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19 Modeling of E-Cigarette Use
Pages 631-652

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From page 631...
... The hypothesized pathways can be used to understand both individual tobacco use trajectories and population-level effects, and include • Youth and young adults could begin using e-cigarettes and sub sequently start using combustible tobacco cigarettes, either com pletely switching or using both products concurrently (increasing combustible tobacco cigarette initiation)
From page 632...
... . To inform their view of the likely effects of e-cigarette use at a population level, the committee employed a dynamic model of combustible tobacco cigarette smoking prevalence and health effects to examine the potential impact of e-cigarettes on mortality in the U.S.
From page 633...
... Thus, the effects of increased e-cigarette prevalence are subsumed in the assumptions of increases in both cessation and initiation of combustible tobacco cigarettes. The model does consider gender differences (e.g., relative risks and death rates)
From page 634...
... The committee considered the following specific effect levels: • E-cigarettes increase the smoking initiation rate by 0 percent, 5 percent, 10 percent, 25 percent, or 50 percent; • E-cigarettes increase the net smoking cessation rate by −5 percent, 0 percent, 5 percent, 10 percent, or 15 percent; and • E-cigarettes are 0 percent, 10 percent, 25 percent, or 50 percent as harmful as combustible tobacco cigarettes. The range of parameter values were selected according to the criteria described in the following sections: e-cigarette effect on initiation, e-cigarette effect on cessation, and e-cigarette harm.
From page 635...
... In other words, a positive value indicates that more people in a population have quit smoking than nonsmokers who have started/relapsed, and a negative value indicates the opposite. This net cessation statistic is not a common measure in the literature, which generally reports only a cessation rate based on the percentage of smokers who successfully quit smoking, without regard to non-active smokers at baseline who started or relapsed within a specified time period.
From page 636...
... The likelihood that e-cigarettes have none of the harm of combustible tobacco cigarettes is equally extreme and improbable. SIMULATION SCENARIOS The model runs were designed as follows: First, to establish a base case, the model was used to estimate the number of life-years lost due to smoking over the periods 2015–2050 and 2015–2070, under the assumption that the annual initiation and net cessation rates observed in 2015 (13 percent among young adults age 18–24 and 4.35 percent among adult s ­mokers, respectively [Jamal et al., 2016; Mendez et al., 2017]
From page 637...
... MODELING OF E-CIGARETTE USE 637 TABLE 19-1  Summary of Simulation Runs Considered by the Committee Percent Initiation Percent Net Cessation Percent Case Increases Increases E-Cigarette Harm  1 0 0 0  2 5 0 0  3 10 0 0  4 25 0 0  5 50 0 0  6 0 5 0  7 5 5 0  8 10 5 0  9 25 5 0 10 50 5 0 11 0 10 0 12 5 10 0 13 10 10 0 14 25 10 0 15 50 10 0 16 0 15 0 17 5 15 0 18 10 15 0 19 25 15 0 20 50 15 0 21 0 0 10 22 5 0 10 23 10 0 10 24 25 0 10 25 50 0 10 26 0 5 10 27 5 5 10 28 10 5 10 29 25 5 10 30 50 5 10 31 0 10 10 32 5 10 10 continued
From page 638...
... 638 PUBLIC HEALTH CONSEQUENCES OF E-CIGARETTES TABLE 19-1  Continued Percent Initiation Percent Net Cessation Percent Case Increases Increases E-Cigarette Harm 33 10 10 10 34 25 10 10 35 50 10 10 36 0 15 10 37 5 15 10 38 10 15 10 39 25 15 10 40 50 15 10 41 0 0 25 42 5 0 25 43 10 0 25 44 25 0 25 45 50 0 25 46 0 5 25 47 5 5 25 48 10 5 25 49 25 5 25 50 50 5 25 51 0 10 25 52 5 10 25 53 10 10 25 54 25 10 25 55 50 10 25 56 0 15 25 57 5 15 25 58 10 15 25 59 25 15 25 60 50 15 25 61 0 0 50 62 5 0 50 63 10 0 50 64 25 0 50
From page 639...
... on the net cessation rate, and an increase of 5 percent on the initiation rate (from 13 percent to 13.65 percent) , the estimated total life-years lost due to smoking (counting the extra smokers because of e-cigarettes)
From page 640...
... E-cigarettes = 0% × risk of combustibles. NOTE: Results shown in red text in parentheses indicate life-years saved compared with a baseline scenario of no effect of e-cigarettes on initiation or net cessation of combustible tobacco cigarettes.
