Smoking for the poor and vaping for the rich? Distributional concerns for novel nicotine delivery systems

•We compare income-related inequalities in smoking vs smoking and NDS.•We estimate the source of income-related inequalities in the use of NDS.•Pro-poor inequalities in smoking are greater than when smoking and NDS are combined.•Significant pro-rich inequalities in use of e-cig and other NDS are found.•A higher take-up of NDS among richer, younger and better-educated smokers is found.

We compare income-related inequalities in the use of traditional smoking and of novel nicotine delivery systems (NDS), such as e-cigarettes and other smokeless products, and we apply a regression-based decomposition method for rank-dependent inequality measures to estimate the source of inequalities in the use of NDS. Using data from the 2013 wave of the Health Survey for England, we find that pro-poor inequality is greater for traditional smoking than for smoking and the smokeless products combined. Significant pro-rich inequalities are found in e-cig and other NDS consumption due to higher take-up among richer, younger and better-educated smokers. These patterns might lead to a long-run equilibrium with both higher average health and higher socioeconomic health inequalities.