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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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Smith EA, Malone RE. An argument for phasing out sales of cigarettes. Tob Control 2019; 29:703-708. [PMID: 31542777 PMCID: PMC7591796 DOI: 10.1136/tobaccocontrol-2019-055079] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/04/2022]
Abstract
The successes of tobacco control in some countries and locales have led to discussions of ending the tobacco epidemic, often called the 'endgame'. In this paper, we recommend articulating the endgame goal as phasing out sales of cigarettes, a goal once called 'unthinkable'. We develop a logic and argumentation for ending cigarette sales intended to move the discussion beyond the shadow of 'prohibition', proposing an approach that appeals to consumer protection standards and suggesting that the effort be led by low-prevalence communities. While phasing out cigarettes will not happen everywhere all at once, and may unfold differently along several lines, we argue that the gradual phase-out approach we propose will reduce the likelihood of the negative consequences often predicted to come with such a policy. To continue permitting widespread sales of the single most deadly consumer product in history is a public health failure that must be addressed.
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Affiliation(s)
- Elizabeth A Smith
- Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Ruth E Malone
- Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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Willemsen MC, Walters BH, Kotz D, Bauld L. Recommendations on how to achieve tobacco-free nations in Europe. Tob Prev Cessat 2019; 5:24. [PMID: 32411887 PMCID: PMC7205141 DOI: 10.18332/tpc/110587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/28/2019] [Accepted: 07/10/2019] [Indexed: 11/24/2022]
Abstract
European countries vary widely in the development and implementation of effective tobacco-control programs and policies. Why some countries lag behind others is inherently a political matter. National-level policymakers struggle between the need to protect public health and the need to recognize economic and ideological considerations. Within this context, use of scientific evidence plays an important role in the policy making process. Articles 20 and 22 of the World Health Organisation's Framework Convention of Tobacco Control (FCTC) oblige countries to develop and coordinate research on aspects of tobacco control and require of them to facilitate knowledge transfer and capacity building between countries. This paper considers various ways how EU and national policy makers may accomplish this. We conclude that progress in three areas is needed: 1) generation of more scientific evidence relevant for each country; 2) facilitation of policy learning between countries; and 3) building capacity and collaborations between researchers and tobacco-control advocates to bridge the gap from research to policy, especially in countries with weak tobacco-control infrastructures.
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Affiliation(s)
- Marc C. Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, Netherlands
| | - Bethany Hipple Walters
- Netherlands Expertise Center for Tobacco Control, Trimbos Institute, Utrecht, Netherlands
| | - Daniel Kotz
- Addiction Research and Clinical Epidemiology Unit, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Linda Bauld
- College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
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Timberlake DS, Laitinen U, Kinnunen JM, Rimpela AH. Strategies and barriers to achieving the goal of Finland's tobacco endgame. Tob Control 2019; 29:398-404. [PMID: 31152117 PMCID: PMC7361028 DOI: 10.1136/tobaccocontrol-2018-054779] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 01/02/2023]
Abstract
Objectives Finland boldly legislated the end of tobacco use in its 2010 Tobacco Act, and subsequently expanded the goal in 2016 to eradicate other nicotine-containing products. This study explored stakeholders’ perceptions about the strengths, barriers, solutions and rationale for Finland’s comprehensive but conventional strategy to achieve its nicotine-free goal. Design Study participants were selected based on expertise in policy or practice of tobacco control (n=32). Semi-structured interviews, conducted in 2017 and 2018, covered topics ranging from consensus among stakeholders to Finland’s ranking on the 2016 Tobacco Control Scale. The framework method was chosen for analysing interview transcripts. Results A perceived strength of Tobacco-Free Finland 2030 was the consensus and cooperation among members of the tobacco control community. The objective of becoming a nicotine- versus smoke-free society had almost unanimous support, challenged by a small minority who argued for greater discussion of harm reduction approaches. The need for maintaining legitimacy and historical successes in tobacco control were reasons for using a conventional strategy. Barriers to achieving the endgame goal included insufficient funding and over-reliance on non-governmental organisations, political/legal constraints, impact of institutional practices on tobacco disparities, ambivalence about the role of mass media and lack of prioritising smoking cessation. Conclusions Stakeholders’ broad confidence in reaching the goal of Finland’s tobacco endgame suggests that future policy initiatives will reflect the current, conventional strategy. If the Finnish government chooses to continue this approach, then it should designate separate funds for Tobacco-Free Finland 2030 and implement structural changes that will facilitate tobacco control initiatives.
