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

项目摘要/摘要 美国食品和药物管理局(FDA)正在考虑一项法规，该法规将降低人体内的尼古丁含量 香烟不会让人上瘾的程度。这可能会对美国人口的健康产生深远的影响，因为 吸烟仍然是导致疾病和死亡的主要原因，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，减少尼古丁香烟的政策可以避免800多万 早死到2100年，但还没有研究评估其潜在的经济影响。它也是未知的 这项政策如何影响弱势群体，即由于以下原因导致健康状况较差的风险较大的群体 社会因素或疾病和残疾。临床试验表明，减少尼古丁香烟可以减少吸烟 在易受伤害的人群中，没有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的分析 针对两个弱势群体的尼古丁香烟政策：1)患有严重抑郁症的人，他们继续患有 与普通人群相比，吸烟率更高，戒烟成功率更低；以及 社会经济上处于不利地位的育龄妇女，其吸烟增加了罹患不良疾病的风险 孕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，我 以前制定的，包括发病率和经济结果，包括直接医疗费用和 生产力损失。我还将开发一种专门针对育龄和健康水平女性的吸烟模式 教育程度。该模型将模拟怀孕期间吸烟及其对产妇的不利影响。 和婴儿健康，包括早产、低出生体重、小于胎龄和突然出生 死亡综合症。对于这两个弱势群体，我将模拟电子烟的使用和 在减少的尼古丁香烟政策下，正常尼古丁香烟的非法市场。 为了成功进行这项研究，并准确评估拟议法规对成本的影响， 社会，我需要接受经济评估方面的培训。我还需要加深我对科学的理解 上瘾和获得生殖健康背景。为此，我将报名参加成本专业的正式课程- 有效性分析、成瘾神经生物学和生殖健康。我还将接受我的 导师团队，由NIH资助的烟草监管科学、卫生和经济领域的调查人员组成 建模、行为药理学、生殖和心理健康。在耶鲁，我将访问丰富的研究 通过烟草管制科学中心提供的常规机会来保护环境 健康模范单位，以及成瘾医学项目。这个奖项将为我提供技能和 培训我需要成为弱势群体上瘾的健康和经济模型方面的领先专家 并确保我在烟草监管科学领域的职业独立之路。

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.