Association of Socioeconomic Position With e-Cigarette Use Among Individuals Who Quit Smoking in England, 2014 to 2019

Abstract

Importance: e-Cigarette use among individuals who quit smoking more than 1 ago in England is highest among those with lower socioeconomic position and may affect smoking-related health inequalities, depending on whether the devices protect against relapse to tobacco smoking.

Objectives: To assess trends in current e-cigarette use by socioeconomic position among individuals who have quit smoking for at least 1 year, to capture postcessation initiation among those who quit within the past year and did not use an e-cigarette in their most recent quit attempt (representing recent initiation), and to capture postcessation initiation among those who quit smoking before e-cigarettes became popular in 2011 (representing late initiation).

Design, setting, and participants: This cross-sectional study of 34 442 adults (≥16 years) who formerly smoked used data from the Smoking Toolkit Study (conducted 2014-2019), a nationally representative, monthly, repeated, cross-sectional, household survey of smoking and smoking cessation in England. Data analysis was conducted in December 2019.

Exposures: Socioeconomic position based on occupation.

Main outcomes and measures: Current self-reported e-cigarette use.

Results: Weighted samples consisted of 19 297 individuals who had quit smoking for at least 1 year (mean [SD] age, 59.2 [17.0] years; 9024 [46.8%] women), 904 who quit in the past year and did not use an e-cigarette in their most recent quit attempt (mean [SD] age, 41.6 [17.1] years; 445 [49.3%] women), and 14 241 who quit before 2011 (mean [SD] age, 63.6 [14.6] years; 6619 [46.5%] women). Among those who had quit smoking fot at least 1 year, e-cigarette use increased from 3.3% (95% CI, 2.7%-4.0%) in 2014 to 10.4% (95% CI, 9.2%-11.6%) in 2019 among all socioeconomic groups. Use was more common among those with lower socioeconomic position than those with higher socioeconomic position (odds ratio, 1.59; 95% CI, 1.05-2.40; P = .03). Regarding postcessation initiation of e-cigarettes, among those who quit smoking in the past year and did not use an e-cigarette in their most recent quit attempt, 7.1% (95% CI, 5.9%-9.3%) initiated e-cigarette use after smoking cessation, and there was no clear trend over time or any difference according to socioeconomic position. Among those who quit before 2011, there was an overall increase in use of e-cigarettes (0.8% [95% CI, 0.5%-1.2%] in 2014 to 2.1% [95% CI, 1.4%-2.8%] in 2019), but there were no apparent differences in use across socioeconomic position.

Conclusions and relevance: In this study, e-cigarette use increased among all participants from 2014 to 2019 but was highest among those with lower socioeconomic position. Continued monitoring of this socioeconomic patterning is important because if e-cigarettes do not confer the public health benefit of protection against relapse to smoking, then equity-negative disadvantages of long-term usage are more likely. Late, but not recent, postcessation initiation of e-cigarettes has increased over time but is not likely to affect smoking-related health inequalities because there were no differences by socioeconomic position.

Figure.. Trends in e-Cigarette (EC) and Nicotine Replacement Therapy (NRT) Use Among Individuals Who Quit Smoking in England, 2014-2019

ABC1 indicates higher and intermediate managerial, administrative and professional, supervisory occupations, and clerical and junior managerial occupations; and C2DE, semiskilled and unskilled manual workers, state pensioners, casual and lowest-grade workers, and unemployed with state benefits only. Whiskers indicate 95% CIs.