- Adults on low incomes found vapes and nicotine pouches highly convenient, allowing them to manage cravings in places where smoking is impossible.
- Both products significantly reduced cigarette use among participants, with some reporting they no longer craved cigarettes at all.
- Many participants believed vapes and nicotine pouches are “less harmful than cigarettes”, motivating them to switch.
- Nicotine delivery was slower than cigarettes, but most users adapted over time.
A new qualitative study led by Brown University finds that adults with low incomes can significantly cut back on cigarette smoking when they switch to vapes or nicotine pouches.
The research adds important evidence to a growing body of work showing that alternative nicotine delivery systems may help reduce smoking-related health inequalities.
The authors note that individuals with low incomes are “more likely to smoke”, face systemic barriers to quitting, and have “lower cessation rates in comparison to their more affluent counterparts.” These factors make harm-reduction tools especially relevant for people who are not ready or able to stop smoking completely.
The pilot randomised controlled trial, known as Tri-PEC, followed 26 adults who smoked daily and lived below 250 per cent of the US federal poverty level. Participants were given either vapes or nicotine pouches for eight weeks and interviewed about their experiences. Although not a quit-smoking programme, most reduced their cigarette use, and some switched almost entirely to the alternative product.
Convenience drives switching – crucial for people with limited time, mobility or stability
Participants repeatedly emphasised convenience as a major reason they used fewer cigarettes. One vape user said: “I don’t have to have lighters. I don’t have to go outside.. it doesn’t have an odour to it.”
For pouch users, the benefit was even greater, as pouches can be used discreetly anywhere. One participant explained: “I’m sitting in a movie.. I missed a lot cause I got to go outside and have a cigarette. But now I can just throw a pouch in.”
For people balancing shift work, caregiving, difficult commutes or unstable housing, being able to manage nicotine cravings without stepping outdoors made it far easier to replace cigarettes.
Strong craving relief with some smokers going days without cigarettes
Both products offered enough nicotine to replace cigarettes for long periods.
A pouch user said: “The pouch would help keep that nicotine urge.. way longer than just smoking a cigarette would.”
Some vape users described unexpectedly dramatic changes. One said: “After you smoke this.. you don’t crave cigarettes as much.. I haven’t smoked in like a month.”
For low-income adults – who, as the authors note, often smoke to cope with “chronic stress stemming from structural discrimination”- the ability to satisfy cravings quickly and cheaply made switching more manageable.
Seeing vapes and pouches as “less harmful” strengthened motivation to switch
Participants widely viewed alternative products as safer than combustible cigarettes. One vape user said: “With [vapes].. my lungs [aren’t] feeling tired in the morning.”
A pouch user told researchers: “I still think it’s less harmful than cigarettes.. that’s not smoke going into your lungs.”
This belief, combined with strong personal reasons – wanting to avoid the health problems they had seen in family and friends – encouraged participants to cut down.
Slower nicotine delivery was the main challenge, but most adapted
The primary difficulty for users was that nicotine from vapes and pouches took longer to take effect. As one vape participant put it: “I think it takes a little longer.. you have to puff on it a little longer than a cigarette.”
A pouch user noted they had to wait briefly before eating or speaking. But unlike concerns around safety or unfamiliarity, most participants reported that these challenges eased over time as they adjusted to the new products.
What this means for public health
The study’s authors conclude: “Participants indicated that both EC (electronic cigarettes) and ONP (oral nicotine pouches) helped them cut down on CC (combustible cigarette) use due to their convenience and ability to satisfy nicotine cravings.”
They emphasise that alternative nicotine products may be particularly valuable for low-income adults, who experience the highest smoking rates yet face the greatest barriers to quitting. By offering affordable, discreet and effective substitutes, vapes and nicotine pouches could help reduce long-standing health disparities.
