Public health impact of a US ban on menthol in cigarettes and cigars: a simulation study

IntroductionThe US Food and Drug Administration most recently announced its intention to ban menthol cigarettes and cigars nationwide in April 2021. Implementation of the ban will require evidence that it would improve public health. This paper simulates the potential public health impact of a ban on menthol in cigarettes and cigars through its impacts on smoking initiation, smoking cessation and switching to nicotine vaping products (NVPs).MethodsAfter calibrating an established US simulation model to reflect recent use trends in cigarette and NVP use, we extended the model to incorporate menthol and non-menthol cigarette use under a status quo scenario. Applying estimates from a recent expert elicitation on the behavioural impacts of a menthol ban, we developed a menthol ban scenario with the ban starting in 2021. We estimated the public health impact as the difference between smoking and vaping-attributable deaths and life-years lost in the status quo scenario and the menthol ban scenario from 2021 to 2060.ResultsAs a result of the ban, overall smoking was estimated to decline by 15% as early as 2026 due to menthol smokers quitting both NVP and combustible use or switching to NVPs. These transitions are projected to reduce cumulative smoking and vaping-attributable deaths from 2021 to 2060 by 5% (650 000 in total) and reduce life-years lost by 8.8% (11.3 million). Sensitivity analyses showed appreciable public health benefits across different parameter specifications.Conclusions and relevanceOur findings strongly support the implementation of a ban on menthol in cigarettes and cigars.

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The Public Health Gains Had Cigarette Companies Chosen to Sell Very Low Nicotine Cigarettes

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa128 ◽

2020 ◽

Author(s):

David T Levy ◽

K Michael Cummings ◽

Bryan W Heckman ◽

Yameng Li ◽

Zhe Yuan ◽

...

Keyword(s):

Public Health ◽

Expert Elicitation ◽

The Public ◽

Nicotine Content ◽

Premature Deaths ◽

Health Gains ◽

Life Years ◽

Life Years Lost ◽

Technical Capability ◽

The Impact

Abstract Introduction The U.S. Food and Drug Administration (FDA) has proposed lowering the nicotine content of cigarettes to a minimally addictive level to increase smoking cessation and reduce initiation. This study has two aims: (1) to determine when cigarette manufacturers had the technical capability to reduce cigarette nicotine content and (2) to estimate the lost public health benefits of implementing a standard in 1965, 1975, or 1985. Methods To determine the technical capability of cigarette companies, we reviewed public patents and internal cigarette company business records using the Truth Tobacco Industry Documents. To evaluate the impact of a very low nicotine content cigarette (VLNC) standard on smoking attributable deaths (SADs) and life-years lost (LYLs), we applied a validated (CISNET) model that uses past smoking data, along with estimates of the potential impact of VLNCs derived from expert elicitation. Results Cigarette manufacturers recognized that cigarettes were deadly and addictive before 1964. Manufacturers have had the technical capability to lower cigarette nicotine content for decades. Our model projected that a standard implemented in 1965 could have averted 21 million SADs (54% reduction) and 272 million LYLs (64% reduction) from 1965 to 2064, a standard implemented in 1975 could have averted 18.9 million SADs and 245.4 million LYLs from 1975 to 2074, and a standard implemented in 1985 could have averted 16.3 million SADs and 211.5 million LYLs from 1985 to 2084. Conclusions Millions of premature deaths could have been averted if companies had only sold VLNCs decades ago. FDA should act immediately to implement a VLNC standard. Implications Prior research has shown that a mandated reduction in the nicotine content of cigarettes could reduce the prevalence of smoking and improve public health. Here we report that cigarette manufacturers have had the ability to voluntarily implement such a standard for decades. We use a well-validated model to demonstrate that millions of smoking attributable deaths and life-years lost would have been averted if the industry had implemented such a standard.

