Nicotine Reduction Standard in Cigarettes and Estimated Lives Saved and Deaths Averted

Carroll DM, Le TTT, Rubenstein D, Said R, Hatsukami DK, McClernon FJ, Mendez D.
Nicotine Reduction Standard in Cigarettes and Estimated Lives Saved and Deaths Averted
JAMA Health Forum. 2025 Oct 3;6(10):e254069. doi: 10.1001/jamahealthforum.2025.4069. PMID: 41071561; PMCID: PMC12514631.

Importance: A potential policy that has been receiving substantial attention is a nicotine reduction standard (NRS) in cigarettes and other select combusted tobacco products. In 2025, the policy moved to the next phase required for future implementation, which entailed opening the policy to public comment. To date, the significance of this standard has been estimated only for the overall US population.

Objective: To estimate the significance of an NRS by race and ethnicity, rural vs urban residence, and sex.

Design, setting, and participants: The adaptive dynamic simulation model assumed enactment of an NRS in 2025 and was parameterized with population-specific inputs from the 2014 to 2015 and/or 2018 to 2019 Tobacco Use Supplement of the Current Population Survey and the CDC WONDER online database through the National Center for Health Statistics. It was assumed that the proportional association of an NRS with smoking cessation rates across populations would be the same and that those associations would be observed immediately (ie, in 2025). Twenty-four scenarios were simulated that varied the associations of nicotine reduction with the smoking cessation rate for each population (100%, 113%, and 200% increase) and the persistence of those associations (indefinitely or linearly increasing to 80% annual cessation after 25 years) using 4 background initiation rates (baseline, half of the population's baseline value, 5%, and 0%).

Main outcomes: Life-years saved (LYS) and premature deaths averted (PDA) by 2100.

Results: In the scenario with maximal benefits (total LYS: 62 029 200; total PDA: 2 429 900), American Indian or Alaska Native persons gained 1 059 049 LYS and 43 878 PDA, Asian persons gained 894 537 LYS and 33 534 PDA, Black or African American persons gained 10 381 540 LYS and 421 914 PDA, Hispanic persons gained 9 422 976 LYS and 370 373 PDA, and rural residents gained 15 459 437 LYS and 637 993 PDA. For all or most scenarios, American Indian and Alaska Native individuals (0.5% of the population; 1.8% of PDAs based on the maximum scenario), Black/African American individuals (11.7% of the population; 15.2% of PDAs), and rural residents (20.0% of population; 26.3% of PDAs) gained a greater proportion of LYS and PDA than would be expected based on their proportional share of the US population. Large benefits were also estimated for White persons, individuals of both sexes, and urban-residing persons.

Conclusions and relevance: The study results suggest that an NRS may serve as a disparity-reducing policy in addition to offering broad, population-wide benefits.