Main findings In our systematic review, we did not identify any vaping prevalence studies from England, so we are unable to report on rates of vaping among people with mental health conditions in England, or in other parts of the UK. We identified 17 studies that reported vaping prevalence in people with mental health conditions outside the UK. Definitions of current vaping varied across studies, for example, any use in the past 30 days or use every day, on some days or rarely. So, the findings and any comparisons between studies should be treated with caution. Overall, rates of current vaping ranged from 3% to 20% among people with mental health conditions in nationally representative population samples. Rates ranged from 0.3% to 21% in representative state-wide or regional survey samples and from 7% to 45% among participants recruited from clinical settings. These high rates of vaping likely reflect the high prevalence of smoking among people with mental health conditions. Among nationally representative and state-wide or regional samples, current smokers had the highest rates of ever vaping (up to 75%) and current vaping rates (up to 41%). There are currently no published randomised controlled trials (RCTs) evaluating vaping products for smoking cessation or reduction for smokers with mental health conditions. We identified 4 single group ‘pre-post studies’, a type of study looking at participants before and after an intervention, and a secondary data analysis of RCT data that included a sample of people with a mental health condition. In 4 of the studies, participants were not motivated to quit. Complete abstinence from smoking was achieved by 7% to 14% of participants between 4-week and 12-month follow-up across the studies. Study participants who vaped significantly reduced their cigarette intake. The sparse literature that exists on health professionals’ knowledge and attitudes about vaping suggests that many are ambivalent about the role and use of vaping products among smokers with mental health conditions. It also suggests there are unmet training needs.
5.2 Implications One of the actions in the government’s Tobacco Control Plan for England was to explore how more reliable data could be collected to better inform tobacco control measures to support people with mental health conditions. Ongoing studies on vaping (and smoking) in these people in England will help fill some evidence gaps. But more nationally representative data is still needed, particularly for people with severe mental health conditions. High rates of smoking and vaping together suggest that smokers with mental health conditions should be advised and supported to quit smoking completely, as soon as they feel able to do so. More research is needed on vaping among people with mental health conditions and its efficacy and safety for quitting smoking. There are signs that health professionals need more tailored training on the use of vaping products among people with mental health conditions. Resources on vaping among people in mental health settings are available from the Mental Health & Smoking Partnership in England. Since vaping is allowed in most mental health trusts in England, the experience of using vaping products over time in these settings should be explored, including their effect on completely switching from smoking to vaping.