Vaping and socioeconomic inequalities in smoking cessation and relapse: a longitudinal analysis of the UK Household Longitudinal Study.

Background: Smoking is a key cause of socioeconomic health inequalities. Vaping is considered less harmful than smoking and has become a popular smoking cessation aid, and therefore has potential to reduce inequalities in smoking.

Methods: We used longitudinal data from 25 102 participants in waves 8-10 (2016 to early 2020) of the UK Household Longitudinal Study to examine how vaping affects socioeconomic inequalities in smoking cessation and relapse. Marginal structural models were used to investigate whether vaping mediates or moderates associations between educational attainment and smoking cessation and relapse over time. Multiple imputation and weights were used to adjust for missing data.

Results: Respondents without degrees were less likely to stop smoking than those with a degree (OR: 0.65; 95% CI 0.54-0.77), and more likely to relapse (OR: 1.74; 95% CI 1.37-2.22), but this inequality in smoking cessation was not present among regular vapers (OR: 0.99; 95% CI 0.54-1.82). Sensitivity analyses suggested that this finding did not hold when comparing those with or without any qualifications. Inequalities in smoking relapse did not clearly differ by vaping status.

Conclusions: Vaping may be especially helpful as a cessation aid for smokers without degree level education and therefore may help reduce inequalities in smoking. Nevertheless, other supports or aids may be needed to reach the most disadvantaged (ie, those with no qualifications) and to help people avoid relapse after cessation, though we did not find clear evidence suggesting that vaping would increase inequalities in relapse.