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Open Access Modeling the Population Health Impact of ENDS in the U.S.

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This article is Open Access under the terms of the Creative Commons CC BY-NC-ND licence.

Objectives: Our objective was to improve understanding of the population health impact of electronic nicotine delivery systems (ENDS) availability in the US via computational modeling. Methods: We present an agent-based population health model (PHM) that simulates annual smoking, ENDS use, and associated mortality for individual agents representing the US population, both adults and youth, between 2000 and 2100. Model transitions were derived from key population surveys and a large longitudinal study of JUUL purchasers. The mortality impact of ENDS is modeled as excess risk relative to smoking. Outcomes are compared between a cigarettes-only Base Case and a Modified Case where ENDS are introduced in 2010. Model validation demonstrates that the PHM simulates population-level behavior and outcomes realistically. Results: The availability of ENDS in the US is projected to reduce smoking and prevent 2.5 million premature deaths by 2100 in the Modified Case. Sensitivity analyses show that a significant population health benefit occurs under all plausible scenarios. Conclusions: Our results suggest the availability of ENDS is likely to result in a significant health benefit to the US population as a whole, after accounting for both beneficial and harmful uses.

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Keywords: AGENT-BASED MODEL; ELECTRONIC NICOTINE DELIVERY SYSTEM; HARM REDUCTION; POPULATION HEALTH MODELING; SMOKING

Document Type: Research Article

Affiliations: 1: Vice President Data, Juul Labs Inc, Washington, DC, United States 2: Modeling and Simulations Scientist, Juul Labs Inc, Washington, DC, United States 3: Director of Data Science and Analytics, Juul Labs Inc, Washington, DC, United States 4: Director of Health Economics and Policy Research, Juul Labs Inc, Washington, DC, United States 5: Research Economist, Juul Labs Inc, Washington, DC, United States

Publication date: May 1, 2021

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  • The American Journal of Health Behavior seeks to improve the quality of life through multidisciplinary health efforts in fostering a better understanding of the multidimensional nature of both individuals and social systems as they relate to health behaviors.

    The Journal aims to provide a comprehensive understanding of the impact of personal attributes, personality characteristics, behavior patterns, social structure, and processes on health maintenance, health restoration, and health improvement; to disseminate knowledge of holistic, multidisciplinary approaches to designing and implementing effective health programs; and to showcase health behavior analysis skills that have been proven to affect health improvement and recovery.

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