Abstract
AIMS: To examine age-specific trends in patterns of nicotine use in England between 2014 and 2024, including types of products used, exclusive and dual use of smoking and vaping, smoking frequency and the smoking history of those who vape. DESIGN: Repeat monthly cross-sectional analysis of data from a nationally representative survey (the Smoking Toolkit Study). SETTING: England, 2014-2024. PARTICIPANTS: 217 433 adults (≥18y). MEASUREMENTS: Prevalence of (non-medicinal) nicotine use overall and by product type (combustible tobacco, e-cigarettes, heated tobacco products and nicotine pouches), exclusive and dual use of smoking and vaping, daily versus non-daily smoking and smoking history among those who vape. Estimates were stratified by age group (18-24, 25-34, 35-44, 45-54, 55-64, ≥65y) and year. Prevalence ratios (PR) with 95% confidence intervals (CI) were calculated to quantify relative changes in prevalence from 2014 to 2024. FINDINGS: Nicotine use patterns varied markedly by age. Among 18-24-year-olds, vaping prevalence increased fivefold, from 5.0% in 2014 to 25.0% in 2024 (PR = 5.00; 95% CI = 4.18-5.91), surpassing smoking by 2023. This contributed to an overall increase in nicotine use (26.1% to 36.5%; PR = 1.40; 95% CI = 1.29-1.53), despite declining smoking rates (25.3% to 19.9%; PR = 0.79; 95% CI = 0.71-0.88). In this age group, exclusive vaping became the most common mode of nicotine use, while nicotine pouch use also increased. Daily smoking declined substantially among 18-24-year-olds who smoked, with a shift toward non-daily smoking. Similar trends were observed among adults aged 25-44, though changes were smaller with increasing age. In older age groups (≥45), daily smoking declined modestly while vaping rose gradually, but there was little overall change in the prevalence of nicotine use. Most adults who vaped had a history of smoking, but the proportion who had never regularly smoked increased, particularly among 18-24-year-olds (4.3% to 34.3%; PR = 7.98; 95% CI = 4.56-26.2). CONCLUSIONS: Generational shifts in nicotine use are occurring in England. Nicotine use has risen among young adults over the past decade, but they are increasingly moving away from daily cigarette smoking towards vaping or non-daily smoking. While older adults have also shown movement away from daily smoking, traditional smoking patterns remain more prevalent in this group. These trends suggest vaping may gradually replace smoking as the dominant form of nicotine consumption.