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Institute of Epidemiology and Health Care Blog



E-cigarettes – a tool to reduce inequalities in smoking?

By guest blogger, on 19 February 2019

Since their arrival in the UK in 2010/11, electronic cigarettes (e-cigarettes or vapes) have rapidly become the most popular aid to help people quit smoking. With evidence continuing to grow showing that vaping 1) poses a small fraction of the risks of smoking and 2) improves smoking quit success, Public Health England have restated that smokers who are struggling to quit should ‘try switching to an e-cigarette’ along with seeking help by trained specialists. But what does this mean for existing inequalities in smoking?

Following a steady decline over the past decade, 15% of the population in England are estimated to currently smoke. However, smoking rates fall along a social gradient, with one in four people from disadvantaged socio-economic groups smoking, compared with one in ten from more affluent groups. This means that a disproportionate number of the ~78,000 deaths and the ~485,000 hospital admissions caused by smoking in England each year fall upon the disadvantaged.

Given their popularity (used by >30% of smokers making a quit attempt) and generally lower cost compared with cigarettes, e-cigarettes have potential to help reduce inequalities in smoking cessation. However, a concern during the early period in which e-cigarettes first arrived on the UK market was that they were more popular with better off smokers. If the devices boost quit success, which appears to be the case, then these differences in use across the social gradient could potentially lead to disadvantaged smokers being left behind, thus worsening the existing inequalities.

Keeping up with change

Since their creation in 2003 by a Chinese pharmacist Hon Lik, e-cigarettes have continued to evolve with novel designs and more effective nicotine delivery systems being rolled out each year. The Smoking Toolkit Study (STS), set up by the Tobacco and Alcohol Research Group at UCL to monitor population trends in smoking in England, is one way that researchers and policy makers can keep up with this ever-changing landscape of e-cigarette use and assess whether they promote or detract from reducing smoking rates.

Using STS data from 2014 to 2017, our recent research published in the journal Addiction was the first of kind to look at the use of e-cigarettes by different socio-economic groups at the population level. Our study analysed data from over 81,000 adults in England, including 16,000 past-year smokers, 5,300 smokers making a quit attempt and 13,500 long-term ex-smokers. E-cigarette use in each group was assessed using participant social grade (based on occupation) or housing status as key indicators of socio-economic position.

Narrowing differences among smokers

Our analysis indicated that in the three years from 2014 to 2016, disadvantaged smokers were around half as likely to use e-cigarettes. However, by 2017 this difference was no longer evident. Similarly, there were no differences in e-cigarette use by smokers making a quit attempt. Should this absence of difference between socioeconomic groups remain going forward then it is unlikely that the use of e-cigarettes among smokers and quit attempters will have a persistent impact on inequalities. However, it will be important to investigate whether there are socio-economic differences in the success of quit attempts with e-cigarettes, something which researchers in our group have been looking into.

Greater e-cigarette use among disadvantaged ex-smokers

Our research also showed a different pattern among smokers who had been quit for over a year, with disadvantaged ex-smokers more than twice as likely to use an e-cigarette. This could have important implications, and really depends on whether e-cigarettes prevent ex-smokers from relapsing back into smoking tobacco. If that were true (unfortunately there isn’t much research on this yet) then e-cigarette use would protect more disadvantaged smokers from slipping back into smoking and act to reduce inequalities; an equity-positive effect.

The wider picture

Inequalities in smoking are driven by a complex and nuanced system acting at the population, community and individual level. Reducing disparity requires action at all levels such as tobacco taxes, public health media and education campaigns and individual specialist support that targets the neurobiological and motivational components of nicotine addiction that dependent smokers struggle with. E-cigarettes are not a magic wand for quitting smoking. Rather, given their popularity and similar effectiveness to other forms of nicotine replacement therapy, they are part of a toolbox of interventions that are contributing to the continuing decline in smoking in the UK. If they are available, affordable and able to deliver nicotine effectively without the loss of social identity that some smokers subscribe to, e-cigarettes may also help redress the persistent inequalities in smoking.

Loren Kock (@loren_kock.) is a Cancer Research UK funded PhD student in Epidemiology and Public health, working within the UCL Tobacco and Alcohol Research Group. His research focusses on how e-cigarettes and other smoking cessation interventions impact on socio-economic inequalities in smoking cessation.

29 Responses to “E-cigarettes – a tool to reduce inequalities in smoking?”

  • 1
    Mohsin wrote on 13 May 2021:

    I’m a cigarette quitter and I’m proud I found vape. The FDA’s attempts to get rid of cigarettes and have repeatedly been delayed or derailed by forces inside and outside the government. I think they think that the tax money from tobacco will be wasted. They think about the tax and don’t even care for the lives of the people. Lung cancer is rising so they should ban this tobacco and promote the vape instead so we can save more lives. Directory Listing

  • 2
    Denver Arborist wrote on 14 May 2021:

    Smoking is the single largest driver of health inequalities in England. Smoking is far more common among people with lower incomes. The more disadvantaged someone is, the more likely they are to smoke and to suffer from smoking-related disease and premature death. https://www.treeservicedenvercolorado.com/

  • 3
    James anderson wrote on 17 May 2021:

    Thank you for such a nice content, wishing you all the best!