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Ranking the Disease Burden of 14 Pathogens in Food Sources in the United States Using Attribution Data from Outbreak Investigations and Expert Elicitation†

Journal of Food Protection ◽

10.4315/0362-028x.jfp-11-418 ◽

2012 ◽

Vol 75 (7) ◽

pp. 1278-1291 ◽

Cited By ~ 285

Author(s):

MICHAEL B. BATZ ◽

SANDRA HOFFMANN ◽

J. GLENN MORRIS

Keyword(s):

Cost Of Illness ◽

Disease Burden ◽

Health Impact ◽

The United States ◽

Expert Elicitation ◽

Food Sources ◽

Sensitivity Analyses ◽

Health Burden ◽

Life Years ◽

Outbreak Investigations

Understanding the relative public health impact of major microbiological hazards across the food supply is critical for a risk-based national food safety system. This study was conducted to estimate the U.S. health burden of 14 major pathogens in 12 broad categories of food and to then rank the resulting 168 pathogen-food combinations. These pathogens examined were Campylobacter, Clostridium perfringens, Escherichia coli O157:H7, Listeria monocytogenes, norovirus, Salmonella enterica, Toxoplasma gondii, and all other FoodNet pathogens. The health burden associated with each pathogen was measured using new estimates of the cost of illness and loss of quality-adjusted life years (QALYs) from acute and chronic illness and mortality. A new method for attributing illness to foods was developed that relies on both outbreak data and expert elicitation. This method assumes that empirical data are generally preferable to expert judgment; thus, outbreak data were used for attribution except where evidence suggests that these data are considered not representative of food attribution. Based on evaluation of outbreak data, expert elicitation, and published scientific literature, outbreak-based attribution estimates for Campylobacter, Toxoplasma, Cryptosporidium, and Yersinia were determined not representative; therefore, expert-based attribution were included for these four pathogens. Sensitivity analyses were conducted to assess the effect of attribution data assumptions on rankings. Disease burden was concentrated among a relatively small number of pathogen-food combinations. The top 10 pairs were responsible for losses of over $8 billion and 36,000 QALYs, or more than 50% of the total across all pairs. Across all 14 pathogens, poultry, pork, produce, and complex foods were responsible for nearly 60% of the total cost of illness and loss of QALYs.

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Public Health Implications of Vaping in the US: The Smoking and Vaping Simulation Model

10.21203/rs.3.rs-36677/v1 ◽

2020 ◽

Author(s):

David T Levy ◽

Jamie Tam ◽

Luz Maria María Sanchez-Romero ◽

Yameng Li ◽

Zhe Yuan ◽

...

Keyword(s):

Public Health ◽

Smoking Cessation ◽

Smoking Initiation ◽

Health Impact ◽

Health Implications ◽

Relative Risks ◽

Life Years ◽

Wide Range ◽

The Us ◽

High Degree

Abstract Background Nicotine vaping products (NVPs) are increasingly popular worldwide. They may provide public health benefits if used as a substitute for smoking, but may create public health harms if used as a gateway to smoking or to discourage smoking cessation. This paper presents the Smoking and Vaping Model (SAVM), which estimates the public health implications of NVPs in the US. Methods SAVM adopts a cohort-approach and is available on an Excel platform. We derive public health implications by comparing smoking- and NVP-attributable deaths under a No-NVP and an NVP Scenario. The No-NVP Scenario projects current, former and never smoking rates via smoking initiation and cessation rates, and incorporates excess risks of smoking. The NVP Scenario allows for NVP relative excess risks, switching from cigarette to NVP use, separate NVP and smoking initiation rates, and separate NVP and smoking cessation rates. The model is validated against recent US survey data on smoking and vaping prevalence. Results The SAVM projects that under current patterns of US NVP use and substitution, NVP use will translate into 5.8 million premature smoking- and vaping-attributable deaths avoided and 96.4 million life years gained between 2013 and 2100. Sensitivity analysis shows that parameters for NVP relative risks, NVP-related switching and smoking cessation are particularly influential in gauging public health impacts. Discussion The SAVM shows potential benefits of e-cigarette use over a wide range of parameters. However, there is a high degree of uncertainty regarding key parameters. Policymakers, researchers and other public health stakeholders can apply the SAVM to estimate the potential public health impact of NVPs in their country or region using their own data sources.

