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Levy DT, Cadham CJ, Yuan Z, Li Y, Gravely S, Cummings KM. Comparison of smoking prevalence in Canada before and after nicotine vaping product access using the SimSmoke model. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:992-1005. [PMID: 37540451 PMCID: PMC10661672 DOI: 10.17269/s41997-023-00792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/29/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES The public health impact of nicotine vaping products (NVPs) is subject to complex transitions between NVP and cigarette use. To circumvent the data limitations and parameter instability challenges in modeling transitions, we indirectly estimate NVPs' impact on smoking prevalence and resulting smoking-attributable deaths using the SimSmoke simulation model. METHODS Canada SimSmoke uses age- and sex-specific data on Canadian population, smoking prevalence and tobacco control policies. The model incorporates the impact of cigarette-oriented policies on smoking prevalence but not the explicit contribution of NVPs. The model was calibrated from 1999 to 2012, thereby projecting smoking prevalence before NVPs were widely used in Canada. The NVP impact on smoking prevalence is inferred by comparing projected 2012-2020 smoking trends absent NVPs to corresponding trends from two Canadian national surveys. We further distinguish impacts before and after NVPs became regulated in 2018 and more available. RESULTS Comparing 2012-2020 survey data of post-NVP to SimSmoke projected smoking prevalence trends, one survey indicated an NVP-related relative reduction of 15% (15%) for males (females) age 15+, but 32% (52%) for those ages 15-24. The other survey indicated a 14% (19%) NVP-related smoking reduction for ages 18+, but 42% (53%) for persons ages 18-24. Much of the gain occurred since Canada relaxed NVP restrictions. NVP-related 2012-2020 smoking reductions yielded 100,000 smoking-attributable deaths averted from 2012 to 2060. CONCLUSION Smoking prevalence in Canada, especially among younger adults, declined more rapidly once NVPs became readily available. The emergence of NVPs into the Canadian marketplace has not slowed the decline in smoking.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
| | - Christopher J Cadham
- Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
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Sánchez-Romero LM, Liber AC, Li Y, Yuan Z, Tam J, Travis N, Jeon J, Issabakhsh M, Meza R, Levy DT. The smoking and vaping model, A user-friendly model for examining the country-specific impact of nicotine VAPING product use: application to Germany. BMC Public Health 2023; 23:2299. [PMID: 37990171 PMCID: PMC10662637 DOI: 10.1186/s12889-023-17152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/04/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Simulation models play an increasingly important role in tobacco control. Models examining the impact of nicotine vaping products (NVPs) and smoking tend to be highly specialized and inaccessible. We present the Smoking and Vaping Model (SAVM),a user-friendly cohort-based simulation model, adaptable to any country, that projects the public health impact of smokers switching to NVPs. METHODS SAVM compares two scenarios. The No-NVP scenario projects smoking rates in the absence of NVPs using population projections, deaths rates, life expectancy, and smoking prevalence. The NVP scenario models vaping prevalence and its impact on smoking once NVPs became popular. NVP use impact is estimated as the difference in smoking- and vaping-attributable deaths (SVADs) and life-years lost (LYLs) between the No-NVP and NVP scenarios. We illustrate SAVM's adaptation to the German adult ages 18+ population, the Germany-SAVM by adjusting the model using population, mortality, smoking and NVP use data. RESULTS Assuming that the excess NVP mortality risk is 5% that of smoking, Germany-SAVM projected 4.7 million LYLs and almost 300,000 SVADs averted associated with NVP use from 2012 to 2060. Increasing the excess NVP mortality risk to 40% with other rates constant resulted in averted 2.8 million LYLs and 200,000 SVADs during the same period. CONCLUSIONS SAVM enables non-modelers, policymakers, and other stakeholders to analyze the potential population health effects of NVP use and public health interventions.
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Affiliation(s)
- Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA.
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jamie Tam
- School of Public Health, Yale University, New Haven, CT, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Mona Issabakhsh
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Integrative Oncology, BC Cancer Research Institute, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Columbia, Canada
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 2115 Wisconsin Ave, suite 300, Washington, DC, 20007, USA
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González-Marrón A, Koprivnikar H, Tisza J, Cselkó Z, Lambrou A, Peruga A, Kilibarda B, Lidón-Moyano C, Carnicer-Pont D, Papachristou E, Nunes E, Carreras G, Gorini G, Pérez-Martín H, Martínez-Sánchez JM, Spizzichino L, Karekla M, Mulcahy M, Vasic M, Ruokolainen O, Guignard R, Schoretsaniti S, Laatikainen T, Nguyen-Thanh V, Ollila H. Tobacco endgame in the WHO European Region: Feasibility in light of current tobacco control status. Tob Induc Dis 2023; 21:151. [PMID: 38026503 PMCID: PMC10647070 DOI: 10.18332/tid/174360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. METHODS In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. RESULTS Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). CONCLUSIONS There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.
