Grant Number:	5R01CA263542-02 Interpret this number
Primary Investigator:	Maciosek, Michael
Organization:	Healthpartners Institute
Project Title:	The Interplay of Ends and Tobacco Control Policy: Impact on the Population Harms of Tobacco
Fiscal Year:	2023

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.





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