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Assessing the Public Health Impact and Effectiveness of Interventions To Prevent Salmonella Contamination of Sprouts

Journal of Food Protection ◽

10.4315/0362-028x.jfp-15-184 ◽

2016 ◽

Vol 79 (1) ◽

pp. 37-42 ◽

Cited By ~ 7

Author(s):

HONGLIU DING ◽

TONG-JEN FU

Keyword(s):

Public Health ◽

Risk Reduction ◽

Seed Treatment ◽

Health Impact ◽

Mitigation Strategies ◽

Public Health Impact ◽

Calcium Hypochlorite ◽

The Public ◽

Life Years ◽

Microbiological Testing

ABSTRACT Sprouts have been a recurring public health challenge due to microbiological contamination, and Salmonella has been the major cause of sprout-associated outbreaks. Although seed treatment and microbiological testing have been applied as risk reduction measures during sprout production, the extent to which their effectiveness in reducing the public health risks associated with sprouts has not been well investigated. We conducted a quantitative risk assessment to measure the risk posed by Salmonella contamination in sprouts and to determine whether and how mitigation strategies can achieve a satisfactory risk reduction based on the assumption that the risk reduction achieved by a microbiological sampling and testing program at a given sensitivity is equivalent to that achieved by direct inactivation of pathogens. Our results indicated that if the sprouts were produced without any risk interventions, the health impact caused by sprouts contaminated with Salmonella would be very high, with a median annual estimated loss of disability-adjusted life years (DALYs) of 691,412. Seed treatment (with 20,000 ppm of calcium hypochlorite) or microbiological sampling and testing of spent irrigation water (SIW) alone could reduce the median annual impact to 734 or 4,856 DALYs, respectively. Combining seed treatment with testing of the SIW would further decrease the risk to 58 DALYs. This number could be dramatically lowered to 3.99 DALYs if sprouts were produced under conditions that included treating seeds with 20,000 ppm of calcium hypochlorite plus microbiological testing of seeds, SIW, and finished products. Our analysis shows that the public health impact due to Salmonella contamination in sprouts could be controlled if seeds are treated to reduce pathogens and microbiological sampling and testing is implemented. Future advances in intervention strategies would be important to improve sprout safety further.

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2720. Potential Public Health Impact of a Pentavalent vaccine targeting Neisseria meningitidis Serogroups A, B, C, W, and Y

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2397 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S957-S957

Author(s):

Sonya J Snedecor ◽

Amit K Sirvastava ◽

Paul Palmer ◽

Liping Huang

Keyword(s):

Public Health ◽

United States ◽

Meningococcal Disease ◽

Health Impact ◽

The United States ◽

Vaccine Uptake ◽

Sensitivity Analyses ◽

Public Health Impact ◽

Pentavalent Vaccine ◽

Potential Public Health

Abstract Background In the United States, most invasive meningococcal disease (IMD) is caused by serogroup B, followed by C, W, and Y. ACIP recommends universal vaccination against MenACWY (Category A) and MenB based on individual clinical decision-making (Category B) (Figure 1). In 2017, MenACWY vaccine uptake among adolescents was 44.3% for ≥2 doses and MenB uptake was 14.5% for ≥1 dose of a multi-dose series. A pentavalent vaccine (MenABCWY or Penta) has the potential to simplify immunization schedules and improve uptake to achieve further reductions in IMD. Our objective was to estimate the potential public health impact of Penta. Methods Using CDC’s enhanced meningococcal disease surveillance data (2015–2017 average), a dynamic transmission model was constructed to estimate the reduction in IMD over 10 years resulting from various implementation strategies including Penta within the existing United States meningococcal vaccination platform. The model assumed that 2-doses of Penta could provide 95% and 85% direct and 25.5% and 0% indirect protection, respectively, against serogroups ACWY and B for 5 years, with 10% relative waning per year. For partial compliance (1 dose Penta only), we assumed protection against ACWY equal to 2-doses but partial protection against B. Future uptake of Penta was assumed higher than 2017 uptake, and sensitivity analyses with lower uptake were conducted. Results Based on 2015–2017 epidemiology, the current schedule and uptake of MenACWY and MenB vaccines (total 4 doses) was estimated to avert 149 IMD cases over 10 years. Replacing MenACWY and/or MenB doses with Penta at 11 and/or 16 years could avert more cases, ranging from 172 to 243 (Figure 2). The most beneficial schedule was 2-doses of Penta at 11 years and 1-dose Penta at 16 years. Additional sensitivity analyses indicated that, even assuming current uptake rates, more cases could be prevented by utilizing Penta. Conclusion Replacing one or more MenACWY/MenB vaccine doses with Penta could improve prevention of IMD caused by all 5 meningococcal serogroups among the US adolescent population and provide substantial public health benefit while reducing the recommended number of vaccine administrations. Disclosures All authors: No reported disclosures.

