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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed and calibrated a microsimulation model using the National Survey on Drug Use and Health 2005\u20132023 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\u2019s expert elicitation estimates of the policy\u2019s anticipated effects on smoking and vaping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Under the proposed product standard, smoking is projected to decline to &lt;1% for people with and without MD by 2040, resulting in 1.6\u2009million premature deaths averted by 2100 and 8.0\u2009million fewer cases of MD. Longer life expectancies under the policy are projected to increase medical costs by US$336\u2009billion, while also increasing worker productivity by US$298\u2009billion and consumer spending by US$1.3\u2009trillion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Timely implementation of a nicotine reduction strategy, either through a federal product standard or state-level sales restrictions, is cost-effective and could prevent millions of premature deaths while reducing smoking disparities by MD status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/tc-2025-059896","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T14:20:12Z","timestamp":1784125212000},"page":"tc-2025-059896","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of reducing nicotine in cigarettes on mortality, economic costs and major depression in the USA"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5974-4344","authenticated-orcid":false,"given":"Sarah Rivero","family":"Skolnick","sequence":"first","affiliation":[{"name":"Rutgers Institute for Nicotine & Tobacco Studies, New Brusnwick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3779-5287","authenticated-orcid":false,"given":"Andrew F","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Michigan, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0228-5461","authenticated-orcid":false,"given":"Chialing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Yale University, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8353-4259","authenticated-orcid":false,"given":"Jamie","family":"Tam","sequence":"additional","affiliation":[{"name":"Rutgers Institute for Nicotine & Tobacco Studies, New Brusnwick, New Jersey, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071507200596000_tc-2025-059896v1.1","unstructured":"U.S. Food and Drug Administration . 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