A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products.
The use of vaporized nicotine products (VNPs), especially e-cigarettes and, to a lesser extent, pressurized aerosol nicotine products and heat-not-burn tobacco products, are being adopted increasingly as an alternative to smoking combusted products, primarily cigarettes. Considerable controversy has accompanied their marketing and use. We propose a framework that describes and incorporates patterns of VNP and combustible cigarette use in determining the total amount of toxic exposure effects on population health. We begin by considering toxicity and the outcomes relevant to population health. We then present the framework and define different measures of VNP use; namely, trial and long-term use for exclusive cigarette smokers, exclusive VNP and dual (cigarette and VNP) use. Using a systems thinking framework and decision theory we considered potential pathways for current, former and never users of VNPs. We then consider the evidence to date and the probable impacts of VNP use on public health, the potential effects of different policy approaches and the possible influence of the tobacco industry on VNP and cigarette use.
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.
David T
DT
Levy
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.
K Michael
KM
Cummings
The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Andrea C
AC
Villanti
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.|The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Ray
R
Niaura
Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA.|The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
David B
DB
Abrams
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.|School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.|Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
Geoffrey T
GT
Fong
Nigel Gray Distinguished Fellow in Cancer Prevention, The Cancer Council Victoria, Melbourne, Victoria, Australia.
Ron
R
Borland
D066300:Electronic Nicotine Delivery Systems / Q000379:methods*; D006801:Humans; D009330:Nebulizers and Vaporizers; D011634:Public Health / Q000379:methods*; D016540:Smoking Cessation / Q000379:methods; D019460:Tobacco Industry; D014481:United States
E-cigarettes; framework; harm reduction; industry response; public health; public policy