title: Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm.
abstract: BACKGROUND
  Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products.
  
  
  RESULTS
  We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors.
  
  
  CONCLUSIONS
  Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.
authors: Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors: Eric D
authors: ED
authors: Vugrin
authors: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America.
authors: Brian L
authors: BL
authors: Rostron
authors: Systems Research, Analysis and Applications, Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors: Stephen J
authors: SJ
authors: Verzi
authors: Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors: Nancy S
authors: NS
authors: Brodsky
authors: Policy and Decision Analytics, Sandia National Laboratories, Albuquerque, New Mexico, United States of America.
authors: Theresa J
authors: TJ
authors: Brown
authors: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America.
authors: Conrad J
authors: CJ
authors: Choiniere
authors: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America.
authors: Blair N
authors: BN
authors: Coleman
authors: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America.
authors: Antonio
authors: A
authors: Paredes
authors: Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America.
authors: Benjamin J
authors: BJ
authors: Apelberg
mesh_terms: D019352:Censuses; D006801:Humans; D008962:Models, Theoretical; D009026:Mortality; D011153:Population; D012907:Smoking / Q000009:adverse effects* / Q000331:legislation & jurisprudence; D016540:Smoking Cessation; D062789:Tobacco Products / Q000009:adverse effects*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000473:pathology