E-Cigarette Use and Onset of First Cigarette Smoking among Adolescents: An Empirical Test of the ‘Common Liability’ Theory

Cheng, Hui G.; Largo, Edward G.; Gogova, Maria

doi:10.2139/ssrn.3422321

Cited by 5 publications

(8 citation statements)

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“…Strict regulation has often been justified for the sake of nicotine-naïve adolescents [ 20 ], due to fears of a “gateway” effect causing nicotine dependence and later combustible cigarette smoking [ 35 ] among youth who otherwise would not have smoked. However, given recent research supporting a common-liability hypothesis which postulates that the apparent relationship between e-cigarette use and smoking is attributable to a pre-existing liability for nicotine use [ 37 , 38 ], the question of primary prevention becomes relevant [ 41 ]. That is, for youth who have a propensity to use nicotine, it is important to direct them to a less harmful product.…”

Section: Discussionmentioning

confidence: 99%

“…The motivation for restricting adolescent e-cigarette use stems from fears of e-cigarettes acting as a “gateway” to tobacco use, including combustible cigarettes [ 34 , 35 ]. Evidence for the gateway mechanism includes adolescents who use e-cigarettes being at much higher risk for subsequent smoking relative to adolescents who have not used e-cigarettes [ 35 , 36 ]; however, these adolescents have pre-existing risk factors that predisposed them to smoking, suggesting they would have gone on to combustible cigarettes anyway [ 37 , 38 ]. Population trend modeling studies have also raised doubts about a gateway effect, as declines in smoking among youth have accelerated after the appearance of e-cigarettes [ 39 , 40 ].…”

Section: Introductionmentioning

confidence: 99%

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Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

Selya

2021

Harm Reduct J

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Background Electronic cigarettes (“e-cigarettes”) have altered tobacco smoking trends, and their impacts are controversial. Given their lower risk relative to combustible tobacco, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the USA. Methods A system dynamics simulation model was constructed, with separate aging chains representing people in different stages of use (both of combustible cigarettes and e-cigarettes). These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of individuals who smoke, chosen to reduce the tobacco-attributable death rate (i.e., mostly combustible cigarette-attributable, but conservatively allowing e-cigarette-attributable deaths) to that due to all accidents in the general population. The policy is two-fold, removing existing e-liquid flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on tobacco smoking occur through three mechanisms: (1) diversion from ever initiating smoking; (2) reducing progression to established smoking; and (3) increasing smoking cessation. An important unintended effect of possible death from e-cigarettes was conservatively included. Results The base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. Simulations suggest tobacco smoking could be reduced to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) could delay and weaken the effect of the policy by up to 62% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time “shock” introduced by policy changes. Conclusions The simulation suggests that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current evidence that e-cigarettes offset or divert from smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles can usefully inform policy design. Ongoing research is needed, given continuing changes in e-cigarette use prevalence, new policies being enacted for e-cigarettes, and emerging evidence for substitution effects between combustible cigarettes and e-cigarettes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

Selya

2021

Harm Reduct J

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“…On the other hand, e-cigarette use among adolescents and/or novice users remains controversial, due to fears of a "gateway" effect whereby e-cigarettes cause youth to become nicotine-dependent and increase their risk of later conventional cigarette smoking (21). However, given recent research supporting a common-liability hypothesis which postulates that the apparent relationship between e-cigarette use and smoking is attributable to a pre-existing liability for nicotine use (23,24), the question of primary prevention becomes relevant (27). That is, for youth who have a propensity to use a nicotine product, it is important to direct them to a less harmful product.…”

Section: Discussionmentioning

confidence: 99%

Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

Selya¹

2020

Preprint

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Abstract Background: Electronic cigarettes (“e-cigarettes”) have altered nicotine use trends, and their impacts are controversial. Given their reduced risk profile relative to conventional cigarettes, e-cigarettes have potential for harm reduction. The current study presents a simulation-based analysis of an e-cigarette harm reduction policy. Methods: A system dynamics simulation model was constructed, with separate aging chains for cigarette smokers and e-cigarette users. These structures work together with a policy module to close the gap between actual (simulated) and a goal number of cigarette smokers, chosen to reduce the nicotine-attributable death rate to the accidental death rate. The policy is two-fold, first removing existing regulations on e-cigarettes (e.g. flavor bans) and second providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing smoking behavior and thus progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the nicotine-related mortality accordingly with an increase in nicotine users due to e-cigarettes.Results: The base-case model replicated the historical exponential decline in conventional cigarette smoking and the exponential increase in e-cigarette use since their introduction circa 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Policy scenarios that included realistic, practical obstacles to implementation delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the same time point in the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

