Modeling the public health impact of e-cigarettes on adolescents and adults

Abstract

Since the introduction of electronic cigarettes to the U.S. market in 2007, vaping prevalence has surged in both adult and adolescent populations. E-cigarettes are advertised as a safer alternative to traditional cigarettes and as a method of smoking cessation, but the U.S. government and health professionals are concerned that e-cigarettes attract young non-smokers. Here, we develop and analyze a dynamical systems model of competition between traditional and electronic cigarettes for users. With this model, we predict the change in smoking prevalence due to the introduction of vaping, and we determine the conditions under which e-cigarettes present a net public health benefit or harm to society.

RETRACTED ARTICLE: Population-level counterfactual trend modelling to examine the relationship between smoking prevalence and e-cigarette use among US adults

“…These lower-than-expected smoking prevalences, correlated with e-cigarette use, suggest population-level displacement of cigarettes by e-cigarettes, consistent with extant modelling literature [ 28 , 29 ]. A significant overall decline in adult cigarette smoking is observed, above what was otherwise expected, even for younger adults, among whom the reported ‘gateway’ effect is claimed to be strong and e-cigarette use is relatively high [ 1 ].…”

“…This further suggests the introduction of some effect on US adult smoking prevalence circa 2010 which is not accounted for by simple extrapolation of prior trends or by models based on population dynamics structures. The lowerthan-expected smoking prevalence of this study as well as Levy et al [27], and Wagner and Clifton [29] suggest that this unaccounted-for effect coincides with the introduction and use of e-cigarettes among adults.…”

“…This algorithm identified 2010 as the inflection point in NHIS cigarette smoking prevalence data. 2010 was also used as the cutoff year in cigarette and e-cigarette use trend modelling studies by Wagner and Clifton [29], and by Foxon and Selya [9], and Selya and Foxon [11]. Indeed, data from objective financial analyses by Wells Fargo and Agora Financial suggest minimal e-cigarette market presence prior to 2010 compared to after [37].…”

“…Another useful approach to determining the overall impact of e-cigarette use on smoking prevalence (i.e., the combination of gateway and substitution effects) at the population level is to model expected trends in smoking prevalence, and then assess whether the introduction of e-cigarettes was associated with a net deviation from the expected smoking prevalence, either an increase (gateway) or decrease (substitution). Such modeling studies have generally found that the introduction of e-cigarettes was associated with more rapid declines in smoking prevalence [ 9 , 26 – 29 ]. The present study uses this approach to assess whether and how much the introduction of e-cigarettes in the US may be correlated with declining smoking prevalence among adults in the following ways.…”

Meta-Analysis of E-Cigarette Price Elasticity

“…Smoking prevalence among youth declined faster after ENDS became widely available, [11][12][13][14] suggesting ENDS may have diverted nicotineseeking youth away from cigarette smoking. Similarly, smoking rates have declined more sharply among adults after ENDS became available, [15][16][17] particularly among younger adults with higher rates of ENDS use. Quasi-experimental economic studies also show an inverse relationship between cigarette smoking and ENDS use.…”