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Affiliation(s)
- Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
- Department of Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Judit Tisza
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Zsuzsa Cselkó
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Angeliki Lambrou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Armando Peruga
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, (CIBERES), Madrid, España
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Biljana Kilibarda
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Dolors Carnicer-Pont
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, (CIBERES), Madrid, España
- Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España
| | - Efstathios Papachristou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Emilia Nunes
- General Directorate of Health, Ministry of Health, Lisbon, Portugal
| | - Giulia Carreras
- Clinical Epidemiology Unit, Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - Giuseppe Gorini
- Clinical Epidemiology Unit, Oncologic network, prevention and research institute (ISPRO), Florence, Italy
| | - Hipólito Pérez-Martín
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Jose M. Martínez-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | | | | | - Maurice Mulcahy
- National Environmental Health Service, Health Service Executive (HSE), Galway Business Park, Dangan, Ireland
| | - Milena Vasic
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Belgrade, Serbia
- Faculty of Dentistry, Pancevo, Serbia
| | | | - Romain Guignard
- Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Sotiria Schoretsaniti
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization (NPHO), Athens, Greece
| | - Tiina Laatikainen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Viêt Nguyen-Thanh
- Santé Publique France, the French National Public Health Agency, Saint-Maurice, France
| | - Hanna Ollila
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework. Tob Control 2023; 32:589-598. [PMID: 35017262 PMCID: PMC10447402 DOI: 10.1136/tobaccocontrol-2021-056825] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.
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Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Sreeramareddy CT, Aye SN. Changes in adult smoking behaviours in ten global adult tobacco survey (GATS) countries during 2008-2018 - a test of 'hardening' hypothesis'. BMC Public Health 2021; 21:1209. [PMID: 34167508 PMCID: PMC8223378 DOI: 10.1186/s12889-021-11201-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hardcore smoking behaviours and test of hardening are seldom reported from low-and-middle-income countries (LMICs). We report country-wise changes in smoking behaviors between two sequential surveys and explored ecologically the relationship between MPOWER scores and smoking behaviors including hardcore smoking. METHODS We analysed sequential Global Adult Tobacco Survey (GATS) data done at least at five years interval in 10 countries namely India, Bangladesh, China, Mexico, Philippines, Russia, Turkey, Ukraine, Uruguay, and Vietnam. We estimated weighted prevalence rates of smoking behaviors namely current smoking (both daily and non-daily), prevalence of hardcore smoking (HCS) among current smokers (HCSs%) and entire surveyed population (HCSp%), quit ratios (QR), and the number of cigarettes smoked per day (CPD). We calculated absolute and relative (%) change in rates between two surveys in each country. Using aggregate data, we correlated relative change in current smoking prevalence with relative change in HCSs% and HCSp% as well as explored the relationship of MPOWER score with relative change in smoking behaviors using Spearman' rank correlation test. RESULTS Overall daily smoking has declined in all ten countries lead by a 23% decline in Russia. In India, Bangladesh, and Philippines HCSs% decreased as the smoking rate decreased while HCSs% increased in Turkey (66%), Vietnam (33%) and Ukraine (15%). In most countries, CPD ranged from 15 to 20 sticks except in Mexico (7.8), and India (10.4) where CPD declined by 18 and 22% respectively. MPOWER scores were moderately correlated with HCSs% in both sexes (r = 0.644, p = 0.044) and HCSp% (r = 0.632, p = 0.05) and among women only HCSs% (r = 0.804, p = 0.005) was significantly correlated with MPOWER score. CONCLUSION With declining smoking prevalence, HCS had also decreased and quit rates improved. Ecologically, a positive linear relationship between changes in smoking and HCS is a possible evidence against 'hardening'. Continued monitoring of the changes in quitting and hardcore smoking behaviours is required to plan cessation services.
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Affiliation(s)
| | - Saint Nway Aye
- Department of Pathology, International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia
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Gredner T, Mons U, Niedermaier T, Brenner H, Soerjomataram I. Impact of tobacco control policies implementation on future lung cancer incidence in Europe: An international, population-based modeling study. THE LANCET REGIONAL HEALTH. EUROPE 2021; 4:100074. [PMID: 34029359 PMCID: PMC8121752 DOI: 10.1016/j.lanepe.2021.100074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite recent trends in declining smoking rates, tobacco smoking remains the most preventable cause of cancer in Europe. We aimed to estimate numbers and proportions of future lung cancer cases that could be potentially prevented over a 20-year period if countries in Europe were to achieve a comprehensive implementation of tobacco control policies. METHODS Historical data from population-based cancer incidence (or mortality) was used to predict sex-specific lung cancer incidence for 30 European countries up to 2037. Hypothetical country-specific smoking prevalence that would be expected if countries would have achieved the highest-level implementation of tobacco control policies (defined by the maximum total score of the Tobacco Control Scale, TCS) was estimated by combining national prevalence data on current smoking and data on the status of implementation of key tobacco control policies. Resulting numbers and proportions of potentially preventable lung cancer cases were estimated taking into account latency periods between changes in smoking prevalence and excess cancer risks. FINDINGS In Europe, an estimated 1·65 million lung cancer cases (21·2%, 19·8% in men and 23·2% in women) could be prevented over a 20-year period with the highest-level implementation of tobacco control policies. Large variation was seen in European regions and countries reflecting the current level of tobacco control, with the largest potential for prevention in Western Europe (24·5%), Southern Europe (23·1%) and Eastern Europe (22·5%), and the lowest but still substantial potential for further prevention in Northern Europe (12·5%). In women, among whom lung cancer incidence is expected to increase, we estimated somewhat larger proportions of preventable lung cancer cases ranging from 9·9 to 33·9% as compared to men (8·6-28·5%). In the final year of study period (2037), these proportions even exceed 50% in women for some countries. INTERPRETATION Improved and expanded implementation of evidence-based tobacco control policies at the most comprehensive level could reduce future lung cancer incidence considerably across Europe. FUNDING The study was funded by the German Cancer Aid ("Deutsche Krebshilfe"), grant number 70112097.
