Location: Poster Hall: Hyatt Regency Orlando, Plaza International Ballroom
Background: Public policy regarding tobacco can be generally divided into Harm Reduction (HR) for existing users and Primary Prevention (PP) of tobacco addiction for never users often focused on young adults and adolescents. E-cigarettes are touted by those favoring HR as cessation tool for current combustible tobacco users. Studies on combustible quit using e-cigarettes range from no improvement to an additional 8 successful combustible quits per 100 attempts. Because there are no E-cigarette products FDA approved for smoking cessation, HR advocates often support less restrictive public policy like opposing restrictions on the sale of flavored tobacco. HR policy position comes at the direct cost of PP policy goals by adopting a more permissive stance on some tobacco policy initiatives. This study will quantify the potential risks and benefits of both policy positions.
Methods: Using US Census data, tobacco surveillance data, and best evidence on tobacco cessation we developed a simple mathematical model to quantify the benefits and costs of harm reduction in smokers who quit for every new under 21 smoker and vape user.
Results: The impact of e-cigarettes for improving cessation has a diminishing marginal benefit and increasing marginal costs over time. When normalized for generation size, assuming a range of improved cessation rates from e-cigarettes (additional 2, 4, or 8 successes per 100 quit attempts), for every person who successfully quits combustible tobacco, there will be 7.1 new young adult vape users (range 6.5 to 13.5) and there will be 0.45 new young adult combustible tobacco users (range 0.42 to 0.86) over the next ten years. Every year the number of new young adult vape and combustible users increases for every adult successful quit.
Conclusion: Public policy focused on harm reduction has diminishing marginal benefit and significant cost in the number of new adolescent and young adult e-cigarette users and combustible tobacco users. Adolescents and young adults who start using assume a disease state with an uncertain health risk and no personal benefit when starting e-cigarettes.
