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Modeling the Policy Impact of Cigarette and Smokeless Use on U.S. Mortality

Principal Investigator: David Levy

Funding Mechanism: National Institutes of Health- Grant

ID number: 1 R01 DA036497-01

Award Date: 9/30/2013

Institution: Georgetown University

Smokeless products have been proposed as less harmful alternatives to cigarette smoking. However, among groups with the highest cigarette smoking rates (i.e., males and young adults), smokeless use may be added to, rather than substituted for, cigarette smoking, thereby increasing overall toxicant exposure and/or delaying cessation. The goal of this project is to conduct statistical analyses of the transitions to and from cigarette and smokeless tobacco use in light of policy effects on initiation, cessation, multiple product use, and quantity smoked. Investigators will apply statistical analyses to three existing models, a tobacco control policy model (SimSmoke) and two natural history of disease models (the Michigan-Fred Hutchinson model and the Massachusetts General Hospital Lung Cancer Policy Model [LCPM]). These models were developed as part of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET). Specific aims are: (1) to conduct a descriptive analysis of cigarette and smokeless tobacco use patterns, quit rates and addiction measures by age and gender, using the Tobacco Use Supplement (TUS); (2) to collect state- and federal-level policy data and review the literature on policy effects on cigarette and smokeless use; (3) to conduct multivariable analyses to distinguish use, initiation, cessation and dose patterns of sole and dual use and to determine how policies are associated with these patterns for cigarette and smokeless users; (4) to extend the SimSmoke, Michigan and LCPM models to examine trends in cigarette and smokeless use, and to develop SimSmoke models for two states with different policy structures (Minnesota and Kentucky) to gauge how the effects of FDA regulations may vary depending on state policies; (5) to adapt the models to estimate the incidence of tobacco-related disease (e.g., lung, head and neck and pancreatic cancers; chronic obstructive pulmonary disease, all cause-mortality) resulting from sole and dual use of cigarettes and smokeless tobacco; and (6) to adapt the models to compare the impact of FDA regulations (e.g. health warnings, retail point-of-sale restrictions, regulation of product content) on national cigarette and smokeless tobacco use prevalence (in total and by age and gender), use patterns, and tobacco-attributable deaths. The models will be developed with the capacity and flexibility to incorporate new data (e.g., Population Assessment of Tobacco and Health [PATH] study data) as it becomes available. This research will provide new information about the effects of possible FDA marketing and product regulations on the sole and dual use of cigarettes and smokeless tobacco products.

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