  Despite a general reduction in smoking in many areas of the developed world,
it remains one of the biggest public health threats. As an alternative to
tobacco, the use of electronic cigarettes (ECig) has been increased
dramatically over the last decade. ECig use is hypothesized to impact smoking
behavior through several pathways, not only as a means of quitting cigarettes
and lowering risk of relapse, but also as both an alternative nicotine delivery
device to cigarettes, as a visible use of nicotine that can lead to imitative
behavior in the form of smoking, and as a gateway nicotine delivery technology
that can build high levels of nicotine tolerance and pave the way for
initiation of smoking. Evidence regarding the effect of ECig use on smoking
behavior change remains inconclusive. To address these challenges, we built an
agent-based model (ABM) of smoking and ECig use to examine the effects of ECig
use on smoking behavior change. The impact of social network (SN) on the
initiation of smoking and ECig use were also explored. Findings from the
simulation suggest that the use of ECig generates substantially lower
prevalence of current smoker (PCS), which demonstrates the potential for
reducing smoking and lowering the risk of relapse. The effects of
proximity-based influences within SN increases the prevalence of current ECig
user (PCEU). The model also suggests the importance of improved understanding
of drivers in cessation and relapse in ECig use, in light of findings that such
aspects of behavior change may notably influence smoking behavior change and
burden.
