A Magic Bullet? The Potential Impact of E-Cigarettes on the Toll of Cigarette Smoking

Abstract Introduction We examine the proportion of US smoking-produced mortality that e-cigarettes might eliminate under assumptions regarding vaping’s ability to increase smoking cessation, vaping’s health risks, and the possibility that vaping will increase smoking among young people. Methods We employ a dynamic population simulation model that tracks individuals from ages 0 to 110, differentiated by gender and smoking status. Using data from the US Census, the National Vital Statistics Reports, Cancer Prevention Study II, and the National Health Interview Survey, we estimate the number of smoking-related life-years lost (LYL) from 2018 to 2100 in a no-vaping scenario. We then compare results for model runs that assess the impact of vaping under a variety of assumptions. Results The combination of assumptions produces 360 possible scenarios. 357 (99%) yield positive estimates of life-years saved (LYS) due to vaping by 2100, from 143 000 to 65 million. Most scenarios result in millions of individuals quitting smoking due to vaping. On average, vaping-induced quitters gain an extra 1.2–2.0 years of life compared to smokers who quit without vaping. The impact of vaping is greatest when it most helps smokers who otherwise have the greatest difficulty quitting smoking. While the numbers of LYS are generally large across all scenarios, they often represent a small fraction of the toll of smoking. Conclusions Vaping is highly likely to reduce smoking-produced mortality. Still, vaping is not “the” answer to the public health crisis created by smoking. Rather, it may well be a tool to add to the armamentarium of effective tobacco control measures. Implications E-cigarettes hold the potential to reduce cigarette smoking’s enormous toll. By itself, however, tobacco harm reduction, as embodied in vaping, is no magic bullet. Going forward, tobacco control will require vigilant application of the evidence-based measures that have brought us so much success in combatting smoking. It will require, as well, the search for and adoption of novel means of attacking the remaining problem. Harm reduction can, and many would say should, be a part of the complex formula that will eventually bring about the demise of smoking.

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A Qualitative Study on Chinese Canadian Male Immigrants’ Perspectives on Stopping Smoking: Implications for Tobacco Control in China

American Journal of Men s Health ◽

10.1177/1557988316644050 ◽

2016 ◽

Vol 12 (4) ◽

pp. 812-818 ◽

Cited By ~ 5

Author(s):

Aimei Mao ◽

Joan L. Bottorff ◽

John L. Oliffe ◽

Gayl Sarbit ◽

Mary T. Kelly

Keyword(s):

Qualitative Study ◽

Tobacco Control ◽

Control Measures ◽

Public Places ◽

Adult Men ◽

Quitting Smoking ◽

Canadian Immigrants ◽

Canadian Culture ◽

Chinese Canadian ◽

The Impact

China has the largest number of smokers in the world; more than half of adult men smoke. Chinese immigrants smoke at lower rates than the mainstream population and other immigrant groups do. This qualitative study was to explore the influence of denormalization in Canada on male Chinese immigrant smoking after migration. Semistructured interviews were conducted with 22 male Chinese Canadian immigrants who were currently smoking or had quit smoking in the past 5 years. The study identified that, while becoming a prospective/father prompted the Chinese smokers to quit or reduce their smoking due to concern of the impacts of their smoking on the health of their young children, changes in smoking were also associated with the smoking environment. Four facilitators were identified which were related to the denomormalized smoking environment in Canada: (a) the stigma related to being a smoker in Canada, (b) conformity with Canadian smoking bans in public places, (c) the reduced social function of smoking in Canadian culture, and (d) the impact of graphic health messages on cigarette packs. Denormalization of tobacco in Canada in combination with collectivist values among Chinese smokers appeared to contribute to participants’ reducing and quitting smoking. Although findings of the study cannot be claimed as generalizable to the wider population of Chinese Canadian immigrants due to the small number of the participants, this study provides lessons for the development of tobacco control measures in China to reverse the current prosmoking social environment.

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FDA-iRISK—A Comparative Risk Assessment System for Evaluating and Ranking Food-Hazard Pairs: Case Studies on Microbial Hazards

Journal of Food Protection ◽

10.4315/0362-028x.jfp-12-372 ◽

2013 ◽

Vol 76 (3) ◽

pp. 376-385 ◽

Cited By ~ 44

Author(s):

YUHUAN CHEN ◽

SHERRI B. DENNIS ◽

EMMA HARTNETT ◽

GREG PAOLI ◽

RÉGIS POUILLOT ◽

...

