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He Y, Liber A, Driezen P, Thompson ME, Levy DT, Fong GT, Cummings KM, Shang C. How do users compare the costs between nicotine vaping products and cigarettes? Findings from the 2016-2020 International Tobacco Control United States surveys. Addiction 2024; 119:885-897. [PMID: 38186201 PMCID: PMC11009094 DOI: 10.1111/add.16425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND AND AIMS Nicotine vaping products (NVPs) can potentially help adult tobacco users quit smoking. This study evaluated how adult consumers compare the costs between NVPs and cigarettes. METHOD We used data from the US arm of the 2016-2020 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys to perform a multinomial logit model with two-way fixed effects to measure how perceived cost comparisons are associated with NVP and cigarette taxes, use patterns, NVP device types and individual sociodemographic factors. RESULTS Higher cigarette taxes are associated with a greater likelihood of perceiving NVPs and cigarettes as costing the same for the overall population and among people who exclusively smoke, and a lower likelihood of perceiving NVPs as more expensive among people who exclusively vape, compared with lower cigarette taxes. Pre-filled cartridge and tank users are more likely to perceive NVPs as less expensive than cigarettes, compared with people who use other types of NVPs. The associations between taxes and perceived cost comparison were more pronounced among males, younger and low-income populations. CONCLUSIONS Higher cigarette taxes are associated with perceived financial incentives for nicotine vaping products (NVPs) over cigarettes, whereas NVP taxes are not associated with perceived cost comparison between NVPs and cigarettes.
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Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Alex Liber
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC, USA
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Mary E. Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON, Canada
| | - David T. Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Ce Shang
- Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
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Brouwer AF, Jeon J, Jimenez-Mendoza E, Land SR, Holford TR, Friedman AS, Tam J, Mistry R, Levy DT, Meza R. Changing patterns of cigarette and ENDS transitions in the USA: a multistate transition analysis of adults in the PATH Study in 2017-2019 vs 2019-2021. medRxiv 2023:2023.10.20.23297320. [PMID: 37905028 PMCID: PMC10614990 DOI: 10.1101/2023.10.20.23297320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction The use of cigarettes and electronic nicotine delivery system (ENDS) has likely changed since 2019 with the rise of pods and disposables, the outbreak of lung injuries related to vaping THC, flavor bans, and the COVID pandemic. We analyzed patterns of initiation, cessation, and transitions between cigarettes, ENDS, and dual use before and after 2019. Methods Using the Population Assessment of Tobacco and Health (PATH) Study, we applied a multistate transition model to 28,061 adults in Waves 4-5 (2017-19) and 24,751 adults in Waves 5-6 (2019-21), estimating transition rates for initiation, cessation, and switching products for each period overall and by age group. Results Cigarette initiation among adults who never used either product decreased from 2017-19 to 2019-21, but ENDS initiation did not significantly change. Persistence of ENDS-only use remained high, with 75-80% still using ENDS only after 1 year. Cigarette-only use transitions remained similar, with about 88% remaining, 7% transitioning to non-current use, and 5% transitioning to dual or ENDS-only use. In contrast, dual use to ENDS-only transitions increased from 9.5% (95%CI: 7.3-11.7%) to 20.1% (95%CI: 17.5-22.7%) per year from 2017-19 to 2019-21, decreasing the persistence of dual use. The dual use to cigarette-only transition remained at about 25%. These changes were qualitatively similar across adult age groups, though adults ages 18-24 years exhibited the highest probability of switching from cigarette-only use to dual use and from dual use to ENDS-only use. Conclusions Persistence of ENDS use among adults remained high in 2019-21, but a larger fraction of dual users transitioned to ENDS-only use compared to 2017-19. Because the fraction of cigarette-only users switching to dual use remained low, the public health implications of the increased dual use to ENDS-only transition are minimal.
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Affiliation(s)
- Andrew F. Brouwer
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Stephanie R. Land
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | | | - Abigail S. Friedman
- Department of Health Management and Policy, Yale University, New Haven, CT, United States
| | - Jamie Tam
- Department of Health Management and Policy, Yale University, New Haven, CT, United States
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
| | - David T. Levy
- Department of Oncology, Georgetown University, Washington, DC, United States
| | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Vu GT, Stjepanović D, Sun T, Leung J, Chung J, Connor J, Thai PK, Gartner CE, Tran BX, Hall WD, Chan G. Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies. Tob Control 2023:tc-2022-057748. [PMID: 37295941 DOI: 10.1136/tc-2022-057748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation. DATA SOURCE AND STUDY SELECTION Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included. DATA EXTRACTION Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively. DATA SYNTHESIS The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence. CONCLUSIONS A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.