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Affiliation(s)
- Thomas Gredner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Cancer Prevention Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Vallata A, O'Loughlin J, Cengelli S, Alla F. Predictors of Cigarette Smoking Cessation in Adolescents: A Systematic Review. J Adolesc Health 2021; 68:649-657. [PMID: 33191057 DOI: 10.1016/j.jadohealth.2020.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To update a systematic review published in 2012 that identified predictors of cigarette smoking cessation among adolescents. METHODS The PubMed and Web of Science databases were searched for relevant articles published between September 2010 and January 2018, using the following keywords: smoking OR tobacco OR cessation; quit OR stop; longitudinal OR prospective OR cohort. Our search identified 3,399 articles. Inclusion criteria included longitudinal studies (intervention and cohort studies) evaluating cigarette smoking cessation in young people (aged 10-24 years). After screening, in total, 34 articles were included in the review. RESULTS In total, 63 predictors of smoking cessation among adolescents were identified, with 36 new predictors that were not identified in the previous review: nine sociodemographic factors, 13 psychosocial factors, five behavioral factors, 19 social influences factors, eight smoking related variables, six environmental factors, 2 health related variables, and one genetic factor. CONCLUSIONS To increase the probability of successful smoking cessation, strategies targeting young smokers should consider both individual and environmental predictors of cessation.
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Affiliation(s)
- Amandine Vallata
- Bordeaux Research Center for Population Health - BPH, U1219 Inserm, University of Bordeaux, Bordeaux, France.
| | | | | | - François Alla
- Bordeaux Research Center for Population Health - BPH, U1219 Inserm, University of Bordeaux, Bordeaux, France
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Fuertes E, Marcon A, Potts L, Pesce G, Lhachimi SK, Jani V, Calciano L, Adamson A, Quint JK, Jarvis D, Janson C, Accordini S, Minelli C. Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden. Sci Rep 2021; 11:2311. [PMID: 33504847 PMCID: PMC7840977 DOI: 10.1038/s41598-021-81876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool "DYNAMO-HIA", this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.
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Affiliation(s)
- Elaine Fuertes
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Potts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giancarlo Pesce
- Sorbonne Université, INSERM UMR-S 1136, Epidemiology of Allergic and Respiratory Diseases (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Saint-Antoine Medical School, Paris, France
| | - Stefan K Lhachimi
- Health Sciences Bremen, Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
| | - Virjal Jani
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alex Adamson
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cosetta Minelli
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
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Levy DT, Tam J, Kuo C, Fong GT, Chaloupka F. The Impact of Implementing Tobacco Control Policies: The 2017 Tobacco Control Policy Scorecard. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:448-457. [PMID: 29346189 PMCID: PMC6050159 DOI: 10.1097/phh.0000000000000780] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Tobacco Control Scorecard, published in 2004, presented estimates of the effectiveness of different policies on smoking rates. Since its publication, new evidence has emerged. We update the Scorecard to include recent studies of demand-reducing tobacco policies for high-income countries. We include cigarette taxes, smoke-free air laws, media campaigns, comprehensive tobacco control programs, marketing bans, health warnings, and cessation treatment policies. To update the 2004 Scorecard, a narrative review was conducted on reviews and studies published after 2000, with additional focus on 3 policies in which previous evidence was limited: tobacco control programs, graphic health warnings, and marketing bans. We consider evaluation studies that measured the effects of policies on smoking behaviors. Based on these findings, we derive estimates of short-term and long-term policy effect sizes. Cigarette taxes, smoke-free air laws, marketing restrictions, and comprehensive tobacco control programs are each found to play important roles in reducing smoking prevalence. Cessation treatment policies and graphic health warnings also reduce smoking and, when combined with policies that increase quit attempts, can improve quit success. The effect sizes are broadly consistent with those previously reported for the 2004 Scorecard but now reflect the larger evidence base evaluating the impact of health warnings and advertising restrictions.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Jamie Tam
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Charlene Kuo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Geoffrey T. Fong
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Frank Chaloupka
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
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Levy DT, Levy J, Mauer-Stender K. Potential impact of strong tobacco-control policies in 11 newly independent states. Cent Eur J Public Health 2019; 27:115-126. [DOI: 10.21101/cejph.a5506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 05/13/2019] [Indexed: 11/15/2022]
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Wang QL, Xie SH, Wahlin K, Lagergren J. Global time trends in the incidence of esophageal squamous cell carcinoma. Clin Epidemiol 2018; 10:717-728. [PMID: 29950901 PMCID: PMC6016013 DOI: 10.2147/clep.s166078] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and aims Esophageal squamous cell carcinoma (ESCC) is the dominant histological type of esophageal cancer worldwide (90%). We aimed to provide an update of the global temporal trends in the incidence of ESCC. Methods Incidence data for ESCC were collected from 30 well-established cancer registries from 20 countries in Europe, Northern America, Australia, or Asia for 1970–2015. Time trends in annual age-standardized incidence rates of ESCC were assessed using joinpoint analysis and log-linear regression. Age–period–cohort analysis was used to estimate the influence of age, calendar-period, and birth-cohort on the observed time trends in incidence. Results The age-standardized incidence rates of ESCC varied more than eightfold in men and sevenfold in women across populations. In 2012, the highest rate of ESCC in men was observed in Nagasaki, Japan (9.7/100,000 person-years) and in women in Scotland (2.7/100,000 person-years). In men, the incidence decreased globally during the study period, as well as during the last few years. In women, the incidence increased in Japan (three regions), the Netherlands, New Zealand, Norway, and Switzerland, whereas it stabilized or decreased in other populations. Among ethnic groups in the United States, black men and women had more pronounced decreases in incidence than other groups. Generally, birth-cohort effects were stronger determinants of incidence trends than calendar-period effects. Conclusion In men, the global ESCC incidence has decreased over time. In women, the incidence trends vary across populations, and the rates have increased in some countries. Changes in the prevalence of tobacco smoking and alcohol consumption may have contributed to these time trends.