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“…On the other hand, e-cigarette use among adolescents and/or novice users remains controversial, due to fears of a "gateway" effect whereby e-cigarettes cause youth to become nicotine-dependent and increase their risk of later conventional cigarette smoking (21). However, given recent research supporting a common-liability hypothesis which postulates that the apparent relationship between e-cigarette use and smoking is attributable to a pre-existing liability for nicotine use (23,24), the question of primary prevention becomes relevant (27). That is, for youth who have a propensity to use a tobacco product, it is important to direct them to a less harmful product.…”

Section: Discussionmentioning

confidence: 99%

“…The motivation for restricting adolescent ecigarette use stems from fears of e-cigarettes acting as a "gateway" to tobacco use, including conventional cigarettes (20,21). Evidence for the gateway mechanism includes e-cigarette users being at much higher risk for subsequent conventional smoking relative to nonusers (21,22); however, these adolescents have pre-existing risk factors that predisposed them to smoking, suggesting they would have gone on to use conventional cigarettes anyway (23,24). Population trend modeling studies have also raised doubts about a gateway effect, as declines in conventional smoking among youth have accelerated after the appearance of e-cigarettes (25,26).…”

Section: Introductionmentioning

confidence: 99%

Reducing the Smoking-Related Health Burden in the US through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

Selya

2020

Preprint

View full text Add to dashboard Cite

Background: Electronic cigarettes (“e-cigarettes”) have altered tobacco use trends, and their impacts are controversial. Given their lower risk relative to conventional cigarettes, e-cigarettes have potential for harm reduction. This study presents a simulation-based analysis of an e-cigarette harm reduction policy set in the US. Methods: A system dynamics simulation model was constructed, with separate aging chains representing different stages of use for both cigarette smokers and e-cigarette users. These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of cigarette smokers, chosen to reduce the tobacco-attributable death rate to that due to all accidents in the general population. The policy is two-fold, removing existing flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. Effects of e-cigarettes on conventional smoking occurs through three mechanisms: 1) diversion from ever initiating conventional smoking; 2) reducing progression to established smoking; and 3) increasing smoking cessation. An important unintended effect was included, which increases the tobacco-related mortality accordingly with an increase in nicotine users due to e-cigarettes. Results: The base-case model replicated the historical exponential decline in smoking and the exponential increase in e-cigarette use since 2010. The ideal-case policy was able to reduce conventional smoking to the goal level approximately 40 years after implementation. Implementation obstacles (time delays, political resistance, and budgetary constraints) delayed and weakened the effect of the policy by up to 95% in the worst case, relative to the ideal-case scenario; however, these discrepancies substantially decreased over time in dampened oscillations as negative feedback loops stabilize the system after the one-time “shock” introduced by policy changes. Conclusions: Current findings demonstrate that the promotion of e-cigarettes as a harm-reduction policy is a viable strategy, given current knowledge of e-cigarettes’ effects on conventional smoking. Given the strong effects of implementation challenges on policy effectiveness in the short term, accurately modeling such obstacles is essential in policy design. Ongoing research is needed with forthcoming data on e-cigarette use prevalence and possible effects on cigarette smoking.

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E-Cigarette Use and Onset of First Cigarette Smoking among Adolescents: An Empirical Test of the ‘Common Liability’ Theory

Cited by 5 publications

References 0 publications

Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

Reducing the smoking-related health burden in the USA through diversion to electronic cigarettes: a system dynamics simulation study

Reducing the Smoking-Related Health Burden through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

Reducing the Smoking-Related Health Burden in the US through Diversion to Electronic Cigarettes: A System Dynamics Simulation Study

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