From page 641...
... This is because, under any scenario that increases adult initiation, the benefits of increased net cessation are felt much sooner than the negative effects of increased initiation. Of note, the committee chose to keep the background rates on smoking initiation and cessation constant, to avoid forecasting future values of those parameters. In reality, current trends indicate that the adult smoking initiation rate is decreasing while the cessation rate is increasing.
From page 642...
... E-cigarettes = 0% × risk of combustibles. NOTE: Results shown in red text in parentheses indicate life-years saved compared with a baseline scenario of no effect of e-cigarettes on initiation or net cessation of combustible tobacco cigarettes.
From page 643...
... (2,575,794) Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.4% −0.7% −1.1% 5% 0.5% 0.0% −0.4% −0.7% −1.1% 10% 0.5% 0.0% −0.3% −0.7% −1.1% 25% 0.6% 0.1% −0.3% −0.6% −1.0% 50% 0.7% 0.2% −0.2% −0.5% −0.9% a Under the assumptions that e-cigarettes are 90 percent less harmful than combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 644...
... 50% 9,314,336 6,778,523 4,385,812 2,121,721 (21,981) Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.5% −1.0% −1.5% 5% 0.7% 0.2% −0.4% −0.9% −1.3% 10% 0.8% 0.3% −0.2% −0.7% −1.2% 25% 1.3% 0.7% 0.2% −0.3% −0.7% 50% 2.0% 1.5% 1.0% 0.5% 0.0% a Under the assumptions that e-cigarettes are 90 percent less harmful than combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 645...
... (1,795,105) Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.3% −0.6% −0.8% 5% 0.5% 0.0% −0.3% −0.5% −0.8% 10% 0.5% 0.0% −0.2% −0.5% −0.8% 25% 0.6% 0.1% −0.2% −0.5% −0.7% 50% 0.7% 0.2% −0.1% −0.3% −0.6% a Under the assumptions that e-cigarettes are 75 percent less harmful than combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 646...
... 25% 5,879,937 3,389,262 1,686,985 81,283 (1,434,236) 50% 9,314,336 6,778,523 5,057,105 3,433,774 1,902,029 Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.4% −0.7% −1.1% 5% 0.7% 0.2% −0.2% −0.6% −0.9% 10% 0.8% 0.3% −0.1% −0.4% −0.8% 25% 1.3% 0.7% 0.4% 0.0% −0.3% 50% 2.0% 1.5% 1.1% 0.8% 0.4% a Under the assumptions that e-cigarettes are 75 percent less harmful than combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 647...
... (541,052) Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.1% −0.3% −0.4% 5% 0.5% 0.0% −0.1% −0.3% −0.4% 10% 0.5% 0.0% −0.1% −0.2% −0.4% 25% 0.6% 0.1% 0.0% −0.2% −0.3% 50% 0.7% 0.2% 0.1% −0.1% −0.2% a Under the assumptions that e-cigarettes are half as harmful as combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 648...
... 10% 3,819,298 1,355,705 693,700 80,639 (487,155) 25% 5,879,937 3,389,262 2,729,445 2,118,781 1,553,567 50% 9,314,336 6,778,523 6,122,353 5,515,683 4,954,769 Percentage of Life-Years Lost Due to E-Cigarettes 0% 0.5% 0.0% −0.1% −0.3% −0.4% 5% 0.7% 0.2% 0.0% −0.1% −0.3% 10% 0.8% 0.3% 0.2% 0.0% −0.1% 25% 1.3% 0.7% 0.6% 0.5% 0.3% 50% 2.0% 1.5% 1.3% 1.2% 1.1% a Under the assumptions that e-cigarettes are half as harmful as combustible tobacco cigarettes and a range of assumptions about smoking initiation and net cessation.
From page 649...
... . As with other models of population health effects of tobacco use, the effects of changing net cessation rates are seen earlier than effects of changing initiation rates, due to the lag in time for serious chronic health effects of combustible tobacco cigarettes to manifest.
From page 650...
... Factors that would maximize potential health benefits associated with these products include determining with more precision whether and under which conditions e-cigarettes could serve as an effective smoking cessation aid; discouraging their use among youth through standard tobacco control strategies, such as education and access restrictions; and increasing their safety through data-driven engineering and design. REFERENCES CDC (Centers for Disease Control and Prevention)
From page 651...
... Morbidity and Mortality Weekly Report 65(22)


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