A Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping Products

David T. Levy (), Christopher J. Cadham, Yameng Li, Zhe Yuan, Alex C. Liber, Hayoung Oh, Nargiz Travis, Mona Issabakhsh, David T. Sweanor, Luz Maria Sánchez-Romero, Rafael Meza and K. Michael Cummings
Additional contact information
David T. Levy: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Christopher J. Cadham: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
Yameng Li: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Zhe Yuan: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Alex C. Liber: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Hayoung Oh: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Nargiz Travis: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Mona Issabakhsh: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
David T. Sweanor: Centre for Health Law, Policy & Ethics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
Luz Maria Sánchez-Romero: Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA
Rafael Meza: Department of Integrative Oncology, BC Cancer Institute, Vancouver, BC V5Z1L3, Canada
K. Michael Cummings: Department of Psychiatry and Behavioral Sciences, Medical University of Charleston, Charleston, SC 29425, USA

IJERPH, 2022, vol. 19, issue 20, 1-17

Abstract: Markets for nicotine vaping products (NVPs) and heated tobacco products (HTPs) have grown as these products became positioned as harm-reduction alternatives to combusted tobacco products. Herein, we present a public health decision-theoretic framework incorporating different patterns of HTP, NVP, and cigarette use to examine their impacts on population health. Our framework demonstrates that, for individuals who would have otherwise smoked, HTP use may provide public health benefits by enabling cessation or by discouraging smoking initiation and relapse. However, the benefits are reduced if more harmful HTP use replaces less harmful NVP use. HTP use may also negatively impact public health by encouraging smoking by otherwise non-smokers or by encouraging initiation or relapse into smoking. These patterns are directly influenced by industry behavior as well as public policy towards HTPs, NVPs, and cigarettes. While substantial research has been devoted to NVPs, much less is known about HTPs. Better information is needed to more precisely define the health risks of HTPs compared to cigarettes and NVPs, the relative appeal of HTPs to consumers, and the likelihood of later transitioning to smoking or quitting all products. While our analysis provides a framework for gaining that information, it also illustrates the complexities in distinguishing key factors.

Keywords: heated tobacco products; e-cigarettes; ENDS; decision theory; public health; policy (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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