Prevalence and patterns of different types of non-cigarette tobacco use in England: a population study

Abstract Introduction Non-cigarette tobacco smoking increased in England between 2013 and 2023, but little is known about the prevalence of use of specific types of non-cigarette tobacco, including smokeless products, or whether the increasing trend has continued. This study examined recent trends in exclusive non-cigarette tobacco smoking and estimated the prevalence of different smoked and smokeless product use by sociodemographic characteristics, vaping and cigarette smoking status. Methods Data came from the Smoking Toolkit Study, a nationally representative monthly cross-sectional survey of adults (≥18y) in England ( n =94,918; April-2020 to February-2025). We used logistic regression to estimate trends in exclusive non-cigarette tobacco smoking. We further examined the prevalence and correlates of (non-exclusive) use of eight specific smoked and smokeless non-cigarette tobacco products among 8,129 participants surveyed October-2024 to February-2025. Results The prevalence of exclusive non-cigarette tobacco smoking increased from 1.3% [1.1-1.6%] in April-2020 to 2.0% [1.8-2.1%] in August-2022, before declining to 1.2% [1.1-1.5%] by February-2025. Between October-2024 and February-2025, 3.7% [3.2-4.1%] of adults reported any non-cigarette tobacco use (∼1.7 million people). Cigars (1.2%) and waterpipes (0.9%) were the most used products. Use patterns varied: cigars, cigarillos, and pipes were more common among men and those who smoked cigarettes, while waterpipes were more common among younger adults, minority ethnic groups, and people who vaped. Smokeless tobacco use was more common among those who smoked (any form of) tobacco. Conclusions In England, exclusive non-cigarette tobacco smoking has fluctuated in recent years. Patterns of smoked and smokeless tobacco use vary across products and sociodemographic groups.