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Affiliation(s)
- Qiao-Li Wang
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Shao-Hua Xie
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karl Wahlin
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.,School of Cancer Sciences, King's College London, London, UK
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Levy DT, Yuan Z, Li Y. The US SimSmoke tobacco control policy model of smokeless tobacco and cigarette use. BMC Public Health 2018; 18:696. [PMID: 29871597 PMCID: PMC5989428 DOI: 10.1186/s12889-018-5597-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background Smokeless tobacco (SLT) prevalence had been declining in the US prior to 2002 but has since increased. Knowledge about the impact of tobacco control policies on SLT and cigarette use is limited. This study examines the interrelationship between policies, cigarette use, and SLT use by applying the SimSmoke tobacco control policy simulation model. Methods Using data from large-scale Tobacco Use Supplement and information on policies implemented, US SimSmoke was updated and extended to incorporate SLT use. The model distinguishes between exclusive SLT and dual use of SLT and cigarettes, and considers the effect of implementing individual and combined tobacco control policies on smoking and SLT use, and on deaths attributable to their use. After validating against Tobacco Use Supplement (TUS) survey data through 2015, the model was used to estimate the impact of policies implemented between 1993 and 2017. Results SimSmoke reflected trends in exclusive cigarette use from the TUS, but over-estimated the reductions, especially among 18–24 year olds, until 2002 and under-estimated the reductions from 2011 to 2015. By 2015, SimSmoke projections of exclusive SLT and dual use were close to TUS estimates, but under-estimated reductions in both from 1993 to 2002 and failed to estimate the growth in male exclusive SLT use, especially among 18–24 year olds, from 2011 to 2015. SimSmoke projects that policies implemented between 1993 and 2017 reduced exclusive cigarette use by about 35%, dual use by 32.5% and SLT use by 16.5%, yielding a reduction of 7.5 million tobacco-attributable deaths by 2067. The largest reductions were attributed to tax increases. Conclusions Our results indicate that cigarette-oriented policies may be effective in also reducing the use of other tobacco products. However, further information is needed on the effect of tobacco control policies on exclusive and dual SLT use and the role of industry.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., Suite 4100, Washington DC, USA.
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., Suite 4100, Washington DC, USA
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13
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West R, Coyle K, Owen L, Coyle D, Pokhrel S. Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction 2018; 113 Suppl 1:19-31. [PMID: 28833834 PMCID: PMC6032933 DOI: 10.1111/add.14006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Estimating 'return on investment' (ROI) from smoking cessation interventions requires reach and effectiveness parameters for interventions for use in economic models such as the EQUIPT ROI tool (http://roi.equipt.eu). This paper describes the derivation of these parameter estimates for England that can be adapted to create ROI models for use by other countries. METHODS Estimates were derived for interventions in terms of their reach and effectiveness in: (1) promoting quit attempts and (2) improving the success of quit attempts (abstinence for at least 12 months). The sources were systematic reviews of efficacy supplemented by individual effectiveness evaluations and national surveys. FINDINGS Quit attempt rates were estimated to be increased by the following percentages (with reach in parentheses): 20% by tax increases raising the cost of smoking 5% above the cost of living index (100%); 10% by enforced comprehensive indoor public smoking bans (100%); 3% by mass media campaigns achieving 400 gross rating points (100%); 40% by brief opportunistic physician advice (21%); and 110% by use of a licensed nicotine product to reduce cigarette consumption (12%). Quit success rates were estimated to be increased by the following ratios: 60% by single-form nicotine replacement therapy (NRT) (5%); 114% by NRT patch plus a faster-acting NRT (2%);124% by prescribed varenicline (5%); 60% by bupropion (1%); 100% by nortriptyline (0%), 10) 298% by cytisine (0%); 40% by individual face-to-face behavioural support (2%); 37% by telephone support (0.5%); 88% by group behavioural support (1%); 63% by text messaging (0.5%); and 19% by printed self-help materials (1%). There was insufficient evidence to obtain reliable, country-specific estimates for interventions such as websites, smartphone applications and e-cigarettes. CONCLUSIONS Tax increases, indoor smoking bans, brief opportunistic physician advice and use of nicotine replacement therapy (NRT) for smoking reduction can all increase population quit attempt rates. Quit success rates can be increased by provision of NRT, varenicline, bupropion, nortriptyline, cytisine and behavioural support delivered through a variety of modalities. Parameter estimates for the effectiveness and reach of these interventions can contribute to return on investment estimates in support of national or regional policy decisions.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Kathryn Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
