Holy smoke! Does income and the price of cigarettes impact use?

How much does price determine or influence cigarette use? As academic researchers, it is important for us to identify societal vulnerabilities and efforts needed to minimize the use of cigarette products. To get a better understanding of this, our team evaluated the frequency of vaping and smoking by annual household income.

Cigarette use is an important risk factor that can result in adverse health consequences and remains an important public health consideration. Price is often an important consideration in deciding between the use of various cigarette products that are available in the U.S. market. There are other important factors that can influence people’s health, and disparities in these factors may place certain individuals at particularly high risk of serious illness.

E-cigarettes can cost more than regular combustible cigarettes due to the availability of a wide variety of flavors and the price of e-cigarette liquid and vaping devices. On the other hand, a cigarette’s cost to the user is generally determined by frequency of use and tax rates. We found that the prevalence of vaping was lower among lower-income earners. In contrast, the prevalence of e-cigarette use was higher among higher-income earners with an increase in the prevalence of vaping over the same time period. Similar trends were noted for cigarette smoking, but these results were not statistically significant.

Why are these results important? Education, income and employment are all interrelated and generally lumped under the umbrella of socioeconomic status. Health metrics are generally better among those of a higher socioeconomic status due to improved medical literacy, health awareness, access to healthcare and the ability to afford healthy lifestyle choices which are often costly.

Our team hypothesizes that an individual’s income may directly affect the ability to purchase and therefore use e-cigarettes. More educated individuals who are typically of a higher socioeconomic status may also perceive e-cigarettes as safer alternatives compared to cigarette smoking and be more likely to vape. People of a lower socioeconomic status, who may not be able to afford e-cigarettes, may resort to cigarettes instead. Lower income earners may have less access to healthcare and a higher number of cardiovascular risk factors, making them particularly susceptible to the health effects of cigarette use.

What are the implications of our findings? We believe our work can guide future research focused on e-cigarette marketing campaigns which target high income earners and be helpful in examining the messaging that is used to encourage e-cigarette use in this income stratum. Future studies should also determine how much price factors into the decision between e-cigarettes versus cigarettes. These results can be used by policy makers for regulating the marketing and sales of e-cigarettes.

To some, this may bring up a question – are e-cigarettes safer than traditional cigarette products? The long-term heart and lung health effects of e-cigarettes are currently not fully known or understood. Marketing strategies promoting these products as safer alternatives compared to cigarette smoking are misleading and could compromise public health gains that have been made in recent decades towards curbing cigarette use by once again normalizing the act of smoking in society. In any case, our team strongly encourages the avoidance and cessation of any cigarette product due to the higher risk of cardiovascular and lung health effects.

Our overall hope is that by learning more about the different factors that impact the choice between smoking and vaping we can better deter people from these behaviors and improve public health. This may be especially important among younger adults, in whom vaping may be a gateway to smoking and use of other recreational drugs. Baylor College of Medicine recognizes the gravity of this problem and has previously addressed the important issue of youth smoking and vaping. Baylor has offered solutions to limit the marketing and sale of cigarette products and strategies aimed at curbing or preventing their use.   

–By Mahmoud Al Rifai, M.D., M.P.H Cardiovascular Medicine fellow physician PGY-5 at Baylor College of Medicine and Salim S. Virani, M.D., Ph.D. professor, Section of Cardiovascular Research