The Interplay of ENDS and Tobacco Control Policy: Impact on the Population Harms of Tobacco

项目摘要 该项目将阐明旨在减少以下人口危害的政策选择的价值和影响 烟草。电子烟等电子尼古丁传递系统(END)的普及 减少烟草对人口危害的机遇和挑战。End可能会减少人口 如果取代相当大比例的可燃香烟(c-cig)，则有害，但这种好处必须是 权衡了这样一个事实，即末端对个人构成风险，在他们不在的情况下，不会使用烟草。 模拟研究可以而且已经被用来评估与END相关的权衡。迄今为止，效果 都是在建立模型时已经实施的烟草控制政策的背景下进行模拟的 并反映了国家政策到位的平均水平。然而，末端的影响可能根据强度的不同而不同。 烟草控制政策的实施情况。对于拟议的研究，我们定义了强化的烟草控制政策 (i-tcp)作为以证据为基础的政策，主要针对C-CIG的使用，并能够大幅减少 将烟草的危害扩大到公共卫生机构建议的水平时，即c-cig 税收，增加为全面烟草控制方案提供资金的烟草控制支出，以及 全面的室内禁烟。因为i-tcp可以大大减少对 对于烟草来说，当i-tcp生效时，END进一步减少这些危害的潜力可能会减弱。 此外，我们目前对i-tcp的健康和经济影响的知识在很大程度上是积累的 在没有尽头的时候。如果市场上的末端的存在导致了更少的 有害形式的尼古丁(如末端)用于更有毒的可燃产品，然后，鉴于普遍存在的 目标的可获得性，i-TCP可能不会像降低烟草的人口健康和经济危害那样 现有的估计表明。I-TCP还可能影响末端的使用模式，从而产生可能 会对两端和I-TCP造成意想不到的健康影响。因此，将结束引入到 市场在我们对政策效果的认识上造成了缺口，这可能会导致政策失误， 增加，而不是减少，烟草种群水平的危害。烟草产品和烟草产品相互交织的影响 政策不能通过任何现实世界的实验来进行有意义的探索。因此，我们将进行一次 通过模拟研究来弥合这些知识空白。尽管没有一个州正在执行所有烟草政策 建议水平，可以利用国家政策的现有变化来揭示个人可能的影响 国家政策。利用现有的数据集，捕捉国家政策时间和强度的差异，我们将 建立模拟模型来估计策略和目标的综合影响。模型模拟将 编制国家和州两级的估计，为旨在减少烟草种群危害的政策提供信息； 同时考虑：在存在或不存在I-TCP的情况下结束的影响，以及I-TCP在 末端的存在或不存在。结果将阐明两端和i-tcp可能产生的影响范围。

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.