Research Project 1: Comparative Modeling of the Impact of E-cigarettes use on Smoking and Long-Term Health Outcomes

项目1摘要 根据《家庭吸烟预防和烟草控制法》，FDA必须证明任何新规则 对烟草产品的营销、销售或含量进行监管是“为了保护公众利益 健康”。为FDA提供一个框架，以评估烟草法规对健康的潜在影响， 该TCORS项目将协调和扩展四个已建立的烟草控制模拟模型， FDA可能采取的不同监管行动对卷烟和电子烟使用未来趋势的影响，以及 相关的健康结果。该项目将侧重于影响分析（目标3、4和5）和健康影响 (Aims 2和3），其次强调行为（目标1）。 使用广义的危害减少框架和统计方法来区分实验和 长期使用烟草制品，我们将制定模型的初始患病率;一系列合理的 按年龄和性别划分的开始和停止吸烟和电子烟的未来现状转变;以及 香烟和电子烟之间的一系列合理转换率。利用文献综述和专家 启发小组为特定的健康结果开发相对风险估计，我们将扩展模型， 全因死亡率也预测了由于心血管和慢性阻塞性肺疾病引起的与烟草有关的死亡率 肺疾病和不利的孕产妇和儿童健康结果。我们还将模型扩展到 考虑与香烟和电子烟使用有关的具体政策的影响，例如提供 关于健康影响的信息，利用文献审查和专家小组来制定政策影响估计数。 在纳入香烟和电子烟使用的常见初始流行率和转变率后， 关于健康结果的扩展，以及政策参数，我们将使用四个模型及其 不同的结构来检查当前和预计未来电子烟使用对整体危害的影响。我们 我还将预测具体的潜在FDA法规单独和组合可能会如何影响 香烟和电子烟的使用率以及未来50年的相关健康结果。比较 将对这四个模型的预测进行分析，以进一步完善可能的最佳情况、最坏情况和 最有可能预测的情景，并更好地评估监管影响。此外，这些车型还将配备 快速使用来自国家监测队列的新数据并纳入新的 监管政策的选择，因为这些出现。我们的模型也将变得足够灵活，以便进一步考虑 替代其他替代尼古丁输送产品，包括雪茄，无烟 烟草和非燃烧产品。

PROJECT 1 Abstract Under the Family Smoking Prevention and Tobacco Control Act, the FDA is required to show that any new rule to regulate the marketing, sale or content of tobacco products is “appropriate for the protection of the public health.” To provide the FDA with a framework to assess the potential health impacts of tobacco regulations, this TCORS Project will harmonize and extend four established tobacco control simulation models to examine the impact of different possible FDA regulatory actions on future trends in cigarette and e-cigarette use, and associated health outcomes. The Project will focus on Impact Analysis (Aim 3, 4, and 5) and Health Effects (Aims 2 and 3), with a secondary emphasis on Behavior (Aim 1). Using a generalized harm reduction framework and statistical approaches to distinguish experimentation from long-term tobacco product use, we will develop initial prevalence rates for the models; a range of plausible future status quo transitions by age and gender for initiation and cessation for cigarettes and e-cigarettes; and a range of plausible switching rates between cigarettes and e-cigarettes. Using literature reviews and expert elicitation panels to develop relative risk estimates for specific health outcomes, we will extend the models from all-cause mortality to also project tobacco-related mortality due to cardiovascular and chronic obstructive pulmonary disease, and adverse maternal and child health outcomes. We will also extend the models to consider the impact of specific policies related to cigarette and e-cigarette use, such as the provision of information about health effects, using literature reviews and expert panels to develop policy effect estimates. Upon incorporating the common initial prevalence and transition rates for cigarette and e-cigarette use, the extensions regarding health outcomes, and the policy parameters, we will use the four models with their different structures to examine the impact of current and projected future e-cigarette use on overall harms. We will also project how specific potential FDA regulations individually and in combination will likely impact cigarette and e-cigarette use rates and associated health outcomes over a 50-year future period. Comparative analyses of the four models’ predictions will be conducted to further refine the likely best-case, worst-case, and most likely projected scenarios and better assess regulatory impacts. In addition, the models will have the capacity and flexibility to rapidly use new data from national surveillance cohorts and incorporate new regulatory policy options as these emerge. Our models will also be made flexible enough to further consider substitution into and away from other alternative nicotine delivery products, including cigars, smokeless tobacco and heat-not-burn products.