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• W4232994213 abstract "To the Editor: We share the concerns expressed by Soneji et al.1 about the potential for e-cigarettes to increase smoking initiation. In fact, this study was prompted by the uncertainty surrounding the effects of e-cigarettes on smoking behavior.2 We excluded adolescents from the model because relevant studies, including those cited by Soneji et al.,3–5 have primarily measured adolescent “ever use” of e-cigarettes. Data on “ever use” of e-cigarettes or “any use in the past 30 days” are not ideal for calibrating computational models of long-term smoking behavior into and throughout adulthood. Nevertheless, we acknowledge that any effect of e-cigarettes on adolescent smoking initiation will also affect adult smoking prevalence, so we ran additional experiments to account for smoking initiation resulting from e-cigarette use among youth. If we assume that youth e-cigarette use increases the likelihood of smoking initiation before age 18 by 200% (i.e., relative risk of 3.0), compared with never users of e-cigarettes, while having no effect on smoking cessation in the population, our model estimates that adult smoking prevalence would reach 16.6% in 2060. This is a 23.8% increase from the corresponding estimate in our baseline model (13.4%), which assumes no e-cigarette effects on initiation or cessation. Our original adults-only model shows that if e-cigarette use increases the likelihood of smoking initiation by 200% with no impact on cessation, smoking prevalence would reach 14.1% by 2060—a much smaller increase of 4.7% relative to baseline. However, our primary objective was to evaluate population-level outcomes that consider e-cigarette effects on both smoking initiation and cessation. If e-cigarette use increases smoking cessation by 200% among adults, while also increasing smoking initiation by 200% among both adolescents and adults, our model estimates that smoking prevalence would drop to 10.3% by 2060—a 23.1% decrease compared with baseline. Thus, even when the model accounts for large initiation effects whereby youth and adult smoking initiation rates escalate due to e-cigarettes, the cessation effects of e-cigarettes on adult smoking offset these undesirable “gateway” effects. This is the primary conclusion of our study.2 We presented a wide range of potential smoking prevalence outcomes when considering both the possible harms and benefits of e-cigarette use on long-term smoking behavior. Our results show smaller relative changes in smoking prevalence generated by e-cigarette effects on smoking initiation in contrast to larger changes generated by e-cigarette effects on smoking cessation. Adolescent smoking rates continue to decline each year, and recent developments suggest that youth e-cigarette use is unlikely to change that trend going forward; FDA has now imposed restrictions on youth access to e-cigarettes, and adolescent e-cigarette 30-day use prevalence remained stagnant from 2014 to 2015.6 Our model simulates a range of smoking prevalence outcomes associated with e-cigarettes amidst a heated tobacco control debate. Robust longitudinal data on e-cigarette use patterns are needed to draw better conclusions about their true impact on smoking. Until then, simulation models such as ours can help decision-makers determine the best public policies that tip the balance toward desirable public health outcomes. Sarah T. Cherng Jamie Tam Paul J. Christine Rafael Meza University of Michigan School of Public Health Ann Arbor, Michigan [email protected]" @default.
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• W4232994213 date "2017-01-01" @default.
• W4232994213 modified "2023-09-25" @default.
• W4232994213 title "The Authors Respond" @default.
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• W4232994213 doi "https://doi.org/10.1097/ede.0000000000000561" @default.
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