The Interplay of ENDS and Tobacco Control Policy: Impact on the Population Harms of Tobacco

电子尼古丁传送系统和烟草控制政策的相互作用：对烟草对人口危害的影响

• 批准号: 10429461
• 负责人: Michael V Maciosek
• 金额: $ 62.08万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10429461
• 关键词: Accounting; Adolescent; Adoption; Adult; Attenuated; Behavior; Biological Markers; Cardiovascular Diseases; Cigarette; Cost Savings; Country; Data Set; Disease; Economics; Electronic Nicotine Delivery Systems; Electronic cigarette; Expenditure; Funding; Future; Goals; Harm Reduction; Health Status; Individual; Knowledge; Lead; Literature; Malignant Neoplasms; Manufacturer Name; Medical Care Costs; Mental Health; Modeling; Nicotine; Pattern; Policies; Policy Maker; Population; Prevalence; Probability; Public Health; Research Personnel; Respiratory Disease; Risk; Smoker; Smoking; Taxes; Time; TimeLine; Tobacco; Tobacco use; Toxic effect; United States Food and Drug Administration; Variant; Youth; combustible cigarette; cost effectiveness; economic impact; economic outcome; evidence base; experience; experimental study; former smoker; health economics; models and simulation; nicotine use; population health; premature; programs; public policy on tobacco; residence; simulation; statistics; tobacco control; tobacco products; tool; uptake; vaping; young adult

Project Summary This project will clarify the value and impact of policy options intended to reduce the population harms of tobacco. The rise in popularity of electronic nicotine delivery systems (ENDS) such as e-cigarettes poses both opportunities and challenges for reducing the population harms of tobacco. ENDS might reduce population harm if substituted for a significant proportion of combustible cigarettes (c-cigs), but such benefits must be weighed against the fact that ENDS pose a risk to individuals who, in their absence, would not use tobacco. Simulation studies can and have been used to assess the trade-offs associated with ENDS. To date, effects have been simulated in the context of tobacco control policy that was in place at the time the model was built and reflect the average of state policies in place. Yet, the effects of ENDS may vary according to the intensity of the tobacco control policies in place. For the proposed study, we define intensified tobacco control policies (I-TCP) as evidence-based policies that primarily target c-cig use and are capable of substantially reducing the population harms from tobacco when scaled to levels recommended by public health agencies, i.e., c-cig taxes, increased tobacco control expenditures that fund comprehensive tobacco control programs, and comprehensive indoor smoking bans. Because I-TCP can substantially reduce the population harms of tobacco, the potential for ENDS to further reduce these harms may be attenuated when I-TCP are in effect. Moreover, our current knowledge of the health and economic impact of I-TCP was, for the most part, amassed during a time when ENDs did not exist. If the presence of ENDS in the marketplace leads to substitution of less harmful forms of nicotine (such as ENDS) for more toxic combustible products, then, given the widespread availability of ENDS, I-TCPs may not lower population health and economic harms of tobacco as much as available estimates indicate. I-TCP may also influence use patterns of ENDS, creating dynamics that could lead to unanticipated levels of health impact for both ENDS and I-TCP. Thus, the introduction of ENDS to the marketplace has created gaps in our knowledge of policy effects, which could precipitate policy missteps that increase, not decrease, population level tobacco harm. The intertwined effects of tobacco products and policies cannot meaningfully be explored through any real-world experiment. Therefore, we will conduct a simulation study to close these knowledge gaps. Although no state is implementing all tobacco policies at recommended levels, existing variation in state policies can be exploited to reveal the likely impact of individual state policies. Leveraging existing data sets that capture variation in state policy timing and intensity, we will build a simulation model to estimate the combined effects of policies and ENDS. Model simulations will produce both national- and state-level estimates to inform policy aimed at reducing tobacco population harms, while accounting for: the effects of ENDS in the presence or absence of I-TCP, and the effects of I-TCP in the presence or absence of ENDS. The results will clarify the plausible range of impacts of both ENDS and I-TCP.

项目概要 该项目将阐明旨在减少人口危害的政策选择的价值和影响 烟草。电子烟等电子尼古丁输送系统 (ENDS) 的普及带来了以下两方面的问题： 减少烟草对人口危害的机遇和挑战。 ENDS 可能会减少人口 如果替代大部分可燃香烟（c-cigs）会造成危害，但这种好处必须 与电子尼古丁传送系统对那些在没有电子烟的情况下不会使用烟草的个人构成风险这一事实进行权衡。 模拟研究可以并且已经被用来评估与 ENDS 相关的权衡。迄今为止，效果 已在模型构建时实施的烟草控制政策的背景下进行了模拟 并反映国家现行政策的平均水平。然而，ENDS 的影响可能会根据强度的不同而有所不同 现有的烟草控制政策。对于拟议的研究，我们定义了强化烟草控制政策 (I-TCP) 作为基于证据的政策，主要针对 c-cig 的使用，并能够大幅减少 当达到公共卫生机构（即 c-cig）建议的水平时，烟草对人口造成的危害 税收、增加为全面烟草控制计划提供资金的烟草控制支出，以及 全面室内禁烟。因为I-TCP可以大幅减少对人群的危害 烟草，当 I-TCP 生效时，ENDS 进一步减少这些危害的潜力可能会减弱。 此外，我们目前对 I-TCP 对健康和经济影响的了解大部分是积累的 在 END 不存在的时期。如果市场上电子尼古丁传送系统的存在导致较少的替代品 有害形式的尼古丁（例如 ENDS）可用于毒性更强的可燃产品，然后，鉴于广泛存在 ENDS、I-TCP 的可用性可能不会像烟草那样降低人口健康和经济危害 现有的估计表明。 I-TCP 还可能影响 ENDS 的使用模式，从而创造可能的动态 对 ENDS 和 I-TCP 造成意想不到的健康影响。因此，将 ENDS 引入 市场在我们对政策效果的了解上造成了差距，这可能会导致政策失误，从而导致 增加而不是减少人口层面的烟草危害。烟草制品和烟草制品的相互交织的影响 政策无法通过任何现实世界的实验进行有意义的探索。因此，我们将进行一次 模拟研究可以弥补这些知识差距。尽管没有一个州正在执行所有烟草政策 建议的水平，可以利用国家政策的现有变化来揭示个人可能的影响 国家政策。利用捕捉国家政策时机和强度变化的现有数据集，我们将 建立模拟模型来估计政策和 ENDS 的综合影响。模型模拟将 产生国家和州一级的估计，为旨在减少烟草人口危害的政策提供信息， 同时考虑：存在或不存在 I-TCP 时 ENDS 的影响，以及 I-TCP 存在时的影响 存在或不存在 ENDS。结果将阐明 ENDS 和 I-TCP 的合理影响范围。