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Article ; Online: Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review.

Cadham, Christopher J / Prosser, Lisa A

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

2023 Volume 26, Issue 6, Page(s) 943–952

Abstract: Objectives: To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation.: Methods: We searched Ovid ( ... ...

Abstract	Objectives: To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation. Methods: We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category. Results: Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education. Conclusions: Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
MeSH term(s)	Humans ; Cost-Benefit Analysis ; Delivery of Health Care ; Surveys and Questionnaires ; Social Welfare ; Cost-Effectiveness Analysis
Language	English
Publishing date	2023-02-18
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	1471745-1
ISSN	1524-4733 ; 1098-3015
ISSN (online)	1524-4733
ISSN	1098-3015
DOI	10.1016/j.jval.2023.02.006
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Article ; Online: Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model.

Levy, David T / Cadham, Christopher J / Yuan, Zhe / Li, Yameng / Gravely, Shannon / Cummings, K Michael

Canadian journal of public health = Revue canadienne de sante publique

2023 Volume 114, Issue 6, Page(s) 992–1005

Abstract: Objectives: The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly ... ...

Abstract	Objectives: The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs' impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model. Methods: Canada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012-2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available. Results: Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060. Conclusion: Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
MeSH term(s)	Adult ; Male ; Female ; Humans ; Adolescent ; Vaping/epidemiology ; Nicotine ; Prevalence ; Canada/epidemiology ; Smoking/epidemiology ; Electronic Nicotine Delivery Systems
Chemical Substances	Nicotine (6M3C89ZY6R)
Language	English
Publishing date	2023-08-04
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	417262-0
ISSN	1920-7476 ; 0008-4263
ISSN (online)	1920-7476
ISSN	0008-4263
DOI	10.17269/s41997-023-00792-3
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Article ; Online: Chemical Profiles and Toxicity of Electronic Cigarettes: An Umbrella Review and Methodological Considerations.

Travis, Nargiz / Knoll, Marie / Cook, Steven / Oh, Hayoung / Cadham, Christopher J / Sánchez-Romero, Luz María / Levy, David T

International journal of environmental research and public health

2023 Volume 20, Issue 3

Abstract: Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and ... ...

Abstract	Background: Electronic cigarettes (ECs) are often marketed as a safer alternative to combustible tobacco products. The global EC market has rapidly expanded since their introduction, creating an urgent need for research describing the toxicity and chemical composition of ECs. We conducted an umbrella review to summarize the evidence from existing systematic reviews (SRs). Methods: The search for SRs was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Results: Twenty-five SRs were included in our umbrella review. Chemical profiles widely varied across studies included in the reviews, which was mainly attributed to the lack of standardized protocols investigating the constituents, and differences in EC devices and e-liquids tested. Metals were more abundant in some EC aerosols than cigarettes, while carbonyls were typically found at lower levels. There was consistent evidence of in vitro toxicity from EC aerosol and e-liquid exposure. AMSTAR-2 revealed important limitations across reviews. Conclusions: While most reviews concluded that ECs were likely less harmful than cigarettes, there was hesitancy to draw clear conclusions due to variable analytical procedures and inconsistent findings among the included studies. Future SRs with improved methodology and reporting are needed to adequately inform tobacco regulatory actions.
MeSH term(s)	Electronic Nicotine Delivery Systems ; Aerosols/toxicity ; Metals
Chemical Substances	Aerosols ; Metals
Language	English
Publishing date	2023-01-20
Publishing country	Switzerland
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20031908
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Article ; Online: The role of flavored electronic nicotine delivery systems in smoking cessation: A systematic review.

Liber, Alex C / Knoll, Marie / Cadham, Christopher J / Issabakhsh, Mona / Oh, Hayoung / Cook, Steve / Warner, Kenneth E / Mistry, Ritesh / Levy, David T

Drug and alcohol dependence reports

2023 Volume 7, Page(s) 100143

Abstract: Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation.: Methods: We searched EMBASE OVID, PsychInfo, ... ...

