England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking‐attributable deaths in England

Abstract

Background and Aims Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. Design Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP‐related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012–2019 counterfactual No‐NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking‐attributable deaths. Setting England, 2000–2019. Participants Nationally representative sample of population. Measurements England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. Findings Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012–2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model‐predicted No‐NVP reduction (males, 7.3%), the implied NVP‐attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%–22.0%) for males and 20.4% (18.7%–22.2%) for females. The NVP‐attributable reduction was 27.2% (22.8%–31.6%) for males and 31.7% (27.4%–36.5%) for females ages 18–24 and 18.6% (15.2%–21.8%) for males and 15.0% (11.1%–18.8%) for females ages 25–34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453–199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. Conclusions An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012–2019 coinciding with the growth in nicotine vaping product use.

US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths

“…Our findings for all US adults are similar to those from the England SimSmoke model that applied the same methodology [78]. We obtained reductions of 14-20% for males and 13-20% for females from 2012 to 2018.…”

Balancing Consideration of the Risks and Benefits of E-Cigarettes

“…65 Consistent with these population studies, simulation analyses have generally found that vaping increases smoking cessation, avoiding large numbers of premature deaths. [66][67][68][69] Other researchers have found regular and frequent e-cigarette use to be associated with increased smoking cessation, while infrequent use was not. 70 -75 This could reflect self-selection, with frequent vapers possibly liking vaping more and being more motivated to quit smoking.…”

Evolution of Tobacco and E-cigarette Experimentation and Use Among French Adolescents Aged 15-16 Years From 2018 to 2020: A Cross-sectional Observational Study

“…Similarly, in the study by Walker et al [2], all measures of e-cigarette use increased and all measures of tobacco use decreased or remained stable over the 2014-2019 period among New Zealand youth aged 14-15 years. Lastly, in the UK, the substantial reduction in smoking prevalence in the adult population was found to coincide with a rise in e-cigarette use between 2012 and 2019 [14]. The upward trend in e-cigarette experimentation and use may be partly explained by the gradual progression from smoking to vaping in the general population, a shift in behaviour actually recommended by bodies such as Public Health England and the French National Academy of Medicine.…”

“…Three Cochrane reviews nd that nicotine e-cigarettes are more effective than nicotine substitutes in helping young adult smokers wean themselves off smoking [10][11][12]. In the UK, the 2021 Public Health England report [13] concludes that e-cigarettes are an effective aid to smoking cessation and reduction, while Levy et al [14] suggest that the observed reduction in smoking prevalence in the adult population is explained by the increased use of nicotine ecigarettes. In France, Legleye et al [15] report a 42% reduction in the risk of becoming a daily smoker in adolescents aged [17][18].5 years who experimented with e-cigarettes rst, and Chyderiotis et al [16] [15] con rm the absence of an increased risk of progression from vaping to daily smoking among adolescents aged 17 years.…”