Evaluating smoking control policies in the e-cigarette era: a modelling study

Abstract

BackgroundIn jurisdictions in which electronic cigarettes are currently prohibited, policy makers must weigh the potentially lower risk compared with conventional cigarettes against the risk of initiation of e-cigarettes among non-smokers.MethodsWe simulated a synthetic population over a 50-year time horizon with an open cohort model using data from Singapore, a country where e-cigarettes are currently prohibited, and data from the USA, the UK and Japan. Using the smoking prevalence and the quality-adjusted life year gained calculated, we compared tobacco control policies without e-cigarettes—namely, raising the minimum legal age (MLA), introducing a smoke-free generation (SFG) and tax rises on tobacco consumption—with policies legalising e-cigarettes, either taking a laissez-faire approach or under some form of restriction. We also evaluated combinations of these policies.ResultsRegardless of the country informing the transition probabilities to and from e-cigarette use in Singapore, a laissez-faire e-cigarette policy could reduce the smoking prevalence in the short term, but it is not as effective as other policies in the long term. The most effective single policies evaluated were SFG and aggressive tax rises; the most effective combination of policies considered was MLA plus moderate tax rises and e-cigarettes on prescription.ConclusionPolicy makers in jurisdictions in which e-cigarettes are not yet established may be advised not to prioritise e-cigarettes in their tobacco end-game strategy, unless their use can be restricted to current smokers seeking to quit.

Closing the gaps in tobacco endgame evidence: a scoping review

“…8 The evidence syntheses we reviewed provided support for the ethicality and legality of this proposed law based on human rights principles, 61 and the modelling studies demonstrated substantial health benefits to the population. 55 59 60 Consistent with the findings of the NZ simulation modelling, which demonstrated that this policy would be insufficient to achieve the country's endgame goal, 60 the proposed law will be introduced as part of a comprehensive plan that also addresses adults who currently smoke. 8 Ending commercial tobacco sales has also been implemented in Bhutan (although recently reversed) 83 and two local government areas in the USA (Beverly Hills and Manhattan Beach).…”

“…Five syntheses, including three simulation modelling studies predicting the impacts of e-cigarette use,53–55 and two narrative reviews focusing on e-cigarettes,34 56 concluded that these products have the potential to substantially reduce combustible tobacco use, and thus potentially achieve a tobacco endgame 34 53–56. Three syntheses also summarised evidence on the harms of reduced risk products, all concluding that they are less harmful than combustible tobacco 56–58.…”

“…Potential limitations of the policy include some people reducing cigarettes smoked per day but not achieving cessation, or continuing to use cigarettes for a multitude of reasons other than nicotine addiction, 35 public misperceptions that VLNC cigarettes are harmful 50 and potential (short-term) negative impacts on behavioural and cognitive performance following a rapid reduction in nicotine. 36 51 Canada, 64 Singapore, 55 Solomon Islands 59 3 60…”

Global youth vaping and respiratory health: epidemiology, interventions, and policies

“…Countries with taxes on e-cigarettes include Italy, Latvia, Portugal, Republic of Korea, Togo, and the United Kingdom 111 . Asian countries that have banned e-cigarettes include Singapore and Thailand, and Japan has banned the use of nicotine-containing e-cigarettes but not e-cigarettes without nicotine 116 . Vaping products are also prohibited in the United Arab Emirates 116 .…”

“…Asian countries that have banned e-cigarettes include Singapore and Thailand, and Japan has banned the use of nicotine-containing e-cigarettes but not e-cigarettes without nicotine 116 . Vaping products are also prohibited in the United Arab Emirates 116 . Switzerland had banned the sale of vaping products until 2018, but now they are available on the market 117 .…”