Abstract	Background: Electronic nicotine delivery systems (ENDS) come in numerous flavors and may aid smoking cessation. This systematic review examines evidence on the role of ENDS flavors in smoking cessation. Methods: We searched EMBASE OVID, PsychInfo, and Medline databases for studies that: 1) examined cigarette cessation outcomes for persons using ENDS (intent, attempts, and success) and 2) reported results separated by respondent's ENDS flavor used. We extracted crude and adjusted odds ratios for associations between cessation outcomes and types of ENDS flavors used (nontobacco vs. tobacco/unflavored; nontobacco and nonmenthol vs. tobacco/unflavored and menthol). We did not consider cessation outcomes among people not using ENDS. We evaluated the evidence using the GRADE approach, focusing on consistency and reliability of findings across studies. Results: 29 studies met inclusion criteria, producing 36 odds ratios (ORs) comparing cessation outcomes across ENDS flavor groups. Three ORs examined quit intent, five examined quit attempts, and 28 examined quit success. Using GRADE, we reached Low levels of certainty that there was not an association between ENDS flavor use and intention to quit smoking or making a quit attempt. There were Very Low levels of certainty that nontobacco flavored versus tobacco/unflavored ENDS use was not associated with smoking cessation success, with similar findings for nonmenthol and nontobacco compared to tobacco and menthol flavored ENDS. Conclusion: The evidence about the role of different flavored ENDS use and smoking cessation outcomes is inconclusive, reflecting highly heterogeneous study definitions and methodological limitations. More high-quality evidence, ideally from randomized controlled trials, is required.
Language	English
Publishing date	2023-03-16
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2772-7246
ISSN (online)	2772-7246
DOI	10.1016/j.dadr.2023.100143
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Article ; Online: The actual and anticipated effects of restrictions on flavoured electronic nicotine delivery systems: a scoping review.

Cadham, Christopher J / Liber, Alex C / Sánchez-Romero, Luz María / Issabakhsh, Mona / Warner, Kenneth E / Meza, Rafael / Levy, David T

BMC public health

2022 Volume 22, Issue 1, Page(s) 2128

Abstract: Objective: To synthesize the outcomes of policy evaluations of flavoured electronic nicotine delivery systems (ENDS) restrictions.: Data sources: PubMed, Scopus, Embase and Web of Science before May 3, 2022.: Study selection: Studies that report ... ...

Abstract	Objective: To synthesize the outcomes of policy evaluations of flavoured electronic nicotine delivery systems (ENDS) restrictions. Data sources: PubMed, Scopus, Embase and Web of Science before May 3, 2022. Study selection: Studies that report sales, behaviour, or compliance outcomes related to implemented or hypothetical ENDS flavour restrictions. Data extraction: Restriction details, whether implemented or hypothetical, whether additional products were restricted, jurisdictional level, study locations, and outcomes classified by sales, behaviour, and compliance. Data synthesis: We included 30 studies. Of those, 26 were conducted exclusively in the US, two in India, and two surveyed respondents in multiple countries, including the US. Twenty-one evaluated implemented restrictions, while nine considered hypothetical restrictions. Five studies evaluated product sales, 17 evaluated behaviour, and 10 evaluated compliance, with two studies reporting multiple outcomes. Two studies reported an increase and one a reduction in cigarette sales following restrictions, while three reported reductions in ENDS sales. Behavioural studies presented a mixed view of the impacts of regulations on ENDS and cigarette use. However, the use of disparate outcomes limits the comparability of studies. Studies of hypothetical restrictions suggest decreased ENDS use, increased cigarette use, and increased use of illicit markets. Studies of compliance with flavoured product restrictions that included ENDS found that 6-39% of stores sold restricted flavoured products post-restrictions. Online stores remain a potential source of restricted products. Conclusion: Our findings highlight the need for additional research on the impacts of ENDS restrictions. Research should further evaluate the impact of restrictions on youth and adult use of nicotine and tobacco products in addition to the effects of restrictions in countries beyond the US to enable a robust consideration of the harm-benefit trade-off of restrictions.
MeSH term(s)	Adult ; Adolescent ; Humans ; Electronic Nicotine Delivery Systems ; Flavoring Agents ; Tobacco Products ; Commerce ; Nicotine
Chemical Substances	Flavoring Agents ; Nicotine (6M3C89ZY6R)
Language	English
Publishing date	2022-11-19
Publishing country	England
Document type	Review ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-14440-x
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Article ; Online: An analysis of cigarette sales during Poland's menthol cigarette sales ban: small effects with large policy implications.

Liber, Alex C / Stoklosa, Michal / Levy, David T / Sánchez-Romero, Luz María / Cadham, Christopher J / Pesko, Michael F

European journal of public health

2022 Volume 32, Issue 5, Page(s) 735–740

Abstract: Background: In May 2020, the European Union Tobacco Products Directive mandated that EU member states, including Poland, ban the sale of menthol cigarettes. With menthol making up 28% of cigarette sales before the ban, Poland is the country with likely ... ...

