Use, perceptions, and effectiveness of e-cigarettes for smoking cessation among older adults in England: a population study, 2014-2024.

Background: This study aimed to characterise patterns of tobacco smoking and vaping among older adults (≥ 65 years) in England, to explore harm perceptions of e-cigarettes among those who smoke, and to estimate the real-world effectiveness of e-cigarettes for helping older adults to stop smoking.

Methods: Data were collected as part of a representative monthly cross-sectional household survey in England between April 2014 and April 2024 (n = 197,219). We analysed differences between older (≥ 65 years) and younger/middle-aged adults (18-64 years) in (a) time trends in tobacco smoking and vaping, (b) harm perceptions of e-cigarettes vs. cigarettes (adjusting for gender, socioeconomic position, and vaping status), and (c) the real-world effectiveness of e-cigarettes for smoking cessation (adjusting for gender, socioeconomic position, characteristics of the quit attempt, and use of other evidence-based cessation aids).

Results: Tobacco smoking prevalence remained relatively unchanged over time among older adults (at ~ 9%; 9.5% [8.5-10.6%] in April 2014 and 8.7% [7.7-9.8%] in April 2024) but vaping prevalence increased (from 2.1% [1.6-2.7%] to 3.7% [3.0-4.6%], respectively). These trends differed from those observed among younger/middle-aged adults, among whom there was a clear decline in smoking (from 21.8% [21.0-22.7%] to 18.2% [17.3-19.0%]) and a larger increase in vaping (from 5.6% [5.2-6.1%] to 16.2% [15.3-17.0%]). Older adults were consistently less likely than younger/middle-aged adults to use e-cigarettes to support attempts to quit smoking (26.8% [17.2-39.3%] vs. 43.7% [39.6-48.0%] in April 2024). Older smokers reported greater uncertainty about the harms of e-cigarettes compared with cigarettes (OR = 2.48 [2.28-2.69]). E-cigarettes appeared to be effective for helping older adults to stop smoking (OR = 1.50 [0.96-2.34]); whether effectiveness was lower than for younger/middle-aged adults was inconclusive.

Conclusions: Over the past decade, smoking prevalence has remained stable among older adults while decreasing among the rest of the adult population in England. Older adults are more unsure about the relative harms of e-cigarettes and less likely to use them to support attempts to quit smoking, despite evidence that they are effective for smoking cessation in this population.