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Affiliation(s)
- David S Timberlake
- Program in Public Health, University of California, Irvine, Irvine, California, USA .,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Ulla Laitinen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Jaana M Kinnunen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Arja H Rimpela
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,PERLA - Tampere Centre for Childhood, Youth and Family Research, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Pitkäniemi Hospital, Tampere University Hospital, Nokia, Finland
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Robertson L, Marsh L. Estimating the effect of a potential policy to restrict tobacco retail availability in New Zealand. Tob Control 2018; 28:466-468. [DOI: 10.1136/tobaccocontrol-2018-054491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 11/03/2022]
Abstract
IntroductionReducing tobacco retailer density is suggested to be a key component of tobacco endgames. Where tobacco retail reduction policies exist, ‘grandfathering’ is typically used, where existing retailers are exempt from restrictions aimed at reducing outlet density. We examined the possible impact on tobacco outlet density in New Zealand of a policy preventing new retail outlets from selling tobacco, but allowing existing retail outlets to continue selling tobacco until they ceased trading or relocated.MethodsWe obtained data on numbers of tobacco outlets and the number of outlet closures recorded annually from 2006 to 2016. We calculated the mean and the lowest and highest 3-year rolling average closure rates for each type of tobacco outlet. We projected decreases in the number of tobacco outlets that would hypothetically be permitted to sell tobacco from 2020 onwards and estimated when the combined number of tobacco outlets would decline by 50% and 95%.ResultsBased on mean annual closure rates, the total number of tobacco outlets would decrease by 50% by 2032 and a 95% reduction could be achieved by 2072. By 2025, the number of tobacco outlets would decrease by 27%; by 2050, this reduction would reach 84%.ConclusionA tobacco retail reduction policy that prevented new retail outlets from selling tobacco and grandfathered existing retailers would be unlikely to achieve New Zealand’s target of a 95% reduction in tobacco outlet density within several decades of being enacted. Nonetheless, this policy could achieve a 50% reduction in tobacco retail availability in the first decade of implementation.
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Ruokolainen O, Ollila H, Patja K, Borodulin K, Laatikainen T, Korhonen T. Social climate on tobacco control in an advanced tobacco control country: A population-based study in Finland. NORDIC STUDIES ON ALCOHOL AND DRUGS 2018; 35:152-164. [PMID: 32934524 PMCID: PMC7434151 DOI: 10.1177/1455072518767750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/26/2018] [Indexed: 11/17/2022] Open
Abstract
Aims Finland has implemented a gradually tightening tobacco control policy for decades. Recently the objective of a tobacco-free Finland was introduced. Still, the population's acceptance of tobacco control policy has not been measured. More knowledge is needed on differences in attitudes and factors associated with tobacco control opinions for future policy-making. Methods A population-based study with quantitative analysis. Attitudes on smoking and tobacco control policy were assessed within the National FINRISK 2012 Study in Finland involving 25-74-year-old adults (N = 4905). In analyses, smoking status groups were compared. Results In general, attitudes differed systematically by smoking status. Differences increased or decreased when moving from never smokers to other smoking groups. Similarities in attitudes were found particularly on youth smoking, while differences between smoking groups were notable on statements regarding smoking on balconies and availability of tobacco products. The adjusted analysis showed that smoking status was most strongly associated with attitudes on different tobacco control policy measures. Daily smokers viewed stricter tobacco control policy and workplace smoking bans more negatively than others, though they viewed societal support for quitters and sufficiency of tobacco control policy more positively compared with others. Differences were vast compared with non-smokers, but also occasional smokers differed from daily smokers. Conclusions Tightening tobacco control and workplace smoking bans were supported by the Finnish adult population, but societal support for quitters to a lesser extent. Attitude change, where smokers are seen as deserving help to quit smoking, is important.
