Background: Smoking contributes significantly to socioeconomic health inequalities. Vaping has captured much interest as a less harmful alternative to smoking, but may be harmful relative to non-smoking. Examining inequalities in vaping by smoking status, may offer insights into potential impacts of vaping on socioeconomic inequalities in health.
Methods: Data were from 3291 youth (aged 10-15) and 35,367 adults (aged 16+) from wave 7 (2015-17) of the UK Household Longitudinal Study. In order to adjust for biases that could be introduced by stratifying on smoking status, marginal structural models were used to estimate controlled direct effects of an index of socioeconomic disadvantage (incorporating household education, occupation and income) on vaping by smoking status (among adults and youth), adjusting for relevant confounders and for selection into smoking states. We also estimated controlled direct effects of socioeconomic disadvantage on being an ex-smoker by vaping status (among adult ever-smokers; n = 18,128).
Results: Socioeconomic disadvantage was associated with vaping among never smoking youth (OR for a unit increase in the socioeconomic index: 1.17; 95%: 1.03-1.34), and among ex-smoking adults (OR: 1.17; 95% CI: 1.09-1.26), with little to no association among never smoking (OR: 0.98; 95% CI: 0.91-1.07) and current smoking (OR: 1.00; 95% CI: 0.93-1.07) adults. Socioeconomic disadvantage was also associated with reduced odds of being an ex-smoker among adult ever-smokers, but this association was moderately weaker among those who vaped (OR: 0.88; 95% CI: 0.82-0.95) than those who did not (OR: 0.82; 95% CI: 0.80-0.84; p-value for difference = 0.081).
Conclusions: Inequalities in vaping among never smoking youth and adult ex-smokers, suggest potential to widen health inequalities, while weaker inequalities in smoking cessation among adult vapers indicate e-cigarettes could help narrow inequalities. Further research is needed to understand the balance of these opposing potential impacts, and how any benefits can be maximised whilst protecting the vulnerable.
Keywords: Adults; E-cigarettes; Smoking; Socioeconomic position; Vaping; Youth.