Health and economic implications of a nicotine product standard

Combustible tobacco smoking is becoming increasingly concentrated among individuals with mental health conditions, coinciding with a growing mental health crisis among youth and young adults. Efforts to achieve the tobacco endgame in the United States must also address populations with behavioral health comorbidities. The FDA has proposed a rule to reduce nicotine levels in cigarettes, but the long-term implications of this product standard for economic costs and tobacco-related health disparities remain uncertain.

This presentation will draw on findings from the Major Depression, Smoking, and E-Cigarettes (MDSE) microsimulation model to evaluate the health and economic outcomes of a nicotine reduction strategy for both the general U.S. population and individuals with major depression. The MDSE model integrates e-cigarette transition data from the Population Assessment on Tobacco and Health (PATH) study, smoking parameters from the Cancer Intervention and Surveillance Modeling Network, and data from the 2005–2023 National Survey on Drug Use and Health (NSDUH). It simulates prevalence, mortality, healthcare costs, productivity, and consumer expenditures under a baseline scenario. These outcomes are then evaluated under a reduced nicotine cigarette (RNC) policy scenario, using best- and worst-case estimates of the policy’s anticipated effects on future vaping, smoking, and product switching.

Findings highlight how the relationship between tobacco use and major depression shapes population health outcomes and influences the projected health and economic benefits of policy intervention.