Abstract	Background: In May 2020, the European Union Tobacco Products Directive mandated that EU member states, including Poland, ban the sale of menthol cigarettes. With menthol making up 28% of cigarette sales before the ban, Poland is the country with likely the largest menthol cigarette sales share in the world to ban their sale. We analyze how this ban changed the Polish tobacco market. Methods: We use monthly NielsenIQ data (May 2018-April 2021) on sales of cigarettes and roll-your-own tobacco by menthol and standard flavor in eight regions of Poland. We set up a bite-style regression model controlling for pre-ban menthol share, climate, border opening status, and Apple movement data to estimate the effect of the May 2020 menthol ban. Results: We find menthol cigarette sales fell at least 97% after the menthol cigarette ban across Poland and standard cigarette sales replaced them. Regression modeling indicates that total cigarette sales fell, after the ban, an average of 2.2 sticks per capita per month, equal to a 2.9% decline, however, results were not significant (P = 0.199). The bite component of our model reveals total cigarette sales did decline significantly in the regions with the highest pre-ban menthol sales shares. Roll-your-own tobacco sales increased by a statistically insignificant 0.03 stick-equivalents after the ban (P = 0.798). Product prices also fell in the wake of the menthol ban. Conclusions: In Poland, the EU state with the one of the largest pre-ban menthol shares, we find mixed evidence that the ban is working as intended.
MeSH term(s)	Commerce ; Humans ; Menthol ; Poland ; Policy ; Nicotiana ; Tobacco Products
Chemical Substances	Menthol (1490-04-6)
Language	English
Publishing date	2022-06-10
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1129243-x
ISSN	1464-360X ; 1101-1262
ISSN (online)	1464-360X
ISSN	1101-1262
DOI	10.1093/eurpub/ckac063
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Article ; Online: Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling.

Chapman, Christina Hunter / Schechter, Clyde B / Cadham, Christopher J / Trentham-Dietz, Amy / Gangnon, Ronald E / Jagsi, Reshma / Mandelblatt, Jeanne S

Annals of internal medicine

2021 Volume 174, Issue 12, Page(s) 1637–1646

Abstract: Background: Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival.: Objective: To compare tradeoffs of screening strategies in Black women versus White women under ... ...

Abstract	Background: Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. Objective: To compare tradeoffs of screening strategies in Black women versus White women under current guidelines. Design: An established model from the Cancer Intervention and Surveillance Modeling Network simulated screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage-, and subtype-specific treatment effects; and non-breast cancer mortality. Setting: United States. Participants: A 1980 U.S. birth cohort of Black and White women. Intervention: Screening strategies until age 74 years with varying initiation ages and intervals. Measurements: Outcomes included benefits (life-years gained [LYG], breast cancer deaths averted, and mortality reduction), harms (mammographies, false positives, and overdiagnoses), and benefit-harm ratios (tradeoffs) by race. Efficiency (benefits per unit resource), mortality disparity reduction, and equity in tradeoffs were evaluated. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from ages 50 to 74 years. Results: Biennial screening from ages 45 to 74 years was most efficient for Black women, whereas biennial screening from ages 40 to 74 years was most equitable. Initiating screening 10 years earlier in Black versus White women reduced Black-White mortality disparities by 57% with similar LYG per mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real-world treatment effectiveness: The less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. Limitation: Single model. Conclusion: Initiating biennial screening in Black women at age 40 years reduces breast cancer mortality disparities and yields benefit-harm ratios that are similar to tradeoffs of White women screened biennially from ages 50 to 74 years. Primary funding source: National Cancer Institute at the National Institutes of Health.
MeSH term(s)	Black or African American ; Aged ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/ethnology ; Breast Neoplasms/mortality ; Breast Neoplasms/therapy ; Computer Simulation ; Female ; Health Services Accessibility ; Humans ; Mammography ; Mass Screening/methods ; Middle Aged ; United States/epidemiology ; White People
Language	English
Publishing date	2021-10-19
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M20-6506
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Article ; Online: Simulation of Chemotherapy Effects in Older Breast Cancer Patients With High Recurrence Scores.

Chandler, Young / Jayasekera, Jinani C / Schechter, Clyde B / Isaacs, Claudine / Cadham, Christopher J / Mandelblatt, Jeanne S

Journal of the National Cancer Institute

2019 Volume 112, Issue 6, Page(s) 574–581

Abstract: Background: Tumor genomic expression profile data are used to guide chemotherapy choice, but there are gaps in evidence for women aged 65 years and older. We estimate chemotherapy effects by age and comorbidity level among women with early-stage, ... ...