  • 4
    Aliah Manzano Manzano wrote on 20 May 2021:

    I agree, very well explained. E‐cigarettes may potentially help young adult smokers to quit smoking, yet . smokers and contribute to the reduction of social inequalities in smoking.

  • 5
    Business Directory wrote on 24 May 2021:

    Absolutely! that e-cigarettes are effective for helping smokers quit. There are other proven, safe, and effective methods for quitting smoking.

  • 6
    Andre Brown wrote on 25 May 2021:

    I agree. The use of e-cigarettes is unsafe for kids, teens, and young adults. Most e-cigarettes contain nicotine.

  • 7
    Tree Removal Greeley Co wrote on 26 May 2021:

    Absolutely! that e-cigarettes are effective for helping smokers quit. There are other proven, safe, and effective methods for quitting smoking.

  • 8
    Tree Removal Castle Rock wrote on 28 May 2021:

    Absolutely! Smoking is the single largest driver of health inequalities in England. Smoking is far more common among people with lower incomes.

  • 9
    Klyde wrote on 28 May 2021:

    I agree. Nicotine is highly addictive and can harm adolescent brain development, which continues into the early to mid-20s. E-cigarettes can contain other harmful substances besides nicotine.

  • 10
    Tom wrote on 28 May 2021:

    Glad you pointed out the dangers of nicotine.

  • 11
    Rich wrote on 28 May 2021:

    Thanks for sharing.

  • 12
    Tommy wrote on 28 May 2021:

    Great info! thanks

  • 13
    Rich wrote on 28 May 2021:

    Thanks for the insights.

  • 14
    Bill wrote on 28 May 2021:

    Awesome information.

  • 15
    Firewood Colorado Springs wrote on 30 May 2021:

    Absolutely! with smoking stigma operating as a proxy for class stigma. This led to increased policy focus on the health of bystanders and children and later also to concerns about electronic cigarettes.

  • 16
    Rich wrote on 31 May 2021:

    Nicotine is not good for your body. Should try to resist all forms.

  • 17
    Tom wrote on 31 May 2021:

    As noted, e-cigs are not a magic wand to quit smoking.

  • 18
    Rich wrote on 31 May 2021:

    Nicotine is not good for you either way. Please refrain.

  • 19
    Emmanuel Orta wrote on 10 June 2021:

    Thank you for such a nice content, wishing you all the best!

  • 20
    jordan wrote on 28 June 2021:

    I agree. Thanks! Among older former cigarette smokers, a strong correlation was shown between smoking duration and health, with longer smoking history associated with greater risk for poor overall health, chronic obstructive pulmonary disease.
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  • 21
    jordan wrote on 27 July 2021:

    Thanks! In males, smoking was disproportionately prevalent in the poor in the majority of countries. In numerous countries the poorest men were over 2.5 times more likely to smoke than the richest men. Business Directory

  • 22
    mark bill wrote on 18 August 2021:

    Most e-cigarettes contain nicotine, which is addictive and toxic to developing fetuses. Nicotine exposure can also harm adolescent and young adult brain development, which continues into the early to mid-20s.Tree Service Thornton

  • 23
    mark drez wrote on 23 August 2021:

    I’m so glad a reputable source has done this study and can spread the word. Plenty of Youtubers have done it already, but hopefully this is the info we need in the U.S. to focus on vaping as a cessation tool and not the “teen epidemic”. Lakewood Roofing Company

  • 24
    mar\ wrote on 4 October 2021:

    Absolutely! Possible approaches to reduce the exposure to toxins from smoking include reducing the amount of tobacco used, and using less toxic products, such as pharmaceutical, nicotine and potential reduced-exposure tobacco products, as an alternative to cigarettes.
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  • 25
    Emmanuel Orta wrote on 6 January 2022:

    Thank you for such a nice content, wishing you all the best!

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  • 26
    Celestino wrote on 21 September 2022:

    I think vaping has been a huge game changer when it comes to the number of people smoking cigarettes.
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  • 27
    Atomizer wrote on 22 September 2022:

    I agree, very well explained. E-cigarettes may help young smokers quit. Protect smokers and contribute to reducing social inequalities related to smoking.

  • 28
    Ilana wrote on 14 December 2023:

    Wanting to quit smoking is merely a minuscule part of the battle. The real fight starts when the first step has been taken when smokers must steer clear of temptations.Studies indicate that the strongest way people show their desire to quit smoking permanently is by trying it 3-5 times.Cigarette smoking is among the most preventable causes of diseases and death in the US. But it also is one of the toughest to avoid and withdraw from. It’s made to be addictive and has, since its conception, proven to work by disrupting thousands of lives. Yet regardless of the estimated 325,000 annual casualties attributed to it, companies continue supplying it.

  • 29
    Emmanuel wrote on 17 March 2024:

    I think vaping has been a huge game changer when it comes to the number of people smoking cigarettes.
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