It’s complicated: health inequalities and e-cigarettes

Guest post by Frances Thirlway, Fuse Associate member, Anthropology Department, Durham University

While the e-cigarette wars continue to rage, we still have very little information on the extent to which the most disadvantaged smokers are using e-cigarettes to quit. The smoking toolkit provides invaluable information regarding overall UK usage; however, most international research into the practices of e-cigarette users has been done via on-line user groups or forums. For anyone concerned with health inequalities and the social gradient in smoking, this is of limited use since the digital divide means that e-cigarette users active on internet forums are unlikely to come from the poorer communities where smoking is now concentrated.

Figure 1: The life cycle of a vaper - but note the gendered image

In contrast, slow research ‘takes the local as a starting point’ and does this through ‘extended interaction in particular sites’ (Adams 2014 p. 181). Anthropological work involving in-depth place-based research and examining local culture as a dynamic influence can be particularly helpful in researching e-cigarette use. This is not only because user practices vary according to age, gender, class and other factors, but also because e-cigarettes themselves are not a single product. Moreover, the typical ‘user life cycle’ involves a progression from basic to more sophisticated models of e-cigarettes over time. Complete smoking cessation can happen at any point in this process and is likely to be gradual and difficult to capture in simplistic smoker/former smoker divisions, which is why research which follows smokers and quitters over months or years is needed – one participant in my recent study took three years to move from dual use of tobacco and e-cigarettes to e-cigarette use only, and he was not untypical. As Figure 1 and the associated article illustrate, most successful users start with ‘first-generation’ models, but those who persevere generally find that second-generation models and beyond are more satisfying.

The key word here is ‘successful’ - because switching from tobacco to e-cigarettes is not an easy process. I found that users: ‘struggle with the time, effort and expense involved in finding the ‘right’ e-cigarette and the frequency of product failure i.e. cheaper tank models splitting, leaking, or bubbling if over-tightened or dropped, and problems with batteries running out or failing to charge.’ This meant that: ‘unless users were highly motivated to quit, smoking was significantly easier, and often cheaper taking into account the cost of e-cigarette replacement and the ready availability of illicit tobacco.’ (Thirlway 2016 pp. 109-110)

Whilst some public bodies and individual users have started to provide information and guidance about using e-cigarettes to quit smoking, many barriers to use remain, particularly for the poorest. There is little doubt that you are more likely to switch successfully if you can afford to try different models, and replace the ones you break. It also helps if you have time to spare, a fondness for electronic gadgets and the ability to feel at home in the – largely male - vaping subculture.

These and other issues are explored further in: Thirlway, F. (2016) Everyday tactics in local moral worlds: e-cigarette practices in a working-class area of the UK. Social Science & Medicine 170 pp. 106-113