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Affiliation(s)
- Giang T Vu
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tianze Sun
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Jack Chung
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason Connor
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Discipline of Psychiatry, The University of Queensland, Brisbane, Queensland, Australia
| | - Phong K Thai
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Viet Nam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wayne D Hall
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
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Levy DT, Cadham CJ, Li Y, Yuan Z, Liber AC, Oh H, Travis N, Issabakhsh M, Sweanor DT, Sánchez-Romero LM, Meza R, Cummings KM. A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products. Int J Environ Res Public Health 2022; 19:13431. [PMID: 36294011 PMCID: PMC9602493 DOI: 10.3390/ijerph192013431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Christopher J. Cadham
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Alex C. Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Hayoung Oh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
| | - David T. Sweanor
- Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Faculty of Law, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | | | - Rafael Meza
- Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA
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Levy DT, Gartner C, Liber AC, Sánchez-Romero LM, Yuan Z, Li Y, Cummings KM, Borland R. The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products. Nicotine Tob Res 2022; 25:486-497. [PMID: 36073731 PMCID: PMC9910149 DOI: 10.1093/ntr/ntac210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND We model the potential impact of relaxing current nicotine vaping product (NVP) restrictions on public health in Australia. AIMS AND METHODS A Restricted NVP Scenario was first developed to project current smoking and vaping rates, where a U.S. smoking model was calibrated to recent Australian trends. To model less restrictive NVP policies, a Permissive NVP Scenario applied rates of switching from smoking to vaping, initiation into NVP and cigarette use, and cessation from smoking and vaping based on U.S. trends. The model measures vaping risk relative to the excess mortality rate of smoking. The public health impacts are measured as the difference between smoking- and vaping-attributable deaths (SVADs) and life years lost (LYLs) in the Restricted and Permissive NVP Scenarios. Sensitivity analysis is conducted regarding the NVP excess risk and other factors. RESULTS Assuming an NVP excess risk of 5% that of smoking, 104.2 thousand SVADs (7.7% reduction) and 2.05 million LYLs (17.3% reduction) are averted during 2017-2080 in the Permissive NVP Scenario compared to the Restricted NVP Scenario. Assuming 40% NVP excess risk, 70 thousand SVADs and 1.2 million LYLs are averted. The impact is sensitive to the rate at which smokers switch to NVPs and quit smoking, and relatively insensitive to the smoking initiation and NVP initiation and cessation rates. CONCLUSIONS The model suggests the potential for public health gains to be achieved by relaxing NVP access regulations. However, the model would benefit from better information regarding the impact of NVPs on smoking under a relaxation of current restrictions. IMPLICATIONS Australia has implemented a strong array of cigarette-oriented policies, but has restricted access to NVPs. The Smoking and Vaping Model offers a framework for modeling hypothetical policy scenarios. The Australian model shows the potential for public health gains by maintaining cigarette-oriented policies while relaxing the current restrictive NVP policy. Modeling results under a permissive NVP policy are particularly sensitive to the estimated rates of smoking cessation and switching to vaping, which are not well established and will likely depend on past and future cigarette-oriented policies and the specific NVP policies implemented in Australia.