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Affiliation(s)
| | - Hanna Ollila
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Katja Borodulin
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Kuopio, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland Joint Municipal Authority for North Karelia Social and Health Services, Siun Sote, Joensuu, Finland
| | - Tellervo Korhonen
- University of Helsinki, Helsinki, Finland National Institute for Health and Welfare, Helsinki, Finland
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Policy coherence, integration, and proportionality in tobacco control: Should tobacco sales be limited to government outlets? J Public Health Policy 2018; 38:345-358. [PMID: 28432335 DOI: 10.1057/s41271-017-0074-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Multiple factors, including marijuana decriminalization/legalization, tobacco endgame discourse, and alcohol industry pressures, suggest that the retail regulatory environment for psychoactive or addictive substances is a dynamic one in which new options may be considered. In most countries, the regulation of tobacco, marijuana, and alcohol is neither coherent, nor integrated, nor proportional to the potential harms caused by these substances. We review the possible consequences of restricting tobacco sales to outlets run by government-operated alcohol retail monopolies, as well as the likely obstacles to such a policy. Such a move would allow governments more options for regulating tobacco sales, and increase coherence, integration, and proportionality of substance regulation. It might also serve as an incremental step toward an endgame goal of eliminating sales of commercial combustible tobacco.
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Reitan T, Callinan S. Changes in Smoking Rates Among Pregnant Women and the General Female Population in Australia, Finland, Norway, and Sweden. Nicotine Tob Res 2017; 19:282-289. [PMID: 27613884 PMCID: PMC5444098 DOI: 10.1093/ntr/ntw188] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/17/2016] [Indexed: 02/02/2023]
Abstract
Introduction: Smoking rates have dropped substantially in most developed countries in recent decades. This general trend has, however, not always been evident among women—particularly younger women. Smoking habits do, however, often change in connection with pregnancy and the aim of this study is to determine whether smoking during pregnancy follows general trends in smoking rates in the general female population in four countries with active anti-tobacco policies and decreasing population smoking rates. Methods: Changes in rates of persistent smoking, that is, smoking in late pregnancy or daily smoking among all women of childbearing age were described according to age groups. Data were retrieved from the Australian Household Drug Surveys during 2000–2013 and from registries and surveys in Finland, Norway, and Sweden between 1995 and 2014. Results: In general, persistent smoking has decreased and late-pregnancy smoking rates are lower than daily smoking rates among all women. However, younger women are more likely to be persistent smokers regardless of pregnancy status. In Norway and Finland, persistent smoking was most common among young pregnant women and in Sweden there was an increased polarization between age groups. In Australia, a steady decrease in smoking rates appears to have stalled in younger pregnant women. Conclusion: Although smoking has declined substantially in recent decades, there are groups lagging behind this general trend. Young pregnant women are of particular concern in this respect. The possibility that these findings reflect the changing characteristics of younger pregnant women is discussed. Implications: This study puts recent trends in maternal smoking into a broader context by relating developments to changes in smoking rates among women in general. By using similar data from four countries we were able to follow changes in smoking rates “within” groups of women within the four countries without being limited by methodological problems related to cross-country or inter-group comparisons. We were above all able to show that aggregate data disclose the strong age gradient in maternal smoking habits.
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Affiliation(s)
- Therese Reitan
- Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, Stockholm, Sweden
| | - Sarah Callinan
- Centre for Alcohol Policy Research, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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LEVY DAVIDT, FONG GEOFFREYT, CUMMINGS KMICHAEL, BORLAND RON, ABRAMS DAVIDB, VILLANTI ANDREAC, NIAURA RAY. The need for a comprehensive framework. Addiction 2017; 112:22-24. [PMID: 27936507 PMCID: PMC5396387 DOI: 10.1111/add.13600] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/17/2016] [Accepted: 09/08/2016] [Indexed: 11/29/2022]
Abstract
To facilitate individual and population-level behavior change, we need policies based on science. We must develop coherent policies that explicitly consider the benefits and risks of different classes of nicotine delivery products, rather than continuing the current ad-hoc approach which fails to adequately address the product itself.
