Investigating the Health Effects of 3 Coexisting Tobacco-Related Products Using System Dynamics Population Modeling: An Italian Population Case Study

ObjectiveTo 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 selectionFour 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 extractionData 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 synthesisThe 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.ConclusionsA 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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A Scoping Review of Behavioural Studies on Heated Tobacco Products

Fearon,

Cordery,

Fitzpatrick

et al. 2024

Cureus

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Heated tobacco products (HTPs) are electronic devices that heat tobacco sticks to temperatures much lower than those which cause pyrolysis and combustion in cigarettes. While this electrical heating causes the formation of an inhalable aerosol which contains nicotine, the aerosol from HTPs contains significantly fewer and lower levels of the harmful and potentially harmful chemicals found in cigarette smoke. As a result, HTP use potentially conveys reduced risks to health compared to cigarette smoking. While this relative reduction in individual health risk is becoming clearer, what is less certain is the impact of HTPs on overall population-level health, taking into account both the potential positive impact on adult smokers who completely switch to using HTPs and any unintended impacts such as use by tobacco non-users and particularly by youth. The aim of this scoping review was to collate and evaluate the published scientific evidence to date, with a cut-off of 1 January 2024, investigating the impact of HTPs on population-level health. This evaluation suggests that HTP use is almost exclusively observed among those with a history of cigarette smoking, and there is a growing body of evidence for the ability of HTPs to provide support for adult smokers to transition away from cigarette smoking, in the absence of any significant "gateway" into tobacco use initiation. Many studies have reported a significant degree of dual use of cigarettes and HTPs, and efforts to assess the reasons for such patterns of use, whether these provide overall exposure reductions, and whether dual use acts as a bridge towards a complete transition away from cigarette smoking, requires further investigation. In addition, correction of the widespread and increasing misperceptions of HTPs among adult smokers is recommended to promote HTP uptake as a potentially less harmful alternative to smoking in this population.

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Investigating the Health Effects of 3 Coexisting Tobacco-Related Products Using System Dynamics Population Modeling: An Italian Population Case Study

Cited by 3 publications

References 22 publications

A systematic review of the modelling and economic evaluation studies assessing regulatory options for e-cigarette use

A systematic review of the modelling and economic evaluation studies assessing regulatory options for e-cigarette use

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

A Scoping Review of Behavioural Studies on Heated Tobacco Products

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