Keyword(s):

Public Health ◽

Risk Assessment ◽

Case Studies ◽

Assessment System ◽

Process Models ◽

Control Measures ◽

Quantitative Risk Assessment ◽

The Public ◽

Life Years ◽

The Impact

Stakeholders in the system of food safety, in particular federal agencies, need evidence-based, transparent, and rigorous approaches to estimate and compare the risk of foodborne illness from microbial and chemical hazards and the public health impact of interventions. FDA-iRISK (referred to here as iRISK), a Web-based quantitative risk assessment system, was developed to meet this need. The modeling tool enables users to assess, compare, and rank the risks posed by multiple food-hazard pairs at all stages of the food supply system, from primary production, through manufacturing and processing, to retail distribution and, ultimately, to the consumer. Using standard data entry templates, built-in mathematical functions, and Monte Carlo simulation techniques, iRISK integrates data and assumptions from seven components: the food, the hazard, the population of consumers, process models describing the introduction and fate of the hazard up to the point of consumption, consumption patterns, dose-response curves, and health effects. Beyond risk ranking, iRISK enables users to estimate and compare the impact of interventions and control measures on public health risk. iRISK provides estimates of the impact of proposed interventions in various ways, including changes in the mean risk of illness and burden of disease metrics, such as losses in disability-adjusted life years. Case studies for Listeria monocytogenes and Salmonella were developed to demonstrate the application of iRISK for the estimation of risks and the impact of interventions for microbial hazards. iRISK was made available to the public at http://irisk.foodrisk.org in October 2012.

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Impact of the WHO FCTC on tobacco control: perspectives from stakeholders in 12 countries

Tobacco Control ◽

10.1136/tobaccocontrol-2019-054940 ◽

2019 ◽

Vol 28 (Suppl 2) ◽

pp. s129-s135 ◽

Cited By ~ 2

Author(s):

Lorraine Craig ◽

Geoffrey T Fong ◽

Janet Chung-Hall ◽

Pekka Puska

Keyword(s):

Tobacco Control ◽

World Bank ◽

Tobacco Industry ◽

Primary Objective ◽

Political Support ◽

Control Measures ◽

Stakeholder Perspectives ◽

Independent Expert ◽

Development Levels ◽

The Impact

BackgroundThe WHO Framework Convention on Tobacco Control (WHO FCTC), the first WHO treaty, entered into force in 2005. In April 2015, a seven-member independent expert group (EG) was established by a decision of the FCTC Conference of the Parties to assess the impact of the Treaty in its first decade.One component of the EG’s methodology was to gather evidence on WHO FCTC impact from Parties themselves. This paper presents findings from 12 country missions on how the FCTC impacted progress on tobacco control.MethodsBetween November 2015 and May 2016, EG members conducted missions in 12 countries representing each of the six WHO regions and the four World Bank economic development levels. In each country, the EG interviewed a broad range of stakeholders to assess the extent to which the FCTC had contributed to tobacco control. The primary objective was to assess whether tobacco control measures would have been developed or passed, or implemented at all, or as quickly, if there had been no FCTC. Through this counterfactual inquiry, the EG sought to determine the FCTC’s causal role.ConclusionThe FCTC was reported to have made contributions along the entire policy/regulation process: the development of a measure, building legislative and political support for a measure and its implementation. These stakeholder perspectives support the conclusion that the FCTC has played a pivotal role in accelerating and strengthening the implementation of tobacco control measures, although tobacco industry interference continues to be a significant obstacle to further advancement.

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Methods of the International Tobacco Control (ITC) EUREST-PLUS ITC Europe Surveys

European Journal of Public Health ◽

10.1093/eurpub/ckz212 ◽

2020 ◽

Vol 30 (Supplement_3) ◽

pp. iii4-iii9 ◽

Cited By ~ 2

Author(s):

Mary E Thompson ◽

Pete Driezen ◽

Christian Boudreau ◽

Nicolas Bécuwe ◽

Thomas K Agar ◽

...

