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: 10654678
• 负责人: Michael V Maciosek
• 金额: $ 58.04万
• 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/10654678
• 关键词: Adolescent; Adoption; Adult; Attenuated; Behavior; Binding; Biological Markers; Cardiovascular Diseases; Cigarette; Cost Savings; Country; Data Set; Disease; Economics; Electronic Nicotine Delivery Systems; Electronic cigarette; Engineering; Expenditure; Funding; Future; Goals; Harm Reduction; Health; Health Status; Individual; Knowledge; Literature; Malignant Neoplasms; Manufacturer; Medical Care Costs; Mental Health; Modeling; Nicotine; Pattern; Policies; Policy Maker; Population; Prevalence; Probability; Public Health; Recommendation; Research Personnel; Respiratory Disease; Risk; Smoker; Smoking; Taxes; Time; 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 assessment; health economics; models and simulation; nicotine use; population health; premature; programs; public policy on tobacco; residence; simulation; statistics; timeline; 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.

项目摘要 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。电子尼古丁输送系统（末端）（例如电子烟）的普及既构成 减少烟草危害人口的机会和挑战。结束可能会减少人口 如果用大量可燃香烟（c-cig）代替危害，但是这种好处必须是 权衡了这一事实，即在缺席的情况下，那些不使用烟草的人会带来风险。 模拟研究可以并且已被用来评估与目的相关的权衡。迄今为止，效果 在构建模型时已经制定的烟草控制策略的背景下进行了模拟 并反映国家政策的平均位置。然而，末端的影响可能会根据强度而有所不同 制定了烟草控制政策。在拟议的研究中，我们定义了加强烟草控制策略 （I-TCP）作为基于证据的政策，主要针对C-cig使用，并且能够大大降低 当扩展到公共卫生机构建议的水平时，人口会损害烟草，即C-cig 税收，增加资助全面烟草控制计划的烟草控制支出，以及 全面的室内吸烟禁令。因为I-TCP可以大大减少人口的伤害 烟草，当I-TCP生效时，可能会减少进一步减少这些危害的目的潜力。 此外，我们目前对I-TCP健康和经济影响的知识在大多数情况下已积累 在不存在目的的时候。如果市场在市场中的存在导致替代较少 尼古丁的有害形式（例如末端），用于更具毒性的可燃产品，然后考虑到广泛 I-TCP的可用性可能不会降低烟草的人口健康和经济危害 可用估计表明。 I-TCP也可能影响使用目的模式，从而产生可能 导致两端和I-TCP的健康影响水平。因此，引入了 市场已经在我们对政策效应的了解方面造成了差距，这可能会加剧政策失误 增加，而不是减少人口水平的烟草伤害。烟草产品和 无法通过任何现实世界实验来有意义地探索政策。因此，我们将进行 模拟研究以缩小这些知识差距。尽管没有州正在实施所有烟草政策 建议的水平，可以利用现有的状态政策变化以揭示个人的可能影响 国家政策。利用捕获状态策略时机和强度变化的现有数据集，我们将 建立一个仿真模型，以估计政策和目的的综合效果。模型模拟将 制定国家和州一级的估计，以告知旨在减少烟草人口危害的政策， 考虑到：在存在或不存在I-TCP的情况下末端的影响以及I-TCP在 存在或不存在。结果将阐明两端和I-TCP的合理影响范围。