Modeling the Population health Impact of ENDS in the U.S.

Introduction:
This text provides a summary of a study that models the population health impact of electronic nicotine delivery systems (ENDS) in the US using an agent-based population health model (PhM). The study compares two scenarios, a Base Case where only combustible cigarettes are available, and a Modified Case where ENDS are introduced in 2010. The PhM simulates annual smoking, ENDS use, and associated mortality for individual agents representing the US population, both adults and youth, between 2000 and 2100.

Key Points:

* The study finds that the availability of ENDS in the US is projected to reduce smoking and prevent 2.5 million premature deaths by 2100 in the Modified Case.
* The PhM is based on an agent-based modeling framework and code base originally developed by Muhammad-Kah et al, and uses transition rates derived from surveys such as the National health Interview Survey (NhIS), the National Youth Tobacco Survey (NYTS), and the Population assessment of Tobacco and health (PaTh).
* The PhM also uses data from a large-scale, longitudinal study of first-time purchasers of a JUUL Starter Kit (aDJUSST) Study.
* The study conducts extensive sensitivity testing and scenario analyses to address uncertainties around key transition rates and the long-term health effects of ENDS use.
* The study finds that the availability of ENDS in the US is likely to result in a significant health benefit to the US population as a whole, after accounting for both beneficial and harmful uses.
* The study also notes potential concerns around ENDS use by groups that would not have otherwise smoked, such as diversion of would-be quitters, initiation among non-nicotine users, and progressions of non-smokers from ENDS use to cigarette smoking.
* The study highlights the potential for a 'gateway effect' where ENDS use leads to subsequent cigarette smoking, but also notes that smoking prevalence has continued to fall even while ENDS use has increased.

Main Message:
The main message of the text is that the availability of ENDS in the US is likely to result in a significant health benefit to the US population as a whole, but also highlights the need for further research and regulation to address potential concerns around ENDS use by groups that would not have otherwise smoked, and to prevent transitions from ENDS use to cigarette smoking. The study also emphasizes the importance of population modeling via computational and statistical techniques to enable a systematic, quantitative assessment of the overall population-level impact of ENDS availability.

Wissmann R, Zhan C, D’amica K, Prakash S, Xu Y. Modeling the Population health Impact of ENDS in the U.S. american journal of health behavior. 2021;45(3):588-610. doi:10.5993/aJhB.45.3.12