| | - Lesley Owen
- Centre for GuidelinesNational Institute for Health and Care ExcellenceLondonUK
| | - Doug Coyle
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
- School of Epidemiology and Public HealthUniversity of OttawaOttawaCanada
| | - Subhash Pokhrel
- Health Economics Research Group (HERG), Institute of Environment, Health and SocietyBrunel University LondonUxbridgeUK
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Levy DT, Wijnhoven TMA, Levy J, Yuan Z, Mauer-Stender K. Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries. Eur J Public Health 2018; 28:693-701. [DOI: 10.1093/eurpub/cky028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- David T Levy
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Trudy M A Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Jeffrey Levy
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Cancer Causes and Control, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Kristina Mauer-Stender
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
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Buczkowski K, Basinska MA, Ratajska A, Lewandowska K, Luszkiewicz D, Sieminska A. Smoking Status and the Five-Factor Model of Personality: Results of a Cross-Sectional Study Conducted in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020126. [PMID: 28134805 PMCID: PMC5334680 DOI: 10.3390/ijerph14020126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/05/2017] [Accepted: 01/17/2017] [Indexed: 12/27/2022]
Abstract
Tobacco smoking is the single most important modifiable factor in increased morbidity and premature mortality. Numerous factors—including genetics, personality, and environment—affect the development and persistence of tobacco addiction, and knowledge regarding these factors could improve smoking cessation rates. This study compared personality traits between never, former, and current smokers, using the Five-Factor Model of Personality in a country with a turbulent smoking reduction process.: In this cross-sectional study, 909 Polish adults completed the Revised Neuroticism-Extraversion-Openness Personality Inventory. Our results showed that current smokers’ scores for extraversion, one of the five global dimensions of personality, were higher relative to never smokers. Neuroticism, openness to experience, agreeableness, and conscientiousness did not differ significantly according to smoking status. Facet analysis, which described each dimension in detail, showed that current smokers’ activity and excitement seeking (facets of extraversion) scores were higher relative to those of never and former smokers. In turn, current smokers’ dutifulness and deliberation (facets of conscientiousness) scores were lower than those found in former and never smokers. Never smokers scored the highest in self-consciousness (a facet of neuroticism) and compliance (a component of agreeableness). The study conducted among Polish individuals showed variation in personality traits according to their smoking status; however, this variation differed from that reported in countries in which efforts to reduce smoking had begun earlier relative to Poland. Knowledge regarding personality traits could be useful in designing smoking prevention and cessation programs tailored to individuals’ needs.
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Affiliation(s)
- Krzysztof Buczkowski
- Department of Family Medicine, Nicolaus Copernicus University in Torun, L. Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Małgorzata A Basinska
- Institute of Psychology, Kazimierz Wielki University, Leopolda Staffa 1, 85-867 Bydgoszcz, Poland.
| | - Anna Ratajska
- Institute of Psychology, Kazimierz Wielki University, Leopolda Staffa 1, 85-867 Bydgoszcz, Poland.
- Department of Palliative Care, Nicolaus Copernicus University in Torun, L. Rydygier Collegium Medicum in Bydgoszcz, Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Katarzyna Lewandowska
- Department of Oncology and Radiotherapy, Medical University of Gdansk, Dębinki 7, 80-210 Gdańsk, Poland.
| | - Dorota Luszkiewicz
- Department of Family Medicine, Nicolaus Copernicus University in Torun, L. Rydygier Collegium Medicum in Bydgoszcz, M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland.
| | - Alicja Sieminska
- Department of Allergology, Chair of Lung Disease, Medical University of Gdansk, Dębinki 7, 80-210 Gdańsk, Poland.
