AVA Synopsis:
The authors employed a dynamic simulation model to track US adults over time and examined cigarette smokers, former smokers, and never smokers. The authors simulated the effects of smoking initiation as a result of e-cigarette use and “cessation on life-years saved or lost to the year 2070,” due the use of e-cigarettes.
The authors assumed that e-cigarettes and vapor products increase smoking initiation by 2 percent and smoking cessation by 10 percent. A sensitivity analysis was included that raised the smoking initiation rate to 6 percent and decreased the smoking cessation rate to 5 percent.
In the best-case scenario, the authors estimated that the US population would gain almost 3.3 million life-years by 2070. In the worst-case scenario, with increased initiation and decreased cessation, the authors still found the US would gain over 580,000 life-years by 2070.
The authors find that the effectiveness of e-cigarettes as a smoking cessation tool “exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators.”
Implications:
Many policymakers fear that youth e-cigarette use will lead to increased youth combustible cigarette use, despite many studies that have found youth combustible cigarette use to be an all-time low. This study adds to that literature and provides further evidence that e-cigarettes are a useful smoking cessation tool.
Abstract:
Introduction: The public health community is divided regarding electronic cigarettes. Skeptics emphasize potential vaping-induced increases in smoking among children and possible health hazards for adults. Enthusiasts consider e-cigarettes much less dangerous than smoking and believe they increase adult smoking cessation. We compare potential health benefits and costs to put these two perspectives in context.
Methods: Using a dynamic model that tracks the US adult population’s smoking status and smoking-related deaths over time, we simulate the effects of vaping-induced smoking initiation and cessation on life-years saved or lost to the year 2070. The base case assumes that vaping annually increases smoking initiation by 2% and smoking cessation by 10%. Sensitivity analyses raise the initiation rate increase to 6% while decreasing the cessation rate increase to 5%. Sensitivity analyses also test vaping’s reducing the health benefits of quitting smoking by 10%.
Results: With base-case assumptions, the population gains almost 3.3 million life-years by 2070. If all people who quit smoking by vaping lose 10% of the benefit of quitting smoking, the net life-year gain falls to 2.4 million. Under worst-case assumptions, in which vaping increases smoking initiation by 6% and cessation by 5%, and vaping-induced quitters lose 10% of the health benefits, the population gains over 580000 life-years.
Conclusion: Potential life-years gained as a result of vaping-induced smoking cessation are projected to exceed potential life-years lost due to vaping-induced smoking initiation. These results hold over a wide range of plausible parameters.
Implications: Our analysis strongly suggests that the upside health benefit associated with e-cigarettes, in terms of their potential to increase adult smoking cessation, exceeds their downside risk to health as a result of their possibly increasing the number of youthful smoking initiators. Public messaging and policy should continue to strive to reduce young people’s exposure to all nicotine and tobacco products. But, they should not do so at the expense of limiting such products’ potential to help adult smokers to quit.
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