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Affiliation(s)
- David T Levy
- Corresponding Author: David T. Levy PhD, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA. Telephone: 301-275-2396; fax: 202-687-0305; E-mail:
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | | | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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van der Eijk Y, Tan Ping Ping G, Ong SE, Tan Li Xin G, Li D, Zhang D, Min Shuen L, Kee Seng C. E-Cigarette Markets and Policy Responses in Southeast Asia: A Scoping Review. Int J Health Policy Manag 2022; 11:1616-1624. [PMID: 33906338 PMCID: PMC9808234 DOI: 10.34172/ijhpm.2021.25] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/13/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The global e-cigarette market has proliferated and is increasingly dominated by transnational tobacco companies. While Southeast Asian countries have received relatively little attention in e-cigarette research, the region represents an area of potentially untapped growth for the industry. We review the e-cigarette situation in Southeast Asia in terms of the e-cigarette markets, advertising and promotion of e-cigarettes, reported health impacts of e-cigarette use, and policy responses in the region. METHODS We examined e-cigarette market data from the Euromonitor Global Market Information Database (GMID) Passport database, searched in the academic literature, grey literature and news archives for any reports or studies of e-cigarette related diseases or injuries, e-cigarette marketing, and e-cigarette policy responses in Southeast Asian countries, and browsed the websites of online e-cigarette retailers catering to the region's active e-cigarette markets. RESULTS In 2019, e-cigarettes were sold in six Southeast Asian markets with a total market value of $595 million, projected to grow to $766 million by 2023. E-commerce is a significant and growing sales channel in the region, with most of the popular or featured brands in online shops originating from China. Southeast Asian youth are targeted with a wide variety of flavours, trendy designs and point of sale promotions, and several e-cigarette related injuries and diseases have been reported in the region. Policy responses vary considerably between countries, ranging from strict bans to no or partial regulations. CONCLUSION Although Southeast Asia's e-cigarette market is relatively nascent, this is likely to change if transnationals invest more heavily in the region. Populous countries with weak e-cigarette regulations, notably Indonesia, Malaysia, Vietnam and the Philippines, are desirable targets for the transnationals. Regulatory action is needed to prevent e-cigarette use from becoming entrenched into these societies, especially among young people.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Grace Tan Ping Ping
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Suan Ee Ong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Research for Impact, Singapore, Singapore
| | - Grace Tan Li Xin
- Department of Political Science, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - David Li
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Dijin Zhang
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Loo Min Shuen
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Chia Kee Seng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Wilson N, Summers JA, Ait Ouakrim D, Hoek J, Edwards R, Blakely T. Improving on estimates of the potential relative harm to health from using modern ENDS (vaping) compared to tobacco smoking. BMC Public Health 2021; 21:2038. [PMID: 34749706 PMCID: PMC8577029 DOI: 10.1186/s12889-021-12103-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the harm to health from electronic nicotine delivery systems (ENDS) compared to smoked tobacco remains highly uncertain, society and governments still need to know the likely range of the relative harm to inform regulatory policies for ENDS and smoking. METHODS We identified biomarkers with specificity of association with different disease groupings e.g., volatile organic compound (VOCs) for chronic obstructive pulmonary disease; and tobacco-specific N´-nitrosamines (TSNAs) and polycyclic aromatic hydrocarbons (PAHs) for all cancers. We conducted a review of recent studies (post January 2017) that compared these biomarkers between people exclusively using ENDS and those exclusively smoking tobacco. The percentage differences in these biomarkers, weighted by study size and adjusted for acrolein from other sources, were used as a proxy for the assumed percentage difference in disease harm between ENDS and smoking. These relative differences were applied to previously modelled estimates of smoking-related health loss (in health-adjusted life-years; HALYs). RESULTS The respective relative biomarker levels (ENDS vs smoking) were: 28% for respiratory diseases (five results, three studies); 42% for cancers (five results, four studies); and 35% for cardiovascular (seven results, four studies). When integrated with the HALY impacts by disease, the overall harm to health from ENDS was estimated to be 33% that of smoking. CONCLUSIONS This analysis, suggests that the use of modern ENDS devices (vaping) could be a third as harmful to health as smoking in a high-income country setting. But this estimate is based on a limited number of biomarker studies and is best be considered a likely upper level of ENDS risk given potential biases in our method (i.e., the biomarkers used being correlated with more unaccounted for toxicants in smoking compared to with using ENDS).
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Affiliation(s)
- Nick Wilson
- University of Otago, Wellington, New Zealand.
| | | | - Driss Ait Ouakrim
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Janet Hoek
- University of Otago, Wellington, New Zealand
| | | | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Stöver H. [Diversification of smoking cessation programmes-the role of e-cigarettes]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1473-1479. [PMID: 34642773 PMCID: PMC8550195 DOI: 10.1007/s00103-021-03435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/20/2021] [Indexed: 10/26/2022]
Abstract
The question of whether e‑cigarettes are a useful tool for smoking cessation is part of an ongoing and highly controversial scientific debate. In practice, however, the number of people trying to quit tobacco consumption by using these products is steadily increasing. This discussion article provides an outline of the current state of research on the issue of whether and to what extent e‑cigarettes can help people quit smoking.Of course, e‑cigarettes also have a certain potential for harm, especially if nicotine dependence is unnecessarily prolonged. Nevertheless, it can make an important contribution to harm reduction in nicotine consumption. Hence, the product should get treated as a serious alternative to nicotine replacement therapies (NRTs) in the scientific discussion. Like NRTs, e‑cigarettes offer a less harmful way of consuming nicotine that greatly reduces many of the health risks associated with tobacco consumption, such as the absorption of carcinogenic substances. Recent studies and reviews suggest that the product can be at least as effective as nicotine replacement therapies in helping people quit smoking. Individual studies even demonstrate the increased effectiveness of e‑cigarettes in supporting smoking cessation.Nevertheless, the review of the current literature shows that more high-quality research is needed to further understand the product and its properties. In terms of the harm reduction approach, however, it would already be more appropriate to also rely on e‑cigarettes instead of trying to force immediate and complete nicotine abstinence. After all, in the process of quitting smoking, the fastest possible cessation of the more unhealthy consumption of tobacco should be prioritized in order to immediately minimize unnecessary health risks.
