Investigating the Health Effects of 3 Coexisting Tobacco-Related Products Using System Dynamics Population Modeling: An Italian Population Case Study.

With the proliferation of tobacco products, there might be a need for more complex models than current two-product models. We have developed a three-product model able to represent interactions between three products in the marketplace. We also investigate if using several implementations of two-product models could provide sufficient information to assess 3 coexisting products. Italy is used as case-study with THPs and e-cigarettes as the products under investigation. We use transitions rates estimated for THPs in Japan and e-cigarettes in the USA to project what could happen if the Italian population were to behave as the Japanese for THP or USA for e-cigarettes. Results suggest that three-product models may be hindered by data availability while two product models could miss potential synergies between products. Both, THP and E-Cigarette scenarios, led to reduction in life-years lost although the Japanese THP scenario reductions were 3 times larger than the USA e-cigarette projections.