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.

项目概要/摘要 美国食品和药物管理局 (FDA) 正在考虑制定一项法规，减少尼古丁含量 香烟达到不成瘾的程度。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，减少香烟尼古丁摄入的政策可以避免超过 800 万 到 2100 年，人们都会过早死亡，但还没有研究评估其潜在的经济影响。也是未知数 这项政策如何影响弱势群体，这些群体被定义为因以下原因而面临更大健康状况不佳风险的群体： 社会因素或疾病和残疾。临床试验表明减少尼古丁香烟可以减少吸烟 在弱势群体中，但没有研究评估其潜在的长期影响。 我计划使用模拟建模方法对减少的健康和经济影响进行分析 针对两个弱势群体的尼古丁卷烟政策：1）患有重度抑郁症的人，他们继续患有抑郁症 与一般人群相比，吸烟率较高，戒烟成功率较低；和 2) 社会经济地位处于不利地位的育龄妇女，她们吸烟会增加不良风险 孕产妇和婴儿健康结果。我将扩展一个吸烟和抑郁的模拟模型 以前开发的目的是考虑发病率和经济结果，包括直接医疗费用和 生产力损失。我还将开发一个专门针对育龄女性和吸烟水平的吸烟模型 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、小于胎龄和突发婴儿 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和 在减少尼古丁卷烟政策下，正常尼古丁卷烟的非法市场。 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 社会，我需要经济评估方面的培训。我还需要加深对科学的理解 成瘾并获得生殖健康的背景。为此，我将报名参加成本方面的正式课程—— 有效性分析、成瘾神经生物学和生殖健康。我也将接受我的培训 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、行为药理学以及生殖和心理健康。在耶鲁，我将获得丰富的研究成果 通过烟草监管科学中心、公众定期提供的机会来保护环境 健康建模单位和成瘾医学项目。这个奖项将为我提供技能和 培训 我需要成为弱势群体成瘾健康和经济模型方面的领先专家 人口，并确保我在烟草监管科学领域的职业独立之路。