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Affiliation(s)
- DAVID T. LEVY
- Georgetown University – Oncology, Washington, DC, USA
| | - GEOFFREY T. FONG
- Department of Psychology, University of Waterloo, Waterloo, Ontario,
Canada
| | - K. MICHAEL CUMMINGS
- Department of Psychiatry and Behavioral Sciences, Medical University of
South Carolina, Charleston, SC, USA
| | - RON BORLAND
- Cancer Council Victoria—Centre for Behavioural Research in Cancer,
Victoria, Australia
| | - DAVID B. ABRAMS
- Schroeder Institute for Tobacco Research and Policy Studies at Truth
Initiative, Washington, DC, USA,Johns Hopkins University Bloomberg School of Public Health Ringgold standard
institution— Health, Behavior and Society, Baltimore, MD, USA,Georgetown Lombardi Comprehensive Cancer Center Ringgold standard
institution—Oncology, Washington, DC, USA
| | - ANDREA C. VILLANTI
- Schroeder Institute for Tobacco Research and Policy Studies at Truth
Initiative, Washington, DC, USA
| | - RAY NIAURA
- Schroeder Institute for Tobacco Research and Policy Studies at Truth
Initiative, Washington, DC, USA
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Levy DT, Huang AT, Havumaki JS, Meza R. The role of public policies in reducing smoking prevalence: results from the Michigan SimSmoke tobacco policy simulation model. Cancer Causes Control 2016; 27:615-25. [PMID: 26983616 PMCID: PMC4840036 DOI: 10.1007/s10552-016-0735-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Michigan has implemented several of the tobacco control policies recommended by the World Health Organization MPOWER goals. We consider the effect of those policies and additional policies consistent with MPOWER goals on smoking prevalence and smoking-attributable deaths (SADs). METHODS The SimSmoke tobacco control policy simulation model is used to examine the effect of past policies and a set of additional policies to meet the MPOWER goals. The model is adapted to Michigan using state population, smoking, and policy data starting in 1993. SADs are estimated using standard attribution methods. Upon validating the model, SimSmoke is used to distinguish the effect of policies implemented since 1993 against a counterfactual with policies kept at their 1993 levels. The model is then used to project the effect of implementing stronger policies beginning in 2014. RESULTS SimSmoke predicts smoking prevalence accurately between 1993 and 2010. Since 1993, a relative reduction in smoking rates of 22 % by 2013 and of 30 % by 2054 can be attributed to tobacco control policies. Of the 22 % reduction, 44 % is due to taxes, 28 % to smoke-free air laws, 26 % to cessation treatment policies, and 2 % to youth access. Moreover, 234,000 SADs are projected to be averted by 2054. With additional policies consistent with MPOWER goals, the model projects that, by 2054, smoking prevalence can be further reduced by 17 % with 80,000 deaths averted relative to the absence of those policies. CONCLUSIONS Michigan SimSmoke shows that tobacco control policies, including cigarette taxes, smoke-free air laws, and cessation treatment policies, have substantially reduced smoking and SADs. Higher taxes, strong mass media campaigns, and cessation treatment policies would further reduce smoking prevalence and SADs.
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Feirman SP, Donaldson E, Glasser AM, Pearson JL, Niaura R, Rose SW, Abrams DB, Villanti AC. Mathematical Modeling in Tobacco Control Research: Initial Results From a Systematic Review. Nicotine Tob Res 2016; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/05/2015] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The US Food and Drug Administration has expressed interest in using mathematical models to evaluate potential tobacco policies. The goal of this systematic review was to synthesize data from tobacco control studies that employ mathematical models. METHODS We searched five electronic databases on July 1, 2013 to identify published studies that used a mathematical model to project a tobacco-related outcome and developed a data extraction form based on the ISPOR-SMDM Modeling Good Research Practices. We developed an organizational framework to categorize these studies and identify models employed across multiple papers. We synthesized results qualitatively, providing a descriptive synthesis of included studies. RESULTS The 263 studies in this review were heterogeneous with regard to their methodologies and aims. We used the organizational framework to categorize each study according to its objective and map the objective to a model outcome. We identified two types of study objectives (trend and policy/intervention) and three types of model outcomes (change in tobacco use behavior, change in tobacco-related morbidity or mortality, and economic impact). Eighteen models were used across 118 studies. CONCLUSIONS This paper extends conventional systematic review methods to characterize a body of literature on mathematical modeling in tobacco control. The findings of this synthesis can inform the development of new models and the improvement of existing models, strengthening the ability of researchers to accurately project future tobacco-related trends and evaluate potential tobacco control policies and interventions. These findings can also help decision-makers to identify and become oriented with models relevant to their work.
