Through a combination of public policy (e.g., cigarette taxes, age restrictions on purchasing, and bans on advertising to youth) and increased public awareness of the health dangers of smoking, the USA has had success in drastically reducing the smoking prevalence over the past several decades, from 42% in 1965 to about 16% currently however, recent years show this reduction hitting a plateau, possibly due to “hardening” of remaining smokers as detailed below, implementation gaps in existing policies, or barriers to smoking cessation among vulnerable groups. Smoking tobacco is a causal factor in a wide range of adverse health effects including cancers, cardiovascular disease, macular degeneration, birth defects, rheumatoid arthritis, inflammation, and impaired immune function, and exacerbates diabetes. An important unintended effect of possible death from e-cigarettes was conservatively included. Effects of e-cigarettes on tobacco smoking occur through three mechanisms: (1) diversion from ever initiating smoking (2) reducing progression to established smoking and (3) increasing smoking cessation. Realistic practical implementation challenges are modeled in the policy sector, including time delays, political resistance, and budgetary limitations. The policy is two-fold, removing existing e-liquid flavor bans and providing an informational campaign promoting e-cigarettes as a lower-risk alternative.
These structures interact with a policy module to close the gap between actual (simulated) and goal numbers of individuals who smoke, chosen to reduce the tobacco-attributable death rate (i.e., mostly combustible cigarette-attributable, but conservatively allowing e-cigarette-attributable deaths) to that due to all accidents in the general population. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Ī system dynamics simulation model was constructed, with separate aging chains representing people in different stages of use (both of combustible cigarettes and e-cigarettes). If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.
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