Impact analysis to prepare the nation and states for potential cigarette product standards

PROJECT SUMMARY To increase smoking cessation rates from the status quo (7.4% of people who smoke [PWS] quit smoking each year in the U.S.) and curb cancer, the U.S. Food and Drug Administration (FDA) is considering the implementation of two cigarette product standards. The first is the FDA’s proposed menthol ban (MB). The second is a nicotine reduction standard (NRS). Based on published literature encompassing modeling studies, behavioral intent estimates, and expert elicitation, as well as our team’s preliminary data, the MB is anticipated to motivate 7.3% to 17.7% of PWS menthol cigarettes to quit and the NRS is anticipated to motivate 46.8% to 57.5% of all PWS to quit. These levels of quitting above the status quo will mean that quitlines and other state- based cessation initiatives will be severely under-resourced to meet the needs of PWS. Our research is thus highly significant as our overarching objective is to ensure that the U.S. is fully prepared to maximize smoking cessation during and following the implementation of cigarette product standards by providing state departments of health, tobacco quitline operators, as well as state policy and law makers, with state-specific estimates of the number of PWS who will quit smoking in response to cigarette standards and the number of quitline enrollees. We will also provide state-specific estimates for populations at higher risk for tobacco-related disease and death which can be leveraged to purposively plan for equitable resource distribution. Additionally, the added benefit of mass media campaigns, which will likely be used to introduce the cigarette standards and promote smoking cessation and cessation resources, will be forecasted. A constituent advisory council (CAC) comprised of state public health professionals and representatives of national non-profits and advocacy organizations with interests in tobacco control will guide our efforts and help ensure that end users of the estimates understand the methods, assumptions, and limitations while providing opportunities to maximize the utility of the estimates. The aims of this three-year project are as follow: Aim 1: To estimate, for each U.S. state, the number of and fold increase in PWS, both overall and in priority populations, who will quit smoking and enroll in the quitline in the year following the MB and the NRS. Aim 2: To estimate the added number of PWS who would quit and enroll into quitlines if mass media campaigns are implemented alongside the MB and the NRS for each state and in priority populations. Aim 3: To conduct a constituent-centered design process, involving CAC inputs and usability assessments to inform the development of a public portal for disseminating the estimates. Our research is consistent with the NCI’s Tobacco Control Research Branch scientific priorities including research on “tobacco cessation interventions at individual, system, and population levels” and “tobacco control interventions for underserved and at-risk populations.” It is aligned with the recently released Department of Health and Human Services draft cessation framework which will be a roadmap to “drive further progress toward smoking cessation and to deliver equitable outcomes for all persons in America.”