Health and economic impact analysis of a reduced nicotine cigarette policy on vulnerable populations

减少尼古丁卷烟政策对弱势群体的健康和经济影响分析

• 批准号: 10501110
• 负责人: Jamie Pearl Tam
• 金额: $ 14.67万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10501110
• 关键词: Adult; Adverse effects; Affect; Age; Award; Behavioral; Caring; Cessation of life; Cigarette; Clinical Trials; Cost Effectiveness Analysis; Cost Savings; Data; Drug usage; Economic Models; Educational Status; Electronic cigarette; Enrollment; Ensure; Environment; Expenditure; Funding; General Population; Health; Health Benefit; Health Care Costs; Infant Health; Infant Mortality; Lead; Low Birth Weight Infant; Major Depressive Disorder; Maternal Health; Medical; Medical Care Costs; Medicine; Mental Depression; Mental Health; Mentors; Methods; Modeling; Morbidity - disease rate; National Health Interview Survey; Neurobiology; Nicotine; Nicotine Dependence; Outcome; Persons; Policies; Population; Pregnancy; Pregnant Women; Premature Birth; Productivity; Public Health; Regulation; Reproductive Health; Research; Research Personnel; Risk; Risk Factors; Science; Scientist; Secure; Small for Gestational Age Infant; Smoke; Smoker; Smoking; Societies; Socioeconomic Status; Sudden infant death syndrome; Surveys; Tobacco; Training; United States Food and Drug Administration; United States National Institutes of Health; Vulnerable Populations; Woman; addiction; behavioral economics; behavioral health; behavioral pharmacology; behavioral response; career; cigarette smoking; cost; disability; disadvantaged women; economic cost; economic evaluation; economic impact; economic outcome; electronic cigarette use; health economics; low nicotine content cigarette; member; models and simulation; mortality; premature; productivity loss; programs; reproductive; response; skills training; smoking addiction; smoking cessation; smoking during pregnancy; smoking initiation; smoking-related disease; social factors; societal costs; socioeconomic disadvantage; success; tobacco regulatory science

PROJECT SUMMARY/ABSTRACT The Food and Drug Administration (FDA) is considering a regulation that would reduce nicotine content in cigarettes to non-addictive levels. This could have profound implications for the health of the US population as cigarette smoking remains a leading cause of morbidity and mortality, and incurs nearly $170 billion in annual health care costs. An FDA analysis shows that a reduced nicotine cigarette policy could avert over 8 million premature deaths through 2100, but no study has evaluated its potential economic impact. It is also unknown how this policy could affect vulnerable populations, defined as groups at greater risk for poor health due to social factors or illness and disability. Clinical trials suggest that reduced nicotine cigarettes decrease smoking among vulnerable populations, but no study has evaluated their potential long-term implications. I plan to use simulation modeling methods to conduct health and economic impact analysis of a reduced nicotine cigarette policy for two vulnerable populations: 1) people with major depression, who continue to have higher smoking rates and less success with quitting compared to the general population; and 2) socioeconomically disadvantaged women of reproductive age, whose smoking increases risk for adverse maternal and infant health outcomes. I will extend a simulation model of smoking and depression that I previously developed to incorporate morbidity and economic outcomes, including direct medical costs and productivity losses. I will also develop a smoking model specific to women of reproductive age and level of educational attainment. This model will simulate smoking during pregnancy and its adverse effects on maternal and infant health, including premature delivery, low-birth-weight, small for gestational age, and sudden infant death syndrome. For both vulnerable populations, I will simulate the potential effects of e-cigarette use and an illicit market for normal nicotine cigarettes under a reduced nicotine cigarette policy. To be successful with this study and accurately assess the impact of the proposed regulation on costs to society, I need training in economic evaluation. I also need to deepen my understanding of the science of addiction and acquire background in reproductive health. To that end, I will enroll in formal coursework in cost- effectiveness analysis, addiction neurobiology, and reproductive health. I will also receive training from my team of mentors, who consist of NIH-funded investigators in tobacco regulatory science, health and economic modeling, behavioral pharmacology, and reproductive and mental health. At Yale, I will access a rich research environment through regular opportunities offered by the Tobacco Center of Regulatory Science, the Public Health Modeling Unit, and the Program in Addiction Medicine. This award will provide me with the skills and training I need to become a leading expert in health and economic modeling of addiction in vulnerable populations, and secure my path to career independence in tobacco regulatory science.

项目总结/摘要 美国食品和药物管理局（FDA）正在考虑一项法规，将减少尼古丁含量， 香烟到不上瘾的水平。这可能对美国人口的健康产生深远的影响， 吸烟仍然是发病率和死亡率的主要原因，每年造成近1700亿美元的损失。 医疗保健费用。FDA的一项分析显示，减少尼古丁的香烟政策可以避免超过800万人吸烟。 早死的人数一直持续到2100年，但没有研究评估其潜在的经济影响。也是未知数 这一政策如何影响弱势群体，弱势群体被定义为由于以下原因而面临更大健康风险的群体： 社会因素或疾病和残疾。临床试验表明，减少尼古丁香烟减少吸烟 在弱势群体中，没有任何研究评估其潜在的长期影响。 我计划用模拟建模的方法来进行健康和经济影响分析， 尼古丁香烟政策适用于两个弱势群体：1）患有严重抑郁症的人，他们继续患有 与普通人群相比，吸烟率较高，戒烟成功率较低;以及2） 在社会经济上处于不利地位的育龄妇女，其吸烟增加了不良反应的风险， 产妇和婴儿的健康结果。我将扩展一个吸烟和抑郁的模拟模型， 以前制定的，以纳入发病率和经济结果，包括直接医疗费用， 生产力损失。我还将制定一个吸烟模式，具体到育龄妇女和水平， 教育程度。该模型将模拟怀孕期间吸烟及其对产妇的不良影响 和婴儿健康，包括早产、低出生体重、小于胎龄儿和婴儿猝死 死亡综合症对于这两个弱势群体，我将模拟电子烟使用的潜在影响， 在降低尼古丁香烟政策下非法销售正常尼古丁香烟。 为了成功完成这项研究，并准确评估拟议法规对成本的影响， 我需要经济评估方面的培训。我还需要加深我对科学的理解， 成瘾和获得生殖健康方面的背景知识。为此，我将报名参加正式课程的成本- 有效性分析、成瘾神经生物学和生殖健康。我也将接受培训， 导师团队，由NIH资助的烟草监管科学、健康和经济研究人员组成 建模，行为药理学，生殖和心理健康。在耶鲁，我将访问一个丰富的研究 通过烟草监管科学中心提供的定期机会， 健康建模单位，并在成瘾医学计划。这个奖项将为我提供技能， 培训我需要成为一个领先的专家在健康和经济模型的成瘾在脆弱的 人口，并确保我在烟草监管科学中的职业独立。