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Levy D, Abrams DB, Levy J, Rosen L. Complying with the framework convention for tobacco control: an application of the Abridged SimSmoke model to Israel. Isr J Health Policy Res 2016; 5:41. [PMID: 27651891 PMCID: PMC5024508 DOI: 10.1186/s13584-016-0101-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The World Health Organization Framework Convention for Tobacco Control (FCTC) established the MPOWER policy package to provide practical country-level guidance on implementing effective policies to reduce smoking rates. The Abridged SimSmoke tobacco control policy simulation model is applied to Israel to estimate the effects on reducing smoking-attributable mortality resulting from full implementation of MPOWER policies. METHODS Smoking prevalence from the 2014 Israel National Health Interview Survey 3 and population data from the Israel Central Bureau of Statistics were used to calculate the number of current smokers. The status of current Israeli policy was determined using information from MPOWER 2015 and from local sources. Based on existing knowledge that between 50 % and 65 % of smokers will die prematurely from smoking, the model is used to determine mortality reductions among current smokers from full implementation of MPOWER policies. RESULTS We estimate that between 547 and 711 thousand smokers of the current 1.1 million Israeli smokers will prematurely die due smoking. Within 40 years, complete implementation of MPOWER policies is projected to reduce smoking prevalence among current smokers by 34% and avert between 187 and 243 thousand deaths. Taxes, smoke-free air laws, marketing restrictions and media campaigns each reduce smoking by about 5 % within 5 years. Improved cessation treatment and health warnings each have smaller effects in the next five years, but their effects grow rapidly over time. CONCLUSIONS Israel Abridged SimSmoke shows that complete implementation of the MPOWER strategies has the potential to substantially reduce smoking prevalence, and avert premature deaths due to smoking. Additional benefits are also expected from reduced morbidity, reduced initiation among nonsmokers, and reduction in exposure of nonsmokers to tobacco smoke.
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Affiliation(s)
- David Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA
| | - David B Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC USA ; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Laura Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Levy DT, Fouad H, Levy J, Dragomir AD, El Awa F. Application of the Abridged SimSmoke model to four Eastern Mediterranean countries. Tob Control 2016; 25:413-21. [PMID: 26080365 PMCID: PMC4681690 DOI: 10.1136/tobaccocontrol-2015-052334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/20/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The WHO established the MPOWER policy package to boost the implementation of the WHO Framework Convention for Tobacco Control (WHO FCTC) in 2008 and to provide practical guidance on policies effective at reducing smoking rates. An easily applied Abridged SimSmoke was developed to help countries gauge the effect of these policies using data from the WHO MPOWER/WHO Report (MPOWER Report) and is applied to four Eastern Mediterranean countries. METHODS The number of smokers in a country is calculated using the country's smoking prevalence and population. Policy effect sizes, based on previously validated SimSmoke models, are applied to the smoker populations to determine the reduction in the number of smokers resulting from implementing policies. The number of smoking-attributable deaths is derived based on findings that half of those smokers alive today will die from smoking. RESULTS Within 40 years, implementing the complete set of MPOWER policies is projected to reduce smoking prevalence by 29% (range 15%, 41%) and avert almost 1 (range 0.5, 1.4) million deaths in Egypt, reduce smoking prevalence by 52% (range 36%, 66%) and avert 156 000 (106 000, 196 000) deaths in Lebanon, reduce smoking prevalence by 56% (range 40%, 69%) and avert 3.5 (range 2.5, 4.3) million deaths in Pakistan, and reduce smoking prevalence by 37% (range 21%, 51%) and avert 245 000 (range 138 000, 334 000) deaths in Tunisia. CONCLUSIONS The Abridged SimSmoke model has been used to show the number of deaths from smoking and how MPOWER policies can be used to reach the WHO non-communicable deaths voluntary target for cigarette use reduction in four countries.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | | | - Anca D Dragomir
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Kypridemos C, Allen K, Hickey GL, Guzman-Castillo M, Bandosz P, Buchan I, Capewell S, O'Flaherty M. Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options. BMJ 2016; 353:i2793. [PMID: 27279346 PMCID: PMC4898640 DOI: 10.1136/bmj.i2793] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies. DESIGN Microsimulation study of a close-to-reality synthetic population. Five scenarios were considered: baseline scenario, assuming that current trends in risk factors will continue in the future; universal screening; screening concentrated only in the most deprived areas; structural population-wide intervention; and combination of population-wide intervention and concentrated screening. SETTING Synthetic population with similar characteristics to the community dwelling population of England. PARTICIPANTS Synthetic people with traits informed by the health survey for England. MAIN OUTCOME MEASURE Cardiovascular disease cases and deaths prevented or postponed by 2030, stratified by fifths of socioeconomic status using the index of multiple deprivation. RESULTS Compared with the baseline scenario, universal screening may prevent or postpone approximately 19 000 cases (interquartile range 11 000-28 000) and 3000 deaths (-1000-6000); concentrated screening 17 000 cases (9000-26 000) and 2000 deaths (-1000-5000); population-wide intervention 67 000 cases (57 000-77 000) and 8000 deaths (4000-11 000); and the combination of the population-wide intervention and concentrated screening 82 000 cases (73 000-93 000) and 9000 deaths (6000-13 000). The most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health. CONCLUSIONS When primary prevention strategies for reducing cardiovascular disease burden and inequalities are compared, universal screening seems less effective than alternative strategies, which incorporate population-wide approaches. Further research is needed to identify the best mix of population-wide and risk targeted CVD strategies to maximise cost effectiveness and minimise inequalities.
