Impact of reducing nicotine in cigarettes on mortality, economic costs and major depression in the USA

INTRODUCTION: The US Food and Drug Administration has proposed a product standard that would reduce the nicotine content and addictiveness of cigarettes. It is unclear what impact this would have on economic outcomes or priority populations who are disproportionately harmed by tobacco use, such as people with major depression (MD). We evaluated the long-term health and economic impacts of a nicotine product standard for the US population by MD status. METHODS: We developed and calibrated a microsimulation model using the National Survey on Drug Use and Health 2005-2023 data on smoking, e-cigarette use and MD episodes. We used this model to simulate a nicotine product standard from 2027 to 2100 based on the FDA's expert elicitation estimates of the policy's anticipated effects on smoking and vaping. RESULTS: Under the proposed product standard, smoking is projected to decline to