Poor smokers and harm reduction: why smoking still makes sense

Dr Frances ThirlwayUniversity of York

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Fifth Global Forum on Nicotine - ‘Rethinking Nicotine’Marriott Hotel, Warsaw, Poland,

14th to 16th June 2018

Cheap cigarette shop, Newcastle - Image: art crimes 2010 (CC BY-NC-ND)http://www.flickr.com/photos/artcriminal/4519058738

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About me

• University of York Research Fellow (Sociology Dept); smoking cessation in working-class areas

• Cancer Research UK-funded project:e-cigarettes, health inequalities and smoking cessation

• Fieldwork in North East and North West of England, pilot fieldwork in Northern France

• No industry funding (tobacco, pharmaceutical, e-cigarette, other)

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Barriers to vaping for poor smokers:problems with e-cigarettes 1Expense

• Capital cost of starter kit• Cost as risk = tobacco budget spent• Easily broken, dropped, lost or stolen

Confusing information

• health effects• addiction • no advice from non-specialist shops and online• variable advice in specialist shops• how much nicotine

E-cigarette market stall, North East England – photo F Thirlway

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E-cigarette market stall, North East England –photo F Thirlway

Some stalls give excellent advice to vapers

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Barriers to vaping for poor smokers:problems with electronic cigarettes 2

Difficult to use• unreliability: spills, leaks, burning out the coil etc.

• fiddly: requires manual dexterity

• running out of charge

• running out of liquid

• parts not compatible

• new independent pod vapes easier BUT more expensive

Cigarette butts and e-liquid box outside Working Men’s Club, North East England – F Thirlway

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Cigarette butts and e-liquid box outside Working Men’s Club, North East England – F Thirlway

does this show the ratio of smokers to vapers…?

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… but do these barriers apply to poor smokers more than to other smokers?

Confusing information? No

Difficulty of use? No

Expense? Not as much as you might think…

‘research participants bought and sold e-cigarettes, tobacco and other goods mainly through informal outlets and personal networks which are not easily captured by official figures’ (Thirlway 2016)

Harry’s ‘oils’ - Working Men’s Club, North East England – F Thirlway

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‘a friend gave me that one’

But what if the problem isn’t moving TO vaping, but moving AWAY FROM smoking…

Barriers to smoking for poor smokers 3:why smoking still makes sense

• Denormalisation, what denormalisation?= rich & poor areas: 5% versus 35% smoking prevalence

• Smoking still part of fabric of everyday life= memories of cigarette coupons, sponsorship etc

• Smoking cessation as betrayal of sociality= associated with sociality and hospitality

• Smoking cessation as pretentious

= attention to health seen as feminized & middle-class by working-class men

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Sampoerna ad, Indonesia 2013 (Philip Morris)

Camel ad, USA 1970s (R J Reynolds)

Tobacco companies have not changed

Harm reduction and poor smokers

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Smoking cessation as betrayal of sociality= make vaping a sociable alternative to smoking: avoid unnecessary restrictions

Smoking cessation as pretentious= avoid medicalisation, emphasise pleasure, maximise variety

Tobacco companies have not changed= work with the independent vape industry

Some of Adam (electrician)’s collection

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Thank youBottorff, J.L., Carey, J., Mowatt, R., Varcoe, C., Johnson, J.L., Hutchinson, P., et al. (2009). Bingo halls and smoking: Perspectives of First Nations women. Health & Place, 15, 1014-1021.

Kohrman, M. (2007). Depoliticizing tobacco's exceptionality: Male sociality, death and memory-making among Chinese cigarette smokers. China Journal, 58, 85-109.

Mao, A., Yang, T., Bottorff, J.L., & Sarbit, G. (2014). Personal and social determinants sustaining smoking practices in rural China: a qualitative study. International Journal for Equity in Health, 13.

Thirlway, F. (2018) How will e-cigarettes affect health inequalities? Applying Bourdieu to smoking and cessation. International Journal of Drug Policy, vol 54 p. 99-104

Thirlway, F. (2016) Everyday tactics in local moral worlds: e-cigarette practices in a working-class area of the UK. Social Science & Medicine; 170: 106-113

Thirlway, F. (2015) Re: Why e-cigarettes are dividing the public health community. Rapid response, BMJ, 8 July 2015

White, C., Oliffe, J.L., & Bottorff, J.L. (2012). Fatherhood, Smoking, and Secondhand Smoke in North America: An Historical Analysis With a View to Contemporary Practice. American Journal of Mens Health, 6, 146-155.

Joe’s cigarettes & lighter ready for the day

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In memory of

Martin Pickering

Friend, research participant, bus driverSmoked Lambert & Butler for 40 years

Died age 62

RIP

In memory of

Martin Pickering

Friend, research participant, bus driverSmoked Lambert & Butler for 40 years

Died age 62

RIP