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Estimated public health gains from German smokers switching to risk-reduced alternatives: Results from population health impact modelling

10.21203/rs.3.rs-135255/v1 ◽

2020 ◽

Author(s):

Romana Rytsar ◽

Smilja Djurdjevic ◽

Alexander K Nussbaum ◽

Ashok Kaul ◽

Emanuel Bennewitz ◽

...

Keyword(s):

Public Health ◽

Cigarette Smoking ◽

Population Health ◽

Transition Probabilities ◽

Health Impact ◽

Life Years ◽

Life Years Lost ◽

Age Range ◽

The Impact ◽

Reduced Risk

Abstract Background Smoking is associated with cancer and cardiorespiratory disease mortality. Reducing smoking prevalence reduces deaths and life-years lost. Here, we estimate the impact of introducing heat-not-burn products and e-cigarettes in Germany from 1995 to 2015 on mortality from lung cancer, chronic obstructive pulmonary disease, ischaemic heart disease, and stroke in men and women aged 30–79 years. Methods We used the previously described population health impact model. Modelling starts with individuals of a given sex and age range with a defined cigarette smoking distribution. They are then followed under a “Null Scenario”, where reduced-risk products are never introduced, and one of seven “Alternative Scenarios”, where they are. Transition probabilities allow tobacco product use to change annually, and the individual product histories then allow estimation of risks, relative to never users, for each year and Scenario, which are then used to estimate reductions in deaths and life-years lost for each Alternative Scenario. Results In the Null Scenario, we estimated 852,357 deaths from cigarette smoking, with 8.61 million life-years lost. Had everyone quit in 1995, with no further use of the three products, these numbers would reduce by 216,650 and 2.88 million. The reductions would be 159,278 and 2.06 million with an immediate complete switch from cigarettes to heat-not-burn products, and 179,470 and 2.34 million with an immediate switch to 50% heat-not-burn products and 50% e-cigarettes. In four Scenarios with a more gradual switch, estimated decreases were 39,818–81,293 deaths and 0.50–1.05 million life-years, representing 17.5%-37.5% of the effect of cessation. These estimates assume switching to heat-not-burn products and e-cigarettes involves risk decreases of 80% and 95% of those from quitting. The decreases would have increased, had more diseases and a wider age range been considered, and also with a longer follow-up period, the decreases increasing markedly with time. Conclusions Various limitations are discussed, none affecting our conclusion that introducing these new products into Germany in 1995 could have substantially reduced mortality. Our results imply deaths from cigarette smoking could be substantially reduced, both by cessation and switching to reduced-risk products. Risk-proportionate public health campaigns and regulation might increase such switching.

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Public health impact model estimating the impact of introducing an adjuvanted recombinant zoster vaccine into the UK universal mass vaccination programme

BMJ Open ◽

10.1136/bmjopen-2018-025553 ◽

2019 ◽

Vol 9 (5) ◽

pp. e025553

Author(s):

Desirée A M van Oorschot ◽

Manjit Hunjan ◽

Benjamin Bracke ◽

Stéphane Lorenc ◽

Desmond Curran ◽

...

