2025 Session 4 Seminars

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.

While a contentious debate persists within the tobacco control community as to whether vaping decreases cigarette smoking, those supporting the affirmative side of the debate have the unusual good fortune of being able to draw on four completely different kinds of evidence in support of their position. These include (i) randomized controlled trials, (ii) population studies (including analyses of population-wide aggregated data and individual-level survey data); (iii) market behavior (including cigarette and e-cigarette sales data and stock market reactions); and (iv) economic studies finding that vaping and cigarette smoking are substitutes (some noting unintended adverse consequences of policies intended primarily to reduce youth vaping). This presentation will highlight the implication of having such diverse types of evidence all sharing the same conclusion about vaping’s impact on smoking cessation. Additionally, the presentation will examine the strengths and limitations of these bodies of evidence

Replication of studies is important, but triangulating data sources provides stronger evidence. Both replication and triangulation are crucial for building robust evidence on the effectiveness and acceptability of e-cigarettes for smoking cessation. Current research from various study designs shows that nicotine-containing e-cigarettes help adults who smoke to quit successfully and maintain abstinence. Emerging evidence also suggests that e-cigarettes are acceptable among individuals facing social disadvantages. However, there is ongoing debate about their role among young people. Using triangulation models, this talk will evaluate the strength of evidence for e-cigarette use among adults compared with young people.

During this talk, Dr Steve Cook will discuss how many of the methodological problems found in cross-sectional studies on the health effects of e-cigarette use are at risk of being repeated for any nicotine or tobacco product marketed as a ‘safer alternative’ to cigarettes. Using nationally representative cross-sectional data from Wave 7 of the Population of Tobacco and Health (PATH) Study from the United States, Dr Cook will provide an example of a seemingly robust but spurious association between oral nicotine pouches and chronic obstructive pulmonary disease (COPD) and will discuss why all cross-sectional health effects studies should be interpreted with extreme caution unless they examine dose-response relationships and account for temporality and cigarette smoking confounding. The session will conclude by emphasizing the importance of developing a best practice framework to ensure that poorly constructed health effects research doesn’t lead to bad tobacco regulatory decision-making. 

On the heels of remarkable progress in reducing cigarette smoking, we face potential threats to continued success. These threats are multifaceted and multisectorial, and we are now in an era of volatility and disruption. In the face of this shifting landscape, our familiar strategies and instincts may need to be rethought. This presentation will explore what core strategies we may need to change, which ones stay true, and a potential path forward. Both the tobacco marketplace and the context of regulation in the U.S. are changing. Thus, as scientists and a field dedicated to reducing the tremendous toll from combustible tobacco use, we need to adapt and mobilize to meet these new challenges. This presentation will highlight pillars of an approach for moving forward.

Tobacco, Nicotine & Public Health

• Is nicotine dependence per se a public health priority
• Can we address or research the smoking crisis without discussing health inequalities and economic disparities
• Has the recent focus on nicotine and addiction created a confusing message for current smokers