Presentation link: Nicotine addiction as a moral problem: barriers to e-cigarette use for smoking cessation in two working class areas in Northern England

Aims: This study explored barriers to use of electronic cigarettes for combusted tobacco cessation amongst smokers in two deprived areas of Northern England in order to understand whether e-cigarettes have the potential to address health inequalities linked to the inverse social gradient in smoking, and what factors might impede this.

Methods: The author carried out eighteen months of qualitative data collection in two areas of Northern England in 2017 and 2018 including ethnography and interviews with 59 smokers and e-cigarette users.

Results: Concern about continued addiction deterred working-class smokers from switching to e-cigarettes and determined how they used e-cigarettes. Reducing nicotine content, rejecting recreational aspects and minimising expenditure were crucial mechanisms by which they managed the shame associated with addiction. Working-class smokers switched to e-cigarettes largely to save money rather than health. They bought cheap tobacco and cheap e-cigarettes and liquids as a way of managing the shame of addiction experienced both as a failure of willpower and a failure of role performance in relation to family responsibilities i.e. thrift as care.

Conclusions: Ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities, not simply because disadvantaged smokers lack financial resources but because minimising spend on their addiction may be of greater moral concern to them than reducing risk to their health.