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Affiliation(s)
- Shari P Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Shyanika W Rose
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
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Han JO, Im JS, Yim J, Choi YH, Ko KP, Kim J, Kim HG, Noh Y, Lim YK, Oh DK. Association of Cigarette Prices with the Prevalence of Smoking in Korean University Students: Analysis of Effects of the Tobacco Control Policy. Asian Pac J Cancer Prev 2015. [PMID: 26225706 DOI: 10.7314/apjcp.2015.16.13.5531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased pricing of cigarettes might be one of the most effective approaches for reducing the prevalence of smoking. This study aimed to investigate the effects of increasing cigarette prices through taxation by a tobacco intervention policy on the changes in smoking prevalence in Korean university students. MATERIALS AND METHODS The participants in this study were 23,047 healthy university students aged 18-29 years from a health examination in 2011-2015. We investigated the adjusted prevalence of daily and occasional smoking before and after increasing cigarette prices through taxation. RESULTS The prevalence of occasional smoking was significantly decreased in 2015 from 2014 in both male (from 10.7% in 2014 to 5.4%) and female (from 3.6% to 1.1%) students, but the prevalence of daily smoking did not decrease significantly. The frequency of individuals who had attempted smoking cessation during the past year was significantly higher among occasional smokers in male students (90.2%) compared with daily smokers (64.9%). For female students, there were no differences in experience of smoking cessation, willingness for smoking cessation, or E-cigarette experience between daily and occasional smokers. CONCLUSIONS We found that a policy of increasing cigarette prices through taxation is associated with decreases in the prevalence of occasional smokers, who have relatively lower nicotine dependence compared with individuals who smoke daily. The results of our study suggest that social support and direct intervention for smoking cessation at the community level are needed for university students alongside the pricing policy.
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Affiliation(s)
- Jin-Ok Han
- Department of Preventive Medicine, Gachon University College of Medicine, Sungnam, Republic of Korea E-mail : and
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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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Pearson AL, van der Deen FS, Wilson N, Cobiac L, Blakely T. Theoretical impacts of a range of major tobacco retail outlet reduction interventions: modelling results in a country with a smoke-free nation goal. Tob Control 2015; 24:e32-8. [PMID: 25037156 DOI: 10.1136/tobaccocontrol-2013-051362] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To inform endgame strategies in tobacco control, this study aimed to estimate the impact of interventions that markedly reduced availability of tobacco retail outlets. The setting was New Zealand, a developed nation where the government has a smoke-free nation goal in 2025. METHODS Various legally mandated reductions in outlets that were phased in over 10 years were modelled. Geographic analyses using the road network were used to estimate the distance and time travelled from centres of small areas to the reduced number of tobacco outlets, and from there to calculate increased travel costs for each intervention. Age-specific price elasticities of demand were used to estimate future smoking prevalence. RESULTS With a law that required a 95% reduction in outlets, the cost of a pack of 20 cigarettes (including travel costs) increased by 20% in rural areas and 10% elsewhere and yielded a smoking prevalence of 9.6% by 2025 (compared with 9.9% with no intervention). The intervention that permitted tobacco sales at only 50% of liquor stores resulted in the largest cost increase (∼$60/pack in rural areas) and the lowest prevalence (9.1%) by 2025. Elimination of outlets within 2 km of schools produced a smoking prevalence of 9.3%. CONCLUSIONS This modelling merges geographic, economic and epidemiological methodologies in a novel way, but the results should be interpreted cautiously and further research is desirable. Nevertheless, the results still suggest that tobacco outlet reduction interventions could modestly contribute to an endgame goal.
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Affiliation(s)
- Amber L Pearson
- Department of Public Health, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), University of Otago, Wellington, New Zealand
| | - Frederieke S van der Deen
- Department of Public Health, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), University of Otago, Wellington, New Zealand
| | - Linda Cobiac
- School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - Tony Blakely
- Department of Public Health, Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE), University of Otago, Wellington, New Zealand
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Klumbiene J, Sakyte E, Petkeviciene J, Prattala R, Kunst AE. The effect of tobacco control policy on smoking cessation in relation to gender, age and education in Lithuania, 1994-2010. BMC Public Health 2015; 15:181. [PMID: 25886060 PMCID: PMC4349467 DOI: 10.1186/s12889-015-1525-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 02/12/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the association between tobacco control policies and trends in smoking cessation according to gender, age and educational level in Lithuania in 1994-2010. METHODS The data were obtained from nine cross-sectional postal surveys conducted biennially within the framework of Finbalt Health Monitor project during 1994-2010. Each survey was based on a nationally representative random sample drawn from the National population register. The sample consisted of 3000 citizens aged 20-64 in 1994-2008 surveys and 4000 in the 2010 survey. In total, 17161 individuals participated in all surveys. The development of tobacco control policy in Lithuania was assessed using the Tobacco Control Scale (TCS). The association of the TCS scores with short-term and long-term quitting according to gender, age and education was examined using logistic regression analysis with control for secular trends. RESULTS Over the last two decades, a large improvement in the development of tobacco control policy has been achieved in Lithuania. At the same time, this progress was associated with the increase in smoking cessation. A significant increase in both short-term and long-term quit ratios was found among people aged 20-44. An increase by 10 points on the TCS was associated with 17% increase in the odds of short-term quitting and with 15% increase in the odds of long-term quitting. The association between tobacco control policies and long-term quitting was stronger among younger than older people. No differential effect of tobacco control policies on smoking cessation was found in relation to gender and educational level. CONCLUSIONS The improvement in Lithuanian tobacco control policies was associated with an increase in smoking cessation in long-term perspective. These policies have not only benefitted highly educated groups, but lower educated groups as well. Nonetheless, further development of comprehensive tobacco control policies is needed in order to decrease social inequalities in smoking cessation.
