Public Health Implications of Vaping in the US: The Smoking and Vaping Simulation Model

Abstract

Background Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), which estimates the public health implications of NVPs in the US. Methods SAVM adopts a cohort-approach and is available on an Excel platform. We derive public health implications by comparing smoking- and NVP-attributable deaths under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former and never smoking rates via smoking initiation and cessation rates, and incorporates excess risks of smoking. The NVP Scenario allows for NVP relative excess risks, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. The model is validated against recent US survey data on smoking and vaping prevalence. Results The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 5.8 million premature smoking- and vaping-attributable deaths avoided and 96.4 million life years gained between 2013 and 2100. Sensitivity analysis shows that parameters for NVP relative risks, NVP-related switching and smoking cessation are particularly influential in gauging public health impacts. Discussion The SAVM shows potential benefits of e-cigarette use over a wide range of parameters. However, there is a high degree of uncertainty regarding key parameters. Policymakers, researchers and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources.