Modeling the public health impact of a flavored cigar ban

ABSTRACT: PROJECT 3 The objective of this project is to estimate the public health impact of a federal flavored cigar sales restriction on tobacco use and mortality in the United States. This project will build a microsimulation model of individuals living in the US who are current, former, or potential users of cigars, cigarettes and e-cigarettes. The model can be used to track tobacco use over time, so the impact of a flavored cigar sales restriction on smoking and mortality in the US population can be estimated. The microsimulation model will be built in three phases corresponding to the specific aims. Specifically, using data from the nationally representative, longitudinal Population Assessment of Tobacco and Health Study, we will estimate tobacco use transition probabilities, with a focus on the effects of cigar use on uptake, cessation, and dual/poly use of tobacco products (Aim 1). We will conduct a systematic review to compile data on cigar users’ tobacco use after a flavored cigar sales restriction and elicit potential sales restriction design effects from tobacco experts. Tobacco experts will be asked to develop plausible and distinct flavored cigar sales restriction scenarios to simulate and compare and quantify how key contextual factors (e.g., enforcement, retailer compliance, alternative products) affect the impact of the sales restriction (Aim 2). Finally, using findings from Aims 1 and 2, and estimates from the literature, we will build a microsimulation model to estimate how tobacco use and mortality change in the presence of a federal flavored cigar sales restriction under alternative plausible sales restriction scenarios (Aim 3). This project will provide a comprehensive understanding of the potential public health impact of a flavored cigar sales restriction. We will also identify key threats to effective restriction for FDA to monitor and address in collaboration with local and state partners. This project addresses FDA research priorities to assess the impact of tobacco product characteristics (i.e., flavors) on uptake of tobacco use and cessation (Behavior, Aim 1) and to understand the public health impact of potential FDA action on tobacco use behavior and health (Impact Analysis, Aims 2 and 3). The UNC TCORS has deep expertise in tobacco science. The integrative theme of the UNC TCORS is building the science for effective public health decision-making about flavored tobacco products.