Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Joseph S. Ross




Smoking is the leading cause of preventable death. While the proportion of the U.S. population that uses combustible tobacco products has been declining over the past decade, use of e-cigarettes among youth and young adults has risen. Our objective was to model the prevalence of tobacco product use in 10 years given the current policy environment and project product use patterns if new policies are adopted.


Using data from the literature, we constructed a microsimulation model for the period 2015 – 2025 with the following Markov states: combustible use only, e-cigarette use only, dual use, former use, never use, and death. We projected the tobacco product use prevalence in 2025 and assessed the policy impact by comparing the difference in projections.


We found that in the current policy environment, the proportion of individuals who do not use tobacco will increase by 5.5 percentage points by 2025, while prevalence of combustible products, e-cigarette, and dual use will decrease by 4.5, 1.1, and 1.3 percentage points, respectively. An implementation of youth restriction to flavored electronic nicotine delivery system (ENDS) products would not result in any changes in the projected tobacco product use pattern in 2025. A menthol ban would lead to a 3.2 percentage points increase in the prevalence of non-users and a 2.9 percentage points decrease in combustible use without any substantial change to the e-cigarette use prevalence.


In the current policy environment, smoking prevalence will continue to drop, as it did over the past decade. A policy restricting youth access to flavored ENDS products will not have any effect on the projected 2025 tobacco product use patterns on its own. On the other hand, a menthol ban would encourage people to quit tobacco use and accelerate the current trend of declining smoking prevalence.

Open Access

This Article is Open Access

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