Modeling the Impact of Tobacco Use and Regulations on Vulnerable Populations

项目4摘要 在美国，烟草使用因种族/民族和社会经济地位（SES）而存在很大差异， 美国印第安人阿拉斯加土著和低教育人口的吸烟率较高， 处于种族/民族和社会经济地位交叉点的弱势亚群（例如，非西班牙裔黑人（NHB）和 具有高中或更低学历的非西班牙裔白色（NHW）个体）。使用雪茄和电子尼古丁 在NHB和NHW个体中，递送系统（ENDS）分别最高。烟草使用轨迹 通过表征香烟（薄荷醇）、雪茄和ENDS中的香料进一步复杂化， 集中在特定的亚群中。 政策制定者正在考虑香料限制政策和其他烟草法规，但缺乏详细的科学依据。 有关这些政策如何影响美国人口和弱势群体的信息。为了解决这个 需要，我们将开发经过验证的烟草模拟模型，以预测风味限制对 烟草使用和下游健康结果之间的脆弱种族/民族和社会经济亚群体。 虽然现有的模拟模型考虑了吸烟，但有些模型现在也评估了ENDS的使用，雪茄 尽管吸烟对与烟草有关的健康具有重要意义，但吸烟尚未被纳入此类模型 差距。该项目旨在按种族/民族描述香烟、雪茄和ENDS的使用模式， 教育和处于其交叉点的弱势群体（目标1）。我们将开发模拟模型， 香烟、雪茄和ENDS用于（a）关键种族/族裔群体（NHB、NHW、西班牙裔和AIAN），（B）四个 不同的教育群体（低于高中，高中学位或GED，一些大学和大学 学位或以上）和（c）种族/民族和教育交叉的群体（NHB，NHW，西班牙裔 （二）教育程度高与低（目标2）。我们将估计风味限制对 根据种族/民族和教育程度，使用来自准实验的信息， 研究、系统评价和专家咨询（目标3）。最后，我们计划将风味的影响 美国烟草产品使用模式的限制和按种族/民族划分的下游死亡率结果， 教育和处于其交叉点的主要弱势群体（目标4）。这将为以下方面奠定坚实的基础： 研究其他潜在法规对弱势亚群体烟草相关健康结果的影响。 作为烟草法规评估中心（CAsToR）的一部分，该项目将提供 美国食品药品监督管理局（FDA）急需外部建模研究，以评估：1） 香料限制对烟草使用行为的影响（科学领域：行为）; 2） 烟草制品和香料对健康的限制（科学领域：健康影响）;和3）潜在的 口味限制对主要弱势群体的不同影响以及与烟草有关的健康差异 （科学领域：影响分析）。

PROJECT 4 Abstract Tobacco use varies greatly by race/ethnicity and socioeconomic status (SES) in the US, with unacceptably high cigarette smoking rates in American Indian Alaska Native and low education populations, as well as vulnerable subpopulations at the intersection of race/ethnicity and SES (e.g. non-Hispanic Black (NHB) and non-Hispanic White (NHW) individuals with a high school degree or less). Use of cigars and electronic nicotine delivery systems (ENDS) are highest among NHB and NHW individuals respectively. Tobacco use trajectories are further complicated by characterizing flavors in cigarettes (menthol), cigars, and ENDS, the use of which is concentrated in specific subpopulations. Policymakers are considering flavor restriction policies and other tobacco regulations but lack detailed scientific information about how such policies could affect the US population and vulnerable subgroups. To address this need, we will develop validated tobacco simulation models to project the impact of flavor restrictions on tobacco use and downstream health outcomes among vulnerable racial/ethnic and socioeconomic subgroups. While existing simulation models consider cigarette smoking, with some now also assessing ENDS use, cigar smoking has yet to be included in such models, despite its important implications for tobacco-related health disparities. This project aims to characterize cigarette, cigar, and ENDS patterns of use by race/ethnicity, education, and for vulnerable subgroups at their intersection (Aim 1). We will develop simulation models of cigarette, cigar, and ENDS use for (a) key race/ethnicity groups (NHB, NHW, Hispanics and AIAN), (b) four different education groups (less than high school, high school degree or GED, some college, and college degree or more) and (c) for groups at the intersection of race/ethnicity and education (NHB, NHW, Hispanic individuals of low vs. high educational attainment) (Aim 2). We will estimate the effects of flavor restrictions on cigarette, cigar, and ENDS use by race/ethnicity and education using information from quasi-experimental studies, systematic reviews, and expert consultations (Aim 3). Finally, we plan to project the impact of flavor restrictions on US patterns of tobacco product use and downstream mortality outcomes by race/ethnicity and education, and for key vulnerable groups at their intersection (Aim 4). This will provide a strong foundation for studying the impact of other potential regulations on tobacco-related health outcomes in vulnerable subgroups. As part of the Center for the Assessment of the Tobacco Regulations (CAsToR), this project will provide the Food and Drug Administration (FDA) with much needed external modeling research that evaluates: 1) the impact of flavor restrictions on tobacco use behaviors (Scientific domain: Behavior); 2) the long-term impact of tobacco products and flavor restrictions on health (Scientific domain: Health Effects); and 3) the potential differential impacts of flavor restrictions on key vulnerable populations and tobacco-related health disparities (Scientific domain: Impact Analysis).