# The real challenge is to make e-cigarettes accessible for poor smokers



## Alex (7/9/15)

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*The real challenge is to make e-cigarettes accessible for poor smokers*
by Clive Bates

DOI: http://dx.doi.org/10.1016/S2213-2600(15)00334-3
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Based on her Comment on e-cigarettes,1 it is hard to avoid the impression that Lucie Kalousova would be happier if there was more smoking-related disease, providing it was more evenly distributed. That poorer groups face barriers to realising the benefits of substituting cigarettes for e-cigarettes is indisputable, but that is a reason to address those barriers, not to argue that e-cigarettes are of no value to poor smokers. By saving money, improving wellbeing, relieving chronic illness, and reducing risks of serious disease, a switch from smoking to vaping could be a major life-enhancing option for the poorest smokers. Low-income status is associated with a greater degree of nicotine dependence,2 and although the lowest income smokers are just as likely to try to quit smoking, they are about half as likely to succeed as the highest.3 It follows that a strategy to reduce harm to continuing nicotine users is a promising opportunity for poorer smokers, and not one that should be discarded because it is also popular with more affluent smokers.

Throughout the world, the public sector has approached this opportunity with denial or equivocation, apparently unable to break away from a medical model of smoking cessation. That is beginning to change, at least in England, with the publication of constructive guidance on e-cigarettes from the National Centre for Smoking Cessation and Training together with Public Health England.4 Further gains could be made through more proactive concern for the welfare of poor smokers: clear statements by trusted bodies affirming that vaping is likely to have at least a 95% lower risk of serious disease than smoking;5 the availability of high quality, easily accessible guidance on how to get started; assistance with the upfront microinvestment necessary to access the more effective vaping products with much lower overall costs; and, finally, creation of a supportive policy environment that does not penalise low-income e-cigarette users by imposing a blanket ban on vaping in public places and does not obstruct e-cigarettes from competing with the entrenched cigarette trade.





Alice S./BSIP/Science Photo Library
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I have been an advocate of tobacco harm reduction strategies for public health reasons since 1998 and I run a related blog called ‘Counterfactual’ (www.clivebates.com). I was Director of Action on Smoking and Health (UK) from 1997 to 2003.

*References*

Kalousova, L. E-cigarettes: a harm-reduction strategy for socioeconomically disadvantaged smokers?. Lancet Respir Med. 2015; 3: 598–600
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Pennanen, M, Broms, U, Korhonen, T et al. Smoking, nicotine dependence and nicotine intake by socio-economic status and marital status. Addict Behav. 2014; 39: 1145–1151
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Kotz, D and West, R. Explaining the social gradient in smoking cessation: it's not in the trying, but in the succeeding. Tob Control. 2009; 18: 43–46
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McRobbie, H and McEwen, A. E-cigarette briefing. National Centre for Smoking Cessation and Training, London; 2014http://www.ncsct.co.uk/usr/pub/e-cigarette_briefing.pdf. ((accessed Aug 18, 2015).)
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West, R and Brown, J. Electronic cigarettes: fact and faction. Br J Gen Pract. 2014; 64: 442–443
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source: http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(15)00334-3/fulltext

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