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Affiliation(s)
- Heino Stöver
- Institut für Suchtforschung Frankfurt (ISFF), Frankfurt University of Applied Sciences, Nibelungenplatz 1, 60318, Frankfurt am Main, Deutschland.
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Berridge V, Hall W, Taylor S, Gartner C, Morphett K. A first pass, using pre-history and contemporary history, at understanding why Australia and England have such different policies towards electronic nicotine delivery systems, 1970s-c. 2018. Addiction 2021; 116:2577-2585. [PMID: 33464706 DOI: 10.1111/add.15391] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 10/30/2019] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
AIMS The United Kingdom and Australia have developed highly divergent policy responses to electronic nicotine delivery systems (ENDS). To understand the historical origins of these differences, we describe the history of tobacco control in each country and the key roles played in setting ENDS policy in its early stages by public health regulations and policy networks, anti-smoking organizations, 'vaper' activist networks and advocates of harm reduction policies towards injecting drug use. METHODS We analysed key government reports, policy statements from public health bodies and non-government organizations (e.g. cancer councils and medical organizations) on ENDS; submissions to an Australian parliamentary inquiry; media coverage of policy debates in medical journals; and the history of tobacco control policy in Australia and England. Key discourses about ENDS were identified for each country. These were compared across countries during a multi-day face-to-face meeting, where consensus was reached on the key commonalities and divergences in historical approaches to nicotine policy. This paper focuses on England, as different policy responses were apparent in constituent countries of the United Kingdom, and Scotland in particular. RESULTS Policymakers in Australia and England differ markedly in the priority that they have given to using ENDS to promote smoking cessation or restricting smokers' access to prevent uptake among young people. In understanding the origins of these divergent responses, we identified the following key differences between the two countries' approaches to nicotine regulation: an influential scientific network that favoured nicotine harm reduction in the United Kingdom and the absence of such a network in Australia; the success of different types of health activism both in England and in Europe in opposing more restrictive policies; and the greater influence on policy in England of the field of illicit drug harm reduction. CONCLUSIONS An understanding of the different policy responses to electronic nicotine delivery systems (ENDS) in England and Australia requires an appreciation of how actors within the different policy structures, scientific networks and activist organizations in each country and region have interpreted the evidence and the priority that policymakers have given to the competing goals of preventing adolescent uptake and encouraging smokers to use ENDS to quit smoking.
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Affiliation(s)
- Virginia Berridge
- Centre for History in Public Health Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, St Lucia, QLD, Australia
| | - Suzanne Taylor
- Centre for History in Public Health Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Coral Gartner
- School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Kylie Morphett
- School of Public Health, The University of Queensland, Herston, QLD, Australia
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Levy DT, Sánchez-Romero LM, Travis N, Yuan Z, Li Y, Skolnick S, Jeon J, Tam J, Meza R. US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths. Int J Environ Res Public Health 2021; 18:4876. [PMID: 34063672 PMCID: PMC8124578 DOI: 10.3390/ijerph18094876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model. Upon validating the model before NVPs were more widely used, we project a No-NVP (i.e., in the absence of NVPs) while controlling for the impact of cigarette-oriented policies. The net impact of NVPs on smoking prevalence is inferred by comparing the projected No-NVP smoking trends to corresponding trends from two US national surveys. Using the TUS-CPS estimates for the period 2012-2018, we estimate that adult smoking prevalence declined in relative terms by 9.7% (95% CI: 7.5-11.7%) for males and 10.7% (95% CI: 9.1-13.0%) for females. Compared to NHIS, smoking prevalence declined by 10.7% (95% CI: 6.8-14.6%) for males and 11.3% (95% CI: 7.4-15.6%) for females. These impacts were confined mainly to ages 18-44. Vaping-related reductions in smoking prevalence were projected to avert nearly 0.4 million SADs between 2012 and 2052. Our analysis indicates that NVP use is associated with substantial reductions in US smoking prevalence among younger adults.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jamie Tam
- Department of Health Policy and Management, Yale University School of Public Health, Hartford, CT 06520, USA;
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
