Nicotine Addiction as a Moral Problem: Barriers to E-Cigarette Use for Smoking Cessation in Two Working-Class Areas in Northern England

Summary of Study

Bottom Line: Tobacco use and socio-economic status are inversely correlated. Working-class smokers avoid e-cigarettes because of moral and financial concerns associated with addiction. These barriers can be overcome when users reduce nicotine content in e-cigarettes and minimize their spending. This suggests that ensuring that vaping is cheaper than smoking is the key to working-class use and associated harm reduction.

While smoking rates in high-income countries have declined over the past thirty years, they remain high among the poorest and contribute significantly to health inequalities. Therefore the working-class has the most to benefit from e-cigarette use. One-third of UK smokers have not tried e-cigarettes, and the fear of swapping one addiction for another is the main reason why.

Research for this study took place in an economically depressed small town in a rural, formerly coal-mining area of the North East of England and a contrasting second site: a deprived urban neighborhood three miles from the center of a North West city.

Many smokers in the study were deterred from e-cigarette use by the fact that the vapers they knew continued to use e-cigarettes indefinitely. Another indication that addiction was seen as a problem was the fact that most vapers were planning to reduce the nicotine content of their e-liquid and/or to give up the e-cigarette completely. Participants exhibited concern about addiction as part of a broader discomfort about losing control.

Many smokers also viewed e-cigarette pleasure with suspicion because hedonism is symbolically linked with addiction, making it necessary for e-cigarettes to be conceptualized as medication in order to be morally acceptable.

Research participants spoke of the benefits of e-cigarettes mainly in terms of money savings, often in relation to family. Whereas smokers with higher social status refer to concerns about future health, poorer smokers tend to speak of cost and current health problems as triggers to stop smoking.

Two forms of moral satisfaction emerged as relevant to e-cigarette use. The first is the moral satisfaction of thrift and its capacity to alleviate concern about addiction by minimizing the diversion of financial resources from the household. The second is the moral satisfaction of enjoying a less harmful alternative to smoking. These findings suggest that working-class smokers switch to e-cigarettes as much or more for the price differential as the health advantages.

Therefore, ensuring that vaping is significantly cheaper than smoking through differential tax regimes and regulation may be key to addressing differential smoking rates and health inequalities among socio-economic classes. 

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