Markov Modeling to Estimate the Population Impact of Emerging Tobacco Products: A Proof-of-Concept Study

Objectives: To develop a modeling tool to assess the population impact of emerging tobacco products and demonstrate its utility. Methods: Discrete state Markov models were developed using TreeAge Pro 2014 to operationalize and estimate current cigarette and e-cigarette use patterns in the US population (including never and former use). State transition probabilities were calculated from a longitudinal survey of US young adults and adjusted using other nationally representative data. Results: Over 10 years, the adjusted base case model approximated national cigarette smoking and former use prevalence and predicted e-cigarette and dual use prevalence between 1% and 2%. Conclusions: This proof-of-concept study provides a heuristic tool to operationalize aspects of the US Food and Drug Administration's new public health standard regarding the impact of new tobacco products on use of existing products.