Abstract	Background: Tumor genomic expression profile data are used to guide chemotherapy choice, but there are gaps in evidence for women aged 65 years and older. We estimate chemotherapy effects by age and comorbidity level among women with early-stage, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers and Oncotype DX scores of 26 or higher. Methods: A discrete-time stochastic state transition simulation model synthesized data from population studies and clinical trials to estimate outcomes over a 25-year horizon for subgroups based on age (65-69, 70-74, 75-79, and 80-89 years) and comorbidity levels (no or low, moderate, severe). Outcomes were discounted at 3%, and included quality-adjusted life-years (QALYs), life-years, and breast cancer and other-cause mortality with chemoendocrine vs endocrine therapy. Sensitivity analysis tested the effect of varying uncertain parameters. Results: Women aged 65-69 years with no or low comorbidity gained 0.16 QALYs with chemo-endocrine and reduced breast cancer mortality from 34.8% to 29.7%, for an absolute difference of 5.1%; this benefit was associated with a 12.8% rate of grade 3-4 toxicity. Women aged 65-69 years with no or low or moderate comorbidity levels, and women aged 70-74 years with no or low comorbidity had small chemotherapy benefits. All women aged 75 years and older experienced net losses in QALYs with chemo-endocrine therapy. The results were robust in sensitivity analyses. Chemotherapy had greater benefits as treatment effectiveness increased, but toxicity reduced the QALYs gained. Conclusion: Among women aged 65-89 years whose tumors indicate a high recurrence risk, only those aged 65-74 years with no or low or moderate comorbidity have small benefits from adding chemotherapy to endocrine therapy. Genomic expression profile testing (and chemotherapy use) should be reserved for women aged younger than 75 years without severe comorbidity.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Antineoplastic Agents, Hormonal/administration & dosage ; Breast Neoplasms/drug therapy ; Breast Neoplasms/epidemiology ; Breast Neoplasms/genetics ; Breast Neoplasms/pathology ; Computer Simulation ; Female ; Gene Expression Profiling ; Humans ; Models, Statistical ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/genetics ; Neoplasm Recurrence, Local/pathology ; Prevalence ; Quality of Life ; SEER Program ; Stochastic Processes ; United States/epidemiology
Chemical Substances	Antineoplastic Agents, Hormonal
Language	English
Publishing date	2019-10-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2992-0
ISSN	1460-2105 ; 0027-8874 ; 0198-0157
ISSN (online)	1460-2105
ISSN	0027-8874 ; 0198-0157
DOI	10.1093/jnci/djz189
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Article ; Online: Health Effects of Electronic Cigarettes: An Umbrella Review and Methodological Considerations.

Travis, Nargiz / Knoll, Marie / Cadham, Christopher J / Cook, Steven / Warner, Kenneth E / Fleischer, Nancy L / Douglas, Clifford E / Sánchez-Romero, Luz María / Mistry, Ritesh / Meza, Rafael / Hirschtick, Jana L / Levy, David T

International journal of environmental research and public health

2022 Volume 19, Issue 15

Abstract: E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and ... ...

Abstract	E-cigarettes are often marketed as a safer alternative to combustible cigarettes. However, their health effects, especially those associated with long-term use, remain largely uncertain. We conducted an umbrella review of the cardiopulmonary and carcinogenic risks of e-cigarette use, distinguishing between short-term and long-term health effects. The search for systematic reviews was conducted across four electronic databases through 25 January 2022. Methodological quality was assessed using the AMSTAR-2 quality appraisal tool. Seventeen systematic reviews, including five meta-analyses, were included in our umbrella review. There was a clear underreporting of e-cigarette devices and e-liquid types, e-cigarette and cigarette exposure, and the health and smoking status of study participants. Overall, the findings suggest that short-term use of e-cigarettes may be associated with acute cardiopulmonary risks, although to a lesser extent than cigarette use. Long-term e-cigarette use may have pulmonary/respiratory benefits in those who switch from chronic cigarette smoking, particularly in individuals with asthma and chronic obstructive pulmonary disease (COPD). Evidence on intermediate and long-term carcinogenic effects is lacking. This umbrella review underscores the urgent need for systematic reviews with better adherence to established reporting guidelines, consistent definitions of duration of e-cigarette use, a focus on newer devices, and accounting for the impacts of former or current smoking.
MeSH term(s)	Carcinogens ; Cigarette Smoking ; Electronic Nicotine Delivery Systems ; Humans ; Systematic Reviews as Topic ; Tobacco Products ; Vaping
Chemical Substances	Carcinogens
Language	English
Publishing date	2022-07-25
Publishing country	Switzerland
Document type	Journal Article ; Review ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19159054
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Article ; Online: A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products.

Levy, David T / Cadham, Christopher J / Li, Yameng / Yuan, Zhe / Liber, Alex C / Oh, Hayoung / Travis, Nargiz / Issabakhsh, Mona / Sweanor, David T / Sánchez-Romero, Luz Maria / Meza, Rafael / Cummings, K Michael

International journal of environmental research and public health

2022 Volume 19, Issue 20

Abstract: Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework ... ...

Abstract	Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.
MeSH term(s)	Humans ; Vaping/epidemiology ; Nicotine ; Nicotiana ; Public Health ; Tobacco Products ; Electronic Nicotine Delivery Systems ; Recurrence
Chemical Substances	Nicotine (6M3C89ZY6R)
Language	English
Publishing date	2022-10-18
Publishing country	Switzerland
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph192013431
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