Abstract

BackgroundElectronic cigarettes (e-cigarettes) may help cigarette smokers quit smoking, yet they may also facilitate cigarette smoking for never-smokers. We quantify the balance of health benefits and harms associated with e-cigarette use at the population level.Methods and findingsMonte Carlo stochastic simulation model. Model parameters were drawn from census counts, national health and tobacco use surveys, and published literature. We calculate the expected years of life gained or lost from the impact of e-cigarette use on smoking cessation among current smokers and transition to long-term cigarette smoking among never smokers for the 2014 US population cohort.ResultsThe model estimated that 2,070 additional current cigarette smoking adults aged 25–69 (95% CI: -42,900 to 46,200) would quit smoking in 2015 and remain continually abstinent from smoking for ≥7 years through the use of e-cigarettes in 2014. The model also estimated 168,000 additional never-cigarette smoking adolescents aged 12–17 and young adults aged 18–29 (95% CI: 114,000 to 229,000), would initiate cigarette smoking in 2015 and eventually become daily cigarette smokers at age 35–39 through the use of e-cigarettes in 2014. Overall, the model estimated that e-cigarette use in 2014 would lead to 1,510,000 years of life lost (95% CI: 920,000 to 2,160,000), assuming an optimistic 95% relative harm reduction of e-cigarette use compared to cigarette smoking. As the relative harm reduction decreased, the model estimated a greater number of years of life lost. For example, the model estimated-1,550,000 years of life lost (95% CI: -2,200,000 to -980,000) assuming an approximately 75% relative harm reduction and -1,600,000 years of life lost (95% CI: -2,290,000 to -1,030,000) assuming an approximately 50% relative harm reduction.ConclusionsBased on the existing scientific evidence related to e-cigarettes and optimistic assumptions about the relative harm of e-cigarette use compared to cigarette smoking, e-cigarette use currently represents more population-level harm than benefit. Effective national, state, and local efforts are needed to reduce e-cigarette use among youth and young adults if e-cigarettes are to confer a net population-level benefit in the future.

Highlights

  • The use of electronic cigarettes (e-cigarettes) has become intensely controversial since their introduction to the US in 2007 [1,2,3,4,5,6,7]

  • The model estimated 168,000 additional never-cigarette smoking adolescents aged 12–17 and young adults aged 18–29, would initiate cigarette smoking in 2015 and eventually become daily cigarette smokers at age 35–39 through the use of e-cigarettes in 2014

  • We conducted a sensitivity analysis by varying the level of four key parameters: (1) the adjusted odds ratio of smoking cessation, (2) the adjusted odds ratio of cigarette smoking initiation, (3) age-group-specific prevalence of current e-cigarette use among current cigarette smokers who tried quitting within the past year, and (4) age-specific prevalence of ever having tried e-cigarettes among never cigarette smokers

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Summary

Introduction

The use of electronic cigarettes (e-cigarettes) has become intensely controversial since their introduction to the US in 2007 [1,2,3,4,5,6,7]. E-cigarettes might facilitate the transition to traditional cigarette smoking among never-smoking adolescents and young adults [13,14,15,16,17,18,19,20,21] This harm is potentially substantial because youth e-cigarette use has risen rapidly over time [6,22,23]. A recent study concluded a net population-level health benefit under a scenario in which e-cigarette use increases in the future only among cigarette smokers interested in quitting, and net harm under a scenario in which e-cigarette use increases in the future only among youth who would have never smoked [29]. We quantify the balance of health benefits and harms associated with e-cigarette use at the population level

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