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Data from: Federal authorization of flavored ENDS products has greater potential to benefit public health than complete prohibition: A population health simulation study

Pope, Derek A.1; Winiger, Evan A.1; Lizhnyak, Pavel N.1; Hannel, Thad1; Vansickel, Andrea R.1

Published Sep 18, 2026 on Dryad. https://doi.org/10.5061/dryad.pc866t25f

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Sep 18, 2026 version files 192.08 KB

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Abstract

Background: The decline in cigarette smoking in the United States has coincided with increased use of electronic nicotine delivery systems (ENDS), particularly flavored products. However, numerous jurisdictions have prohibited flavored tobacco products, including menthol cigarettes and non-tobacco-flavored ENDS, raising concerns about unintended public health consequences including illicit markets or reversion to smoking.

Methods: We updated the Smoking and Vaping Model (SAVM) with recent Population Assessment of Tobacco and Health (PATH) Wave 6–7 restricted-use files (RUF) data (2021–2023) to simulate the 36-year impact (2024–2060) of two federal regulatory scenarios: (1) Complete Authorization of flavored tobacco products and (2) Complete Prohibition of all flavored products, allowing only tobacco-flavored cigarettes and ENDS.

Results: Approximately 90% of ENDS use involved nontobacco flavors, with switching rates projected to be 2.3x higher under Complete Authorization. Although Complete Prohibition was estimated to double smoking cessation immediately after enactment, this impact was assumed to decline 10% annually. Incorporating complete switching from cigarettes to ENDS, the overall cessation rate was ~1.4x higher under Complete Authorization. Although Complete Prohibition was estimated to halve smoking initiation, the relative rate of ENDS to smoking initiation was ~3x higher under Complete Authorization. Together, greater ENDS availability and use under Complete Authorization produced lower smoking rates than Complete Prohibition, yielding 1.6 million fewer adult smoking- and vaping-attributable deaths (SVADs) and 28.9 million life-years gained (LYG). Sensitivity analyses indicated Complete Authorization could avert 0.01–4.3 million deaths, translating to 1.0–80.1 million LYG from 2024-2060.

Conclusions: Simulations consistently projected greater public health benefits from maintaining access to flavored ENDS via Complete Authorization. Flavored ENDS are preferred by most switchers and could accelerate cessation and reduce mortality, especially given enforcement challenges and illicit market responses. Public health impacts ultimately depend on the risk reduction of noncombustibles versus smoking among adults and the risk of initiation among otherwise never-users.

What this deposit contains

This record holds the extended data for the article: aggregate tables produced from the PATH RUF and the output from the SAVM model. It comprises (a) PATH RUF Wave 6–7 transition-rate parameter tables — overall, tobacco-flavored, and nontobacco-flavored — and (b) full SAVM model output tables (annual/cumulative prevalence, smoking- and vaping-attributable deaths [SVADs], and life-years lost [LYL]) for Base, Upper- and Lower-bound Complete Authorization and Complete Prohibition scenarios, respectively, and an additional sensitivity model for the Complete Prohibition Scenario.

Underlying data are not included (access-restricted)

This deposit contains no individual-level (micro) data. Everything here is aggregate or output and is classified as Extended data because the two underlying sources cannot be redistributed by the authors:

  • PATH Restricted-Use Files (RUF): restricted individual-level data accessed through the Inter-university Consortium for Political and Social Research (ICPSR). The PATH Study is an NIH/FDA collaboration conducted by Westat and approved by the Westat Institutional Review Board (45 CFR Part 46). Access is granted only through ICPSR; see the PATH Study Restricted-Use Files User Guide, https://doi.org/10.3886/ICPSR36231.v41. Analyses were conducted in SAS 9.4 using Wave 7 longitudinal and replicate weights per the PATH User Guide.
  • Smoking and Vaping Model (SAVM): third-party software developed by the Center for the Assessment of Tobacco Regulations (CAsToR), available under its own license from the University of Michigan TCORS website (https://tcors.umich.edu/Resources_Download.php?FileType=SAV_Model). It is not redistributed here; obtain it directly under its license terms.