Modeling the public health impact of a national menthol cigarette ban.

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PROJECT SUMMARY/ABSTRACT Smoking is the leading cause of preventable disease and death in the United States. More than one-third of smokers in the United States use menthol cigarettes. Menthol cigarettes are of particular public health concern because they make it easier for adolescents to initiate smoking and are more difficult to quit than non-menthol cigarettes. In addition, menthol cigarettes are disproportionately used by youth, low-income and racial/ethnic minority smokers. In 2011 the Tobacco Products Scientific Advisory Committee (TPSAC), a Congressionally mandated committee assembled to advise the Food and Drug Administration (FDA), reported that “removal of menthol cigarettes from the marketplace would benefit public health in the United States.” Despite TPSAC’s conclusion, the FDA has not banned menthol cigarettes. Instead, the FDA has requested additional research to inform regulatory action. The objective of this project is to use microsimulation modeling to estimate the impact of a national menthol cigarette ban on tobacco use and tobacco-related disease, specifically cardiovascular disease (CVD) and tobacco-related cancers. This research would inform potential FDA regulatory action on menthol cigarettes. The project has three aims. Aim 1 identifies trajectories of cigarette use over time using longitudinal, nationally representative survey data. To achieve this aim, I will use Markov chains to compute transition probabilities of tobacco use behavior (frequency, intensity, flavor preference) over time. Aim 2 systematically reviews and meta-analyzes studies examining the effects of menthol cigarette bans on tobacco product use. This will be the first review to synthesize the literature on the impact of a menthol cigarette ban, providing critical information for microsimulation modeling. Aim 3 builds a microsimulation model of smoking and tobacco-related disease to estimate the impact of a national menthol cigarette ban on smoking, CVD, and tobacco-related cancers. I will establish parameters for the model using the best epidemiological evidence and conduct sensitivity analyses to test the validity of the model. Finally, I will estimate the change in smoking, CVD, and tobacco-related cancers that would occur in the total population and in specific socioeconomic and racial/ethnic groups if a menthol cigarette ban were implemented. I hypothesize that a national menthol cigarette ban will reduce socioeconomic and racial/ethnic disparities in smoking, CVD, and tobacco-related cancers. The career development award will help me achieve my goal of becoming an independent tobacco control and health disparities researcher. I will receive the training and mentorship needed to build an independent research program focused on the role tobacco control policy may play in improving the public’s health, in particular among groups that disproportionately suffer from smoking and tobacco-related disease. This award will culminate in an application for an R01 grant to expand upon my microsimulation model, comparing the impacts of additional tobacco control policies on smoking and disease.