Keyword(s):

Tobacco Control ◽

Sampling Design ◽

Retention Rate ◽

Smoking Status ◽

Retention Rates ◽

Tobacco Products ◽

Nationally Representative ◽

The Impact ◽

Collection Methods ◽

Representative Samples

Abstract Background The EUREST-PLUS ITC Europe surveys aim to evaluate the impact of the European Union’s Tobacco Products Directive (EU TPD) implementation within the context of the WHO FCTC. This article describes the methodology of the 2016 (Wave 1) and 2018 (Wave 2) International Tobacco Control 6 European (6E) Country Survey in Germany, Greece, Hungary, Poland, Romania and Spain; the England arm of the 2016 (Wave 1) and 2018 (Wave 2) ITC 4 Country Smoking and Vaping (4CV) Survey; and the 2016 (Wave 10) and 2017 (Wave 11) ITC Netherlands (NL) Survey. All three ITC surveys covering a total of eight countries are prospective cohort studies with nationally representative samples of smokers. Methods In the three surveys across the eight countries, the recruited respondents were cigarette smokers who smoked at least monthly, and were aged 18 and older. At each survey wave, eligible cohort members from the previous waves were retained, regardless of smoking status, and dropouts were replaced by a replenishment sample. Results Retention rates between the two waves of the ITC 6E Survey by country were 70.5% for Germany, 41.3% for Greece, 35.7% for Hungary, 45.6% for Poland, 54.4% for Romania and 71.3% for Spain. The retention rate for England between ITC 4CV1 and ITC 4CV2 was 39.1%; the retention rates for the ITC Netherlands Survey were 76.6% at Wave 10 (2016) and 80.9% at Wave 11 (2017). Conclusion The ITC sampling design and data collection methods in these three ITC surveys allow analyses to examine prospectively the impact of policy environment changes on the use of cigarettes and other tobacco products in each country, to make comparisons across the eight countries.

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Estimating the return on investment of the Bureau of Tobacco Free Florida tobacco control programme from 1999 to 2015

BMJ Open ◽

10.1136/bmjopen-2020-040012 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040012

Author(s):

James Nonnemaker ◽

Anna J MacMonegle ◽

Nathan Mann ◽

Robyn Woodlea ◽

Jennifer Duke ◽

...

Keyword(s):

Tobacco Control ◽

Return On Investment ◽

Premature Mortality ◽

Control Programme ◽

Attributable Mortality ◽

Years Of Life Lost ◽

Synthetic Control ◽

Healthcare Expenditures ◽

Life Years ◽

The Impact

ObjectiveTo assess the return on investment (ROI) of the Florida tobacco control programme, the Bureau of Tobacco Free Florida (BTFF), in terms of healthcare expenditure savings and mortality cost saved as a result of reduced mortality due to the programme from 1999 to 2015.MethodsWe use a synthetic control method to estimate the impact of the BTFF on smoking-attributable mortality, years of life lost (YLL), healthcare expenditures, and the economic value of premature mortality due to smoking in Florida from 1999 through 2015. We calculated an ROI for healthcare expenditures and for the value of life years saved.ResultsFrom 1999 to 2015, adult smoking prevalence in Florida averaged 0.98 percentage points lower than prevalence in the synthetic control states (19.6% vs 20.6%). The ROI over the period from 1999 to 2015 was 9.61 for healthcare expenditures and 112.44 for premature mortality. These ROIs suggest that for every US$1 of expenditure by BTFF, smoking-attributable healthcare expenditures decreased by almost US$11 and reductions in the economic costs associated with YLL due to smoking-attributable mortality totaled approximately US$113.ConclusionsOur results suggest the BTFF resulted in fewer YLL, substantial healthcare cost savings and substantial savings in terms of mortality costs. The positive ROIs for healthcare expenditures and premature mortality suggest that the BTFF is a good investment of public funds.

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Developing an indicative model for preserving restaurant viability during the COVID-19 crisis

Tourism and Hospitality Research ◽

10.1177/1467358421998057 ◽

2021 ◽

pp. 146735842199805

Author(s):

Aristeidis Gkoumas

Keyword(s):

Cultural Context ◽

Management Plan ◽

Control Measures ◽

Public Authorities ◽

Health Crisis ◽

The Public ◽

Proposed Model ◽

Food And Beverage ◽

Crisis Management Plan ◽

The Impact

Amid the ongoing COVID-19 pandemic, the relatively small number of reported cases of the coronavirus for the last 8 months in Taiwan suggests that the country has successfully managed to mitigate the outbreak. Following a proactive strategy, an immediate response, and a well-orchestrated monitoring system, the public authorities prevented the epidemic and avoided lockdowns, curfews, or business closures enforced by other governments across the globe. This case study explores the implications for the restaurant sector of governmental control measures created to combat the spread of the virus. Based on ethnographic research, the paper investigates the impact of the health crisis management plan on the economic sustainability of small restaurants in tourism areas of Tainan City, in the south of Taiwan. Proceeding inductively, this research identifies seven key factors for restaurant viability during the COVID-19 pandemic. The results of the study indicate that cultural context, social cohesion, and the cooperation of restaurant professionals are essential to the effectiveness of any strategy for containing the coronavirus. The proposed model aims to provide a feasible tool for food and beverage providers in other countries to adjust their efforts and actions for surviving during a pandemic.

