Abstract
BackgroundWhile some experts have emphasised the potential for e-cigarettes to facilitate cessation among smokers with low socioeconomic status (SES), there is limited evidence of their likely equity impact. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic.MethodsTen electronic databases were searched in February 2017 using terms relating to e-cigarettes, smokeless tobacco and nicotine replacement therapy (NRT); and SES. We included studies published since 1980 that were available in English and examined product use by SES indicators such as income and education. Data synthesis was based on those studies judged to be of medium- to high-quality using guidelines adapted from the Critical Appraisal Skills Programme.ResultsWe identified 54 studies describing NCNP use by SES across 12 countries, of which 27 were judged of sufficient quality to include in data synthesis. We found mixed patterns of e-cigarette current use by SES, with evidence of higher use among low-income adults but unclear or mixed findings by education and occupation. In contrast, smokeless tobacco current use was consistently higher among low SES adults. There was very limited evidence on the SES distribution of NRT in adults and of all NCNPs in young people.ConclusionsThe only NCNP for which there are clear patterns of use by SES is smokeless tobacco, where prevalence is higher among low SES groups. While this suggests a potentially positive impact on inequalities in smoking (if NCNP use displaces smoked tobacco use), this has not been seen in practice. These findings do not support the suggestion that e-cigarettes have the potential to reduce social inequalities in smoking, since i) current evidence does not show a clear trend of higher e-cigarette use in population groups with higher tobacco consumption, and ii) the experience of smokeless tobacco suggests that – even where NCNP use is higher among low SES groups – this does not necessarily replace smoked tobacco use in these groups.
Highlights
While the prevalence of combustible tobacco smoking has decreased over recent decades in many high-income countries [1], cigarette use continues to be higher among groups experiencing social disadvantage [2]
Such inequalities have been observed across numerous measures of social location – including ethnicity, gender and sexual orientation – with the most extensive evidence found in relation to socioeconomic status (SES) [3]
We identified nine qualitative studies examining Non-combustible nicotine-containing products (NCNP) in low SES groups which are considered in a separate report
Summary
While the prevalence of combustible tobacco smoking has decreased over recent decades in many high-income countries [1], cigarette use continues to be higher among groups experiencing social disadvantage [2]. Such inequalities have been observed across numerous measures of social location – including ethnicity, gender and sexual orientation – with the most extensive evidence found in relation to socioeconomic status (SES) [3]. The growing use of e-cigarettes has led to speculation that these may offer an alternative to smoked tobacco among those who struggle to quit, including smokers from lower socioeconomic groups [6, 7]. We assessed the potential for electronic cigarettes and other non-combustible nicotine-containing products (NCNPs) to reduce inequalities in smoking by systematically reviewing evidence on their use by SES in countries at stage IV of the cigarette epidemic
Published Version (Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.