes such as cancer.

There are also reports of increases in children who through vaping have disrupted sleep, disrupted concentration and may be struggling with problems with addiction.

Further serious concerns are being raised about the effects of delivering high doses of nicotine to the lungs through vaping. This in turn raised the point that vaping was found to damage important immune system cells in the lungs, and cause inflammation.

Additionally, dentists say they are seeing some side effects of vaping, such as bad breath, ulcers, soreness in some areas and a dry mouth. This could lead to a lack of saliva and, potentially, tooth decay.

An article that covered the risks associated with vaping was published by the BBC last year. It alarmingly highlighted a study from a school who tested in a laboratory vapes (mostly illegal) confiscated from school pupils that showed the vapes contained high levels of lead, nickel and chromium. It mentions that high levels of lead exposure in children can affect the central nervous system and brain development, according to the World Health Organisation. A further quote from a Professor in the report highlights the following:"Lead is a neurotoxin and impairs brain development, chrome and nickel are allergens and metal particles in general in the bloodstream can trigger blood clotting and can exacerbate cardiovascular disease."

"The carbonyls are mildly carcinogenic and so with sustained use will increase the risk of cancer - but in legal products, the levels of all of these things are extremely low so the lifetime risk to the individual is extremely small."

This further serves to highlight that there are hidden dangers associated with vaping, particularly disposables, which as mentioned earlier, has seen the highest usage rise in the young adults, previously not smokers.

Underwriting and Claims concerns

Our two previous SCORacle articles on Popcorn Lung and Vaping in May 2016 and our December 2019 issue really focussed on highlighting risks for underwriting. We addressed the latest research at the time and provided SCOR’s own philosophy around understanding and accepting such risks.

Pricing for e-cigs and vaping was considered and since then we have also seen many providers charging ex-smoker rates to protect their own portfolios from such risks. With a decrease in actual smoker rates over the last decade, we would hope that our experience is showing an improvement for claims for associated conditions such as heart disease, stroke, lung disease and cancer- purely resulting from smoking.

But perhaps it’s the next 10 years that we should be concerned with and particularly if we start to see a trend or subset of the younger (currently uninsured) generation, non-smokers of tobacco but who vape and continue their habit.

Are we going to see more people already having effects of vaping applying for insurance with a history of earlier complications or illness?

Will we see more people and possibly claims through Critical Illness or Income Protection developing lung cancer, chronic bronchitis and other serious lung conditions because of their vaping? Or perhaps we will even see other earlier conditions through a compromised immune system?

Conclusion

The last 10 years or so have raised many questions for our industry regarding e-cigs and vaping. It’s clear that with ongoing research we need to stay with the pace and follow research and development as we continue to learn more about this topical subject.

There has been a positive picture on how smoking rates have decreased but we must now remain focussed on how the landscape may change, especially for e-cigs/vaping and whether this brings with it more concerns.

As SCOR have promised over the last decade, we will continue to share with you our learnings on this ever-changing subject in future SCORacles.