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Modelling the Potential Acute and Post-Acute Burden of COVID-19 Under the Australian Border Re-Opening Plan

10.21203/rs.3.rs-1066181/v1 ◽

2021 ◽

Author(s):

Mary Rose Angeles ◽

Sithara Wanni Arachchige Dona ◽

Dieu Nguyen ◽

Long Le ◽

Martin Hensher

Keyword(s):

Control Measures ◽

Base Case ◽

Post Vaccination ◽

Healthcare Needs ◽

Disability Adjusted Life ◽

Life Years ◽

Total Base ◽

Potential Impact ◽

The Impact

Abstract Background Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia’s national and state re-opening plans have not incorporated non-acute illness in their modelling. We therefore develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19. Methods A model was developed to estimate the burden of COVID-19 using DALYs. It was then applied to different scenarios drawn from the Doherty Institute’s modelling report, to estimate the likely DALY losses under the Australian national reopening plan. Uncertainty and sensitivity analysis were performed to examine the robustness of the results. Results Mortality was responsible for 72%-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19% and 3% of the total base case DALYs respectively. When included in the analysis, permanent impairment could contribute up to 51%-55% of total DALYs lost. Conclusions The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to COVID-19 burden in Australia’s post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics.

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Simulating future public health benefits of tobacco control interventions: a systematic review of models

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055425 ◽

2020 ◽

pp. tobaccocontrol-2019-055425 ◽

Cited By ~ 1

Author(s):

Ankur Singh ◽

Nick Wilson ◽

Tony Blakely

Keyword(s):

Systematic Review ◽

Tobacco Control ◽

Age Groups ◽

Simulation Models ◽

Time Lags ◽

Future Trends ◽

Medline Search ◽

Policy Model ◽

Life Years ◽

The Impact

BackgroundTo prioritise tobacco control interventions, simulating their health impacts is valuable. We undertook a systematic review of tobacco intervention simulation models to assess model structure and input variations that may render model outputs non-comparable.MethodsWe applied a Medline search with keywords intersecting modelling and tobacco. Papers were limited to those modelling health outputs (eg, mortality, health-adjusted life years), and at least two of cancer, cardiovascular and respiratory diseases. Data were extracted for each simulation model with ≥3 arising papers, including: model type, untimed or with time steps and trends in business-as-usual (BAU) tobacco prevalence and epidemiology.ResultsOf 1911 papers, 186 met the inclusion criteria, including 13 eligible simulation models. The SimSmoke model had the largest number of publications (n=46), followed by Benefits of Smoking Cessation on Outcomes (n=12) and Tobacco Policy Model (n=10). Two of 13 models only estimated deaths averted, 1 had no time steps, 5 had no future trends in BAU tobacco prevalence, 9 had no future trends in BAU disease epidemiology and 7 had no time lags from quitting tobacco to reversal of health harm.ConclusionsConsiderable heterogeneity exists in simulation models, making outputs substantively non-comparable between models. Ranking of interventions by one model may be valid. However, this may not be true if, for example, interventions that differentially affect age groups (eg, a tobacco-free generation policy vs increased cessation among adults) do not account for plausible future trends. Greater standardisation of model structures and outputs will allow comparison across models and countries, and for comparisons of the impact of tobacco control interventions with other preventive interventions.

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Global impact of tobacco control policies on smokeless tobacco use: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-042860 ◽

2020 ◽

Vol 10 (12) ◽

pp. e042860

Author(s):

Monika Arora ◽

Aastha Chugh ◽

Neha Jain ◽

Masuma Mishu ◽

Melanie Boeckmann ◽

...

Keyword(s):

Systematic Review ◽

Tobacco Control ◽

Smokeless Tobacco ◽

Assessment Tool ◽

Eastern Mediterranean ◽

Eastern Mediterranean Region ◽

Control Measures ◽

Cochrane Library ◽

Google Search ◽

The Impact

IntroductionSmokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated.Methods and analysisA systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project’s ‘Quality Assessment Tool for Quantitative Studies’ will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used.Ethics and disseminationPermission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control’s Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences.PROSPERO registration numberCRD42020191946.

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