Reducing the smoking-related health burden in the USa through diversion to electronic cigarettes: a system dynamics simulation study.

Introduction:
This text presents a system dynamics simulation study examining the potential of an e-cigarette harm reduction policy in the USa. The study investigates the impact of promoting e-cigarettes as a lower-risk alternative to combustible cigarettes and removing existing e-liquid flavor bans on tobacco smoking reduction. The text also discusses the challenges of policy implementation and their effects on the effectiveness of the policy.

Key Points:

* The study uses a system dynamics simulation model that includes aging chains representing individuals at different stages of using combustible cigarettes and e-cigarettes.
* The model includes a Goal-Gap of Tobacco-Related Mortality Module, which calculates the discrepancy between actual and goal tobacco-related deaths.
* The policy implementation module includes removing existing e-liquid flavor bans and implementing an educational campaign promoting e-cigarettes as a less harmful alternative.
* The model assumes that the policy has three effects: diverting nicotine-naïve adolescents from ever using combustible cigarettes, reducing smoking behavior among existing smokers, and increasing smoking cessation.
* The model was calibrated using data from the National Youth Tobacco Survey and the National health Interview Survey.
* The study compares the base-case scenario to several policy scenarios, including ideal-world, best-case, time-delayed, and budget-restricted scenarios.
* The study finds that the ideal-policy scenario projects the policy accomplishing its goal shortly after 2050, while realistic obstacles to policy implementation, such as delays in decision-making, uncertain approval, and budgetary limitations, have the effect of delaying and weakening the policy's effects.

Main Message:
The study suggests that promoting e-cigarettes as a harm reduction policy could reduce tobacco-attributed preventable deaths to the rate of accidental deaths in the general population. The study also highlights the importance of considering practical obstacles to policy implementation and the need to balance the risks and benefits of e-cigarette use in promoting their use as a harm reduction strategy. While the study has limitations, it provides valuable insights into the potential impact of an e-cigarette harm reduction policy and highlights the need for further research in this area.

Selya aS. Reducing the smoking-related health burden in the USa through diversion to electronic cigarettes: a system dynamics simulation study. harm reduction journal. 2021;18(1):36. doi:10.1186/s12954-021-00484-6