Observational studyHarm reduction journal2026
E-cigarette use and smoking-related disparities in England: an observational study using small area estimation and nonparametric regression.
Observational study in Harm reduction journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
4 authors.
Funding
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Abstract
backgroundThe uptake of e-cigarettes has been associated with reduced smoking in the UK, and British public health policy has sought to leverage e-cigarettes' potential to encourage cessation. Smoking harms are concentrated in disadvantaged communities in the UK. If e-cigarette use were similarly concentrated in these groups, that could help redress the inequity. On the other hand, disadvantaged communities may be slower to adopt e-cigarettes, and this could perpetuate or exacerbate smoking-related disparities.
methodsThis study examines the association between community-level e-cigarette prevalence and disparities in smoking between those employed in routine and manual occupations (R&M) and those employed in professional, managerial, intermediate, and other (PMI) occupations in England between 2013 and 2019. Using observational data, a small area estimation model is employed to form synthetic estimates of e-cigarette prevalence at the local level. The local socioeconomic gap in smoking (or smoking prevalence by occupation group) is then nonparametrically regressed on the estimated local e-cigarette prevalence.
resultsThe uptake of e-cigarettes is negatively associated with smoking rates in both occupational groups, affirming the role of e-cigarettes as an opportunity for harm reduction. However, the decrease in smoking is smaller for R&M workers. Thus, the uptake of e-cigarettes may have slightly increased the disparity between the two groups.
conclusionsSmall area estimation provides a useful way to synthesize local estimates of e-cigarette use when direct estimation is impossible. The analysis suggests that the uptake of e-cigarettes, while associated with cessation from smoking for both types of workers, may not immediately reduce smoking-related disparities. Additional investigation should examine why the uptake of e-cigarettes may have a less marked effect on smoking cessation among R&M workers and whether these results change as the e-cigarette market matures. The analysis highlights the need to ensure that cessation interventions delivering net benefits reach the communities whose need is greatest.
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