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Amato MS, Bottcher MM, Cha S, Jacobs MA, Pearson JL, Graham AL. "It's really addictive and I'm trapped:" A qualitative analysis of the reasons for quitting vaping among treatment-seeking young people. Addict Behav 2021; 112:106599. [PMID: 32950927 DOI: 10.1016/j.addbeh.2020.106599] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/30/2020] [Accepted: 07/31/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Debate continues over how e-cigarettes have impacted the health of young people, and what regulatory policies should be enacted. The debate has appropriately been informed by quantitative studies, often focused on initiation, prevalence, and product transition among the general population and demographic segments. Factors driving cessation and subjective experiences that motivate young users to quit have been largely absent from the debate. This qualitative study highlights the range of motivating experiences among a population of treatment-seeking young e-cigarette users. METHODS Three researchers coded reasons for quitting provided by a sample of n = 1000 youth (13-17) and n = 1000 young adults (18-24) enrolled in a text message cessation program. Data spanned January 18 - February 22, 2019. Codes were adapted from previous literature. RESULTS The most common reasons were health (50.9%; "I want my lungs back"), financial cost (21.7%; "I don't have enough money to feed my addiction"), freedom from addiction (16.0%; "i hate juuling. it's taking over my life"), and social influence (10.1%; "it's affecting my friendships"). Selected quotes highlight a broad range of additional ways in which e-cigarette use negatively impacted young people, including decreased academic performance and mental health. CONCLUSIONS Young people trying to quit e-cigarettes are motivated by a diversity of reasons including health, financial, social, and academic. The range of impacts should be considered in discussions of policies intended to protect young people, and incorporated into cessation programs designed to serve them.
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Affiliation(s)
- Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Mia M Bottcher
- Innovations Center, Truth Initiative, Washington, DC, USA
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, USA
| | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, USA
| | | | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, USA; Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Reddy KP, Bulteel AJB, Levy DE, Torola P, Hyle EP, Hou T, Osher B, Yu L, Shebl FM, Paltiel AD, Freedberg KA, Weinstein MC, Rigotti NA, Walensky RP. Novel microsimulation model of tobacco use behaviours and outcomes: calibration and validation in a US population. BMJ Open 2020; 10:e032579. [PMID: 32404384 PMCID: PMC7228509 DOI: 10.1136/bmjopen-2019-032579] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Simulation models can project effects of tobacco use and cessation and inform tobacco control policies. Most existing tobacco models do not explicitly include relapse, a key component of the natural history of tobacco use. Our objective was to develop, calibrate and validate a novel individual-level microsimulation model that would explicitly include smoking relapse and project cigarette smoking behaviours and associated mortality risks. METHODS We developed the Simulation of Tobacco and Nicotine Outcomes and Policy (STOP) model, in which individuals transition monthly between tobacco use states (current/former/never) depending on rates of initiation, cessation and relapse. Simulated individuals face tobacco use-stratified mortality risks. For US women and men, we conducted cross-validation with a Cancer Intervention and Surveillance Modeling Network (CISNET) model. We then incorporated smoking relapse and calibrated cessation rates to reflect the difference between a transient quit attempt and sustained abstinence. We performed external validation with the National Health Interview Survey (NHIS) and the linked National Death Index. Comparisons were based on root-mean-square error (RMSE). RESULTS In cross-validation, STOP-generated projections of current/former/never smoking prevalence fit CISNET-projected data well (coefficient of variation (CV)-RMSE≤15%). After incorporating smoking relapse, multiplying the CISNET-reported cessation rates for women/men by 7.75/7.25, to reflect the ratio of quit attempts to sustained abstinence, resulted in the best approximation to CISNET-reported smoking prevalence (CV-RMSE 2%/3%). In external validation using these new multipliers, STOP-generated cumulative mortality curves for 20-year-old current smokers and never smokers each had CV-RMSE ≤1% compared with NHIS. In simulating those surveyed by NHIS in 1997, the STOP-projected prevalence of current/former/never smokers annually (1998-2009) was similar to that reported by NHIS (CV-RMSE 12%). CONCLUSIONS The STOP model, with relapse included, performed well when validated to US smoking prevalence and mortality. STOP provides a flexible framework for policy-relevant analysis of tobacco and nicotine product use.
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Affiliation(s)
- Krishna P Reddy
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander J B Bulteel
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Douglas E Levy
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela Torola
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily P Hyle
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taige Hou
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Benjamin Osher
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liyang Yu
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Milton C Weinstein
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rochelle P Walensky
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Cummings KM, Fong GT. Predicting the future of smoking in a rapidly evolving nicotine market-place. Addiction 2019; 114 Suppl 1:3-5. [PMID: 31430832 PMCID: PMC7015107 DOI: 10.1111/add.14785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC, 29425, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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