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Affiliation(s)
- Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
| | - Kirk Allen
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Graeme L Hickey
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Maria Guzman-Castillo
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, Poland
| | - Iain Buchan
- Farr Institute @ HeRC, University of Manchester, Manchester, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool L69 3GB, UK
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Allen K, Kypridemos C, Hyseni L, Gilmore AB, Diggle P, Whitehead M, Capewell S, O'Flaherty M. The effects of maximising the UK's tobacco control score on inequalities in smoking prevalence and premature coronary heart disease mortality: a modelling study. BMC Public Health 2016; 16:292. [PMID: 27036296 PMCID: PMC4818400 DOI: 10.1186/s12889-016-2962-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Smoking is more than twice as common among the most disadvantaged socioeconomic groups in England compared to the most affluent and is a major contributor to health-related inequalities. The United Kingdom (UK) has comprehensive smoking policies in place: regular tax increases; public information campaigns; on-pack pictorial health warnings; advertising bans; cessation; and smoke-free areas. This is confirmed from its high Tobacco Control Scale (TCS) score, an expert-developed instrument for assessing the strength of tobacco control policies. However, room remains for improvement in tobacco control policies. Our aim was to evaluate the cumulative effect on smoking prevalence of improving all TCS components in England, stratified by socioeconomic circumstance. Methods Effect sizes and socioeconomic gradients for all six types of smoking policy in the UK setting were adapted from systematic reviews, or if not available, from primary studies. We used the IMPACT Policy Model to link predicted changes in smoking prevalence to changes in premature coronary heart disease (CHD) mortality for ages 35–74. Health outcomes with a time horizon of 2025 were stratified by quintiles of socioeconomic circumstance. Results The model estimated that improving all smoking policies to achieve a maximum score on the TCS might reduce smoking prevalence in England by 3 % (95 % Confidence Interval (CI): 1–4 %), from 20 to 17 % in absolute terms, or by 15 % in relative terms (95 % CI: 7–21 %). The most deprived quintile would benefit more, with absolute reductions from 31 to 25 %, or a 6 % reduction (95 % CI: 2–7 %). There would be some 3300 (95 % CI: 2200–4700) fewer premature CHD deaths between 2015–2025, a 2 % (95 % CI: 1.4–2.9 %) reduction. The most disadvantaged quintile would benefit more, reducing absolute inequality of CHD mortality by about 4 % (95 % CI: 3–9 %). Conclusions Further, feasible improvements in tobacco control policy could substantially improve population health, and reduce health-related inequalities in England. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2962-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirk Allen
- Lancaster Medical School, Lancaster University, Lancaster, UK.,Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK.
| | - Lirije Hyseni
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, UK Centre for Tobacco and Alcohol Studies (UKCTAS), Bath, UK
| | - Peter Diggle
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health & Policy, University of Liverpool, Liverpool, UK
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Fleischer NL, Thrasher JF, Reynales-Shigematsu LM, Cummings KM, Meza R, Zhang Y, Levy DT. Mexico SimSmoke: how changes in tobacco control policies would impact smoking prevalence and smoking attributable deaths in Mexico. Glob Public Health 2016; 12:830-845. [PMID: 26837721 DOI: 10.1080/17441692.2015.1123749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We examined the effect of tobacco control policies in Mexico on smoking prevalence and smoking-related deaths using the Mexico SimSmoke model. The model is based on the previously developed SimSmoke simulation model of tobacco control policy, and uses population size, smoking rates and tobacco control policy data for Mexico. It assesses, individually, and in combination, the effect of six tobacco control policies on smoking prevalence and smoking-related deaths. Policies included: cigarette excise taxes, smoke-free laws, anti-smoking public education campaigns, marketing restrictions, access to tobacco cessation treatments and enforcement against tobacco sales youth. The model estimates that, if Mexico were to adopt strong tobacco control policies compared to current policy levels, smoking prevalence could be reduced by 30% in the next decade and by 50% by 2053; an additional 470,000 smoking-related premature deaths could be averted over the next 40 years. The greatest impact on smoking and smoking-related deaths would be achieved by raising excise taxes on cigarettes from 55% to at least 70% of the retail price, followed by strong youth access enforcement and access to cessation treatments. Implementing tobacco control policies in Mexico could reduce smoking prevalence by 50%, and prevent 470,000 smoking-related deaths by 2053.
