Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA.
School of Public Health, Faculty of Medicine, University of Queensland, Queensland, Australia.
Nicotine Tob Res. 2023 Feb 9;25(3):486-497. doi: 10.1093/ntr/ntac210.
We model the potential impact of relaxing current nicotine vaping product (NVP) restrictions on public health in Australia.
A Restricted NVP Scenario was first developed to project current smoking and vaping rates, where a U.S. smoking model was calibrated to recent Australian trends. To model less restrictive NVP policies, a Permissive NVP Scenario applied rates of switching from smoking to vaping, initiation into NVP and cigarette use, and cessation from smoking and vaping based on U.S. trends. The model measures vaping risk relative to the excess mortality rate of smoking. The public health impacts are measured as the difference between smoking- and vaping-attributable deaths (SVADs) and life years lost (LYLs) in the Restricted and Permissive NVP Scenarios. Sensitivity analysis is conducted regarding the NVP excess risk and other factors.
Assuming an NVP excess risk of 5% that of smoking, 104.2 thousand SVADs (7.7% reduction) and 2.05 million LYLs (17.3% reduction) are averted during 2017-2080 in the Permissive NVP Scenario compared to the Restricted NVP Scenario. Assuming 40% NVP excess risk, 70 thousand SVADs and 1.2 million LYLs are averted. The impact is sensitive to the rate at which smokers switch to NVPs and quit smoking, and relatively insensitive to the smoking initiation and NVP initiation and cessation rates.
The model suggests the potential for public health gains to be achieved by relaxing NVP access regulations. However, the model would benefit from better information regarding the impact of NVPs on smoking under a relaxation of current restrictions.
Australia has implemented a strong array of cigarette-oriented policies, but has restricted access to NVPs. The Smoking and Vaping Model offers a framework for modeling hypothetical policy scenarios. The Australian model shows the potential for public health gains by maintaining cigarette-oriented policies while relaxing the current restrictive NVP policy. Modeling results under a permissive NVP policy are particularly sensitive to the estimated rates of smoking cessation and switching to vaping, which are not well established and will likely depend on past and future cigarette-oriented policies and the specific NVP policies implemented in Australia.
我们构建模型，旨在评估澳大利亚放宽当前尼古丁电子烟（NVP）限制对公共健康的潜在影响。
首先，我们构建了受限 NVP 情景，以预测当前吸烟和电子烟使用率，其中，我们校准了美国的吸烟模型以反映澳大利亚的最新趋势。为了模拟更为宽松的 NVP 政策，我们构建了宽松 NVP 情景，该情景基于美国的趋势，对吸烟转向电子烟、初始使用 NVP 和香烟、吸烟和电子烟戒烟的转换率进行了预测。该模型衡量了相对于吸烟超额死亡率的电子烟风险。通过比较受限和宽松 NVP 情景下的归因于吸烟和电子烟的死亡人数（SVAD）和生命年损失（LYL），我们来衡量公共健康影响。我们还对 NVP 超额风险和其他因素进行了敏感性分析。
假设 NVP 风险比吸烟高 5%，在宽松 NVP 情景下，2017 年至 2080 年期间，SVAD（减少 7.7%）和 LYL（减少 17.3%）将分别减少 10.42 万人和 205 万人。假设 NVP 风险高 40%，SVAD 和 LYL 将分别减少 7 万人和 120 万人。结果对吸烟者转向电子烟和戒烟的转换率敏感，而对吸烟起始率、NVP 起始和戒烟率相对不敏感。
该模型表明，放宽 NVP 准入法规可能会带来公共健康效益。但是，该模型需要更好地了解在放宽当前限制的情况下 NVP 对吸烟的影响。
澳大利亚已实施了一系列强有力的香烟政策，但限制了 NVP 的使用。“吸烟和电子烟模型”为构建假设政策情景提供了框架。澳大利亚模型表明，通过维持以香烟为导向的政策，同时放宽当前的限制政策，可能会带来公共健康效益。在宽松的 NVP 政策下，模型结果对戒烟和转向电子烟的估计转换率特别敏感，而这些转换率尚未得到充分证实，并且可能取决于过去和未来的香烟政策以及澳大利亚实施的具体 NVP 政策。
