Potential social impact of electronic tobacco heating devices: modeling results

   Relevance. The anti-smoking policy in Russia has reduced the proportion of smokers to 30.7 %; however, about a third of smokers are not ready to quit. Underestimating the complexity of completely quitting smoking is a serious barrier to improving the health of the population. In recent years, sufficient data has accumulated that tobacco heating systems (THS) are less harmful to health and are quite an effective means of quitting smoking.

   The objective of this study was to model the potential effects of all smokers switching to the use of THS.

   The effect was considered as a decrease in the number of fatalities when using alternative nicotine delivery systems ANDS, compared with the mortality associated with smoking.

   Methodology. The modeling compared the "zero" scenario with the "alternative" one. The "zero scenario" is the current situation with smoking prevalence, the "alternative scenario" assumed that all smokers completely switch to THS, and the reduction in health harm corresponds to the level of reduction in biomarkers of potential harmful effects of tobacco combustion products by 16-49 % for five of the 8 endpoints based on data from available studies.

   Results. The transition of men from cigarette smoking to THS at the age of 35-59 years will save 39,102 lives (19.1 % of tobacco-associated mortality) and 1.3 million DALY years or 27.7 % of the losses that accompany cigarette smoking. In women aged 35-59 years, 3,815 deaths (4.1 %) are potentially prevented and 822 thousand DALY years are saved or a reduction in losses by 15.7 %. If we take into account the reduction in toxicity from the use of ANDS at 49 % and recalculate it for the entire population of smokers, the transition to ANDS can have a significant demographic effect in terms of reducing mortality, primarily in active working ages; the epidemiological gain in per capita GDP metrics could reach 1.5 trillion rubles in 2022.

   Conclusions. The demonstrated potential reduction in health harm and the significant demographic effect in terms of mortality reduction when using electronic heated tobacco systems may serve as sufficiently strong arguments that should be taken into account when developing a regulatory framework for such electronic devices.

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