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Affiliation(s)
- Nancy L Fleischer
- a Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health , University of Michigan , Ann Arbor , MI , USA
| | - James F Thrasher
- b Department of Health Promotion, Education, and Behavior, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,c Department of Tobacco Research, Center for Population Health Research , National Institute of Public Health , Cuernavaca , Mexico
| | - Luz Myriam Reynales-Shigematsu
- c Department of Tobacco Research, Center for Population Health Research , National Institute of Public Health , Cuernavaca , Mexico
| | - K Michael Cummings
- d Department of Psychiatry & Behavioral Sciences , Medical University of South Carolina , Charleston , SC , USA
| | - Rafael Meza
- e Department of Epidemiology , University of Michigan , Ann Arbor , MI , USA
| | - Yian Zhang
- f Department of Oncology , Georgetown University , Washington , DC , USA
| | - David T Levy
- g Lombardi Comprehensive Cancer Center , Georgetown University , Washington , DC , USA
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Levy D, Mohlman MK, Zhang Y. Estimating the Potential Impact of Tobacco Control Policies on Adverse Maternal and Child Health Outcomes in the United States Using the SimSmoke Tobacco Control Policy Simulation Model. Nicotine Tob Res 2015; 18:1240-9. [PMID: 26385929 DOI: 10.1093/ntr/ntv178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 08/08/2015] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Numerous studies document the causal relationship between prenatal smoking and adverse maternal and child health (MCH) outcomes. Studies also reveal the impact that tobacco control policies have on prenatal smoking. The purpose of this study is to estimate the effect of tobacco control policies on prenatal smoking prevalence and adverse MCH outcomes. METHODS The US SimSmoke simulation model was extended to consider adverse MCH outcomes. The model estimates prenatal smoking prevalence and, applying standard attribution methods, uses estimates of MCH prevalence and relative smoking risks to estimate smoking-attributable MCH outcomes over time. The model then estimates the effect of tobacco control policies on adverse birth outcomes averted. RESULTS Different tobacco control policies have varying impacts on the number of smoking-attributable adverse MCH birth outcomes. Higher cigarette taxes and comprehensive marketing bans individually have the biggest impact with a 5% to 10% reduction across all outcomes for the period from 2015 to 2065. The policies with the lowest impact (2%-3% decrease) during this period are cessation treatment, health warnings, and complete smoke-free laws. Combinations of all policies with each tax level lead to 23% to 28% decreases across all outcomes. CONCLUSIONS Our findings demonstrate the substantial impact of strong tobacco control policies for preventing adverse MCH outcomes, including long-term health implications for children exposed to low birth weight and preterm birth. These benefits are often overlooked in discussions of tobacco control.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | | | - Yian Zhang
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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Vugrin ED, Rostron BL, Verzi SJ, Brodsky NS, Brown TJ, Choiniere CJ, Coleman BN, Paredes A, Apelberg BJ. Modeling the potential effects of new tobacco products and policies: a dynamic population model for multiple product use and harm. PLoS One 2015; 10:e0121008. [PMID: 25815840 PMCID: PMC4376806 DOI: 10.1371/journal.pone.0121008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent declines in US cigarette smoking prevalence have coincided with increases in use of other tobacco products. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. METHODS AND FINDINGS We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. The model tracks product use prevalence and mortality attributable to tobacco use for the overall population and by sex and age group. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. Sensitivity analyses were conducted to examine the range of population impacts that could occur due to differences in input values for product use and risk. We demonstrate that potential benefits from cigarette smokers switching to the lower-risk product can be offset over time through increased initiation of this product. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. CONCLUSION Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability.
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Affiliation(s)
- Eric D. Vugrin
- Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Brian L. Rostron
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Stephen J. Verzi
- Systems Research, Analysis and Applications, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Nancy S. Brodsky
- Resilience and Regulatory Effects, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Theresa J. Brown
- Policy and Decision Analytics, Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Conrad J. Choiniere
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Blair N. Coleman
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Antonio Paredes
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
| | - Benjamin J. Apelberg
- Center for Tobacco Products, U.S. Food and Drug Administration, Silver Springs, Maryland, United States of America
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Levy D, Rodríguez-Buño RL, Hu TW, Moran AE. The potential effects of tobacco control in China: projections from the China SimSmoke simulation model. BMJ 2014; 348:g1134. [PMID: 24550245 PMCID: PMC3928439 DOI: 10.1136/bmj.g1134] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To use a computer simulation model to project the potential impact in China of tobacco control measures on smoking, as recommended by the World Health Organization Framework Convention on Tobacco Control (FCTC), being fully implemented. DESIGN Modelling study. SETTING China. POPULATION Males and females aged 15-74 years. INTERVENTION Incremental impact of more complete implementation of WHO FCTC policies simulated using SimSmoke, a Markov computer simulation model of tobacco smoking prevalence, smoking attributable deaths, and the impact of tobacco control policies. Data on China's adult population, current and former smoking prevalence, initiation and cessation rates, and past policy levels were entered into SimSmoke in order to predict past smoking rates and to project future status quo rates. The model was validated by comparing predicted smoking prevalence with smoking prevalence measured in tobacco surveys from 1996-2010. MAIN OUTCOME MEASURES Projected future smoking prevalence and smoking attributable deaths from 2013-50. RESULTS Status quo tobacco policy simulations projected a decline in smoking prevalence from 51.3% in 2015 to 46.5% by 2050 in males and from 2.1% to 1.3% in females. Of the individual FCTC recommended tobacco control policies, increasing the tobacco excise tax to 75% of the retail price was projected to be the most effective, incrementally reducing current smoking compared with the status quo by 12.9% by 2050. Complete and simultaneous implementation of all FCTC policies was projected to incrementally reduce smoking by about 40% relative to the 2050 status quo levels and to prevent approximately 12.8 million smoking attributable deaths and 154 million life years lost by 2050. CONCLUSIONS Complete implementation of WHO FCTC recommended policies would prevent more than 12.8 million smoking attributable deaths in China by 2050. Implementation of FCTC policies would alleviate a substantial portion of the tobacco related health burden that threatens to slow China's extraordinary gains in life expectancy and prosperity.
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Affiliation(s)
- David Levy
- Lombardi Comprehensive Cancer Center, Population Science, Department of Oncology, Georgetown University, Washington, DC 20007, USA
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