Keyword(s):

Public Health ◽

Health Impact ◽

Sensitivity Analyses ◽

Public Health Impact ◽

Base Case ◽

Complication Rates ◽

Zoster Vaccine ◽

Recombinant Zoster Vaccine ◽

The Uk ◽

The Impact

ObjectivesIn 2013, the herpes zoster (HZ) immunisation programme was introduced in the UK, recommending vaccination of adults 70 years of age (YOA) with the zoster vaccine live (ZVL), the only vaccine available at the time. The recently approved adjuvanted recombinant zoster vaccine (RZV) has a substantially different clinical profile that may offer additional benefits.This study aimed to 1) assess the public health impact (PHI) of introducing RZV in the UK compared with the current vaccination strategy and 2) explore via scenario analyses the optimal age group of vaccination in terms of PHI.DesignA previously developed health economic model was adapted to the UK setting.SettingCalculations were based on efficacy data from pivotal clinical trials, HZ incidence and postherpetic neuralgia (PHN) probability from a UK study and HZ-associated complication rates from published literature.PopulationThe base-case population considered a 2018-projected UK vaccination cohort of individuals 70 YOA.InterventionsVaccination with ZVL or RZV, assuming a first-dose coverage of 48.3% for both vaccines and 70% compliance for the second dose of RZV.Outcome measuresOutcomes included reduction of HZ and PHN cases, complications and the use of healthcare resources over a life-time horizon. The impact of coverage and second-dose compliance was also explored.ResultsCompared with no vaccination, RZV would lead to a reduction of 30 262 HZ and 5409 PHN cases while ZVL would lead to a reduction of 7909 HZ and 3567 PHN cases. The number needed to vaccinate to prevent 1 HZ case is 12 with RZV and 45 with ZVL. The highest PHI with RZV could be achieved in individuals 60 or 65 YOA.ConclusionUnder the model assumptions, RZV is predicted to avert more HZ and PHN cases compared with ZVL. Results were robust under different scenario and sensitivity analyses.

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The burden of injuries in Ethiopia from 1990-2017: evidence from the global burden of disease study

Injury Epidemiology ◽

10.1186/s40621-020-00292-9 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Solomon Ali ◽

Zelalem Destaw ◽

Awoke Misganaw ◽

Asnake Worku ◽

Legesse Negash ◽

...

Keyword(s):

Public Health ◽

Interpersonal Violence ◽

Death Rate ◽

Health Impact ◽

Health Concern ◽

Public Health Impact ◽

Global Burden ◽

Life Years ◽

National Burden ◽

Self Harm

Abstract Background Mortality caused by injuries is increasing and becoming a significant global public health concern. Limited evidence from Ethiopia on road traffic, unintentional and intentional injuries indicate the potential public health impact of problems resulting from such injuries. However, there is a significant evidence gap about the actual national burden of all injuries in Ethiopia. This data base study aimed to reveal the national burden of different injuries in Ethiopia. Methodology Data for this study were extracted from the estimates of the Global Burden of Diseases (GBD) 2017 study. Estimates of metrics such as Disability-Adjusted Life Years (DALYs), death rates, incidence, and prevalence were extracted. The metrics were then examined at different injury types, socio-demographic categories such as age groups and sex. Trends of the metrics were also explored for these categories across years from 2007 to 2017. The DALYs and deaths due to injuries in Ethiopia were also compared with other East African countries (specifically Kenya, Tanzania, Uganda, and Zambia) in order to evaluate regional differences across years, by sex and by different injury types such as transport injuries, unintentional injuries, self-harm and interpersonal violence. Results The age-standardized injury death rate has decreased to 69.4; 95% UI: (63.0–76.9) from 90.11; 95% UI: (82.41–97.73) in 2017 as compared with 2007. Road injury, falls, self-harm and interpersonal violence were the leading causes of mortality from injuries occurring in 2017. The age-standardized injury DALYs rate has decreased to 3328.2; 95% UI: (2981.7-3707.8) from 4265.55; 95% UI: (3898.11–4673.64) in 2017 as compared with 2007. The number of deaths resulting from injuries in 2017 was highest for males, children under 5 years, people aged 15–24. Conclusion The current age-standardized death rate and DALYs from injuries is high and the observed annual reduction is not satisfactory. There is a difference in gender and age regarding the number of deaths resulting from injuries. The data indicates that the current national efforts to address the public health impact of injuries in Ethiopia are not sufficient enough to bring a marked reduction. As a result, a more holistic approach to address all injuries is recommended in Ethiopia.

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