A moral problem – Barriers to e-cigarettes for smoking cessation

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Ensuring that vaping is cheaper than smoking is key to harm reduction among poorer communities in the United Kingdom, research by sociologist Frances Thirlway of the University of York has found.

The article “Nicotine addiction as a moral problem: Barriers to e-cigarette use for smoking cessation in two working-class areas in Northern England” was published in the

the Journal Social Science & Medicine.

Other research highlights are that: working-class smokers avoided e-cigarettes because of concern about addiction; those who did switch preferred a medical to a recreational model of use; users reduced nicotine content, minimised spending and avoided exotic flavours; and failure of willpower and role performance (thrift as care) created addiction shame.

Tobacco use in high-income countries correlates with socio-economic disadvantage, Thirlway writes. But although switching to electronic cigarettes could be a safer alternative, little is known about barriers to use.

Drawing on 18 months of data collection in two areas of Northern England in 2017-18 including ethnography and interviews with 59 smokers and e-cigarette users, I show that concern about continued nicotine addiction either deterred working-class smokers from switching to e-cigarettes or dictated the conditions of their use.

Research participants were unhappy about addiction both as loss of control experienced as moral failure and as neglect of financial responsibilities, that is, role performance failure in relation to family responsibilities, or what I call ‘thrift as care’.

They reduced the moral burden of addiction by lowering nicotine content, rejecting pleasure and minimising expenditure.

They chose the cheapest possible tobacco, switched from combusted tobacco to cheaper e-cigarettes and bought cheap e-cigarettes and liquids. For working-class smokers, minimising spend on what they perceive negatively as addiction may be a greater moral concern than reducing health risk.

I conclude that ensuring that vaping is significantly cheaper than smoking may be key to addressing health inequalities linked to tobacco use.

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


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