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Affiliation(s)
- Jurate Klumbiene
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Edita Sakyte
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Janina Petkeviciene
- Public Health Faculty, Lithuanian University of Health Sciences, Siaures av. 57, LT-49264, Kaunas, Lithuania.
| | - Ritva Prattala
- National Institute for Health and Welfare, Helsinki, Finland.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
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Gallus S, Lugo A, Fernandez E, Gilmore AB, Leon ME, Clancy L, La Vecchia C. Support for a tobacco endgame strategy in 18 European countries. Prev Med 2014; 67:255-8. [PMID: 25117519 DOI: 10.1016/j.ypmed.2014.08.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/24/2014] [Accepted: 08/02/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The feasibility of a tobacco endgame strategy, aiming to bring smoking prevalence to near-zero levels, is currently under debate. We provide information on public support for such a strategy in Europe. METHODS In 2010 we conducted a face-to-face representative survey in 18 European countries (Albania, Austria, Bulgaria, the Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden). The present analysis is based on 16,947 individuals aged ≥ 15 years providing information on their attitudes towards a complete ban on the use or sale of tobacco. RESULTS Overall, 34.9% of adults (32.8% in men and 37.0% in women; p<0.001) supported a complete ban strategy on use or sale of tobacco, 41.2% of never, 29.4% of ex- and 25.6% of current smokers. The highest support was observed in southern Europe (42.5%), followed by eastern (39.1%), northern (27.5%) and western Europe (23.0%; p<0.001). A significant inverse trend was observed with both age and education. CONCLUSION Approximately one in three adults (and one in four smokers) supports a comprehensive tobacco endgame intervention. This first study in Europe provides a baseline for evaluating future trends in public support for extreme propositions to end or drastically cut smoking.
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Affiliation(s)
- Silvano Gallus
- Department of Epidemiology, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
| | - Alessandra Lugo
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Esteve Fernandez
- Tobacco Control Unit, Cancer Prevention and Control Program, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Anna B Gilmore
- Department for Health & UK Centre for Tobacco Control Studies, University of Bath, Bath, UK
| | - Maria E Leon
- International Agency for Research on Cancer, Lyon, France
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Monárrez-Espino J, Liu B, Greiner F, Bremberg S, Galanti R. Systematic review of the effect of pictorial warnings on cigarette packages in smoking behavior. Am J Public Health 2014; 104:e11-30. [PMID: 25122019 PMCID: PMC4167086 DOI: 10.2105/ajph.2014.302129] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2014] [Indexed: 12/31/2022]
Abstract
We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods.
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Affiliation(s)
- Joel Monárrez-Espino
- Joel Monárrez-Espino, Bojing Liu, Felix Greiner, Sven Bremberg, and Rosaria Galanti are with the Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Rosaria Galanti is also with the Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden
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Cobiac LJ, Ikeda T, Nghiem N, Blakely T, Wilson N. Modelling the implications of regular increases in tobacco taxation in the tobacco endgame. Tob Control 2014; 24:e154-60. [PMID: 25145342 DOI: 10.1136/tobaccocontrol-2014-051543] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 07/29/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We examine the potential role for taxation in the tobacco endgame in New Zealand, where the goal is to become 'smokefree' (less than 5% smoking prevalence) by 2025. DESIGN Modelling study using a dynamic population model. SETTING AND PARTICIPANTS New Zealand, Māori and non-Māori men and women. INTERVENTIONS Annual increases in tobacco excise tax of 5%, 10%, 15% and 20% (with 10% reflecting the annual increase recently legislated by the New Zealand Government to 2016). RESULTS With a continued commitment to annual 10% increases in tobacco excise tax, in addition to on-going Quitline and cessation support, New Zealand's smoking prevalence is projected to fall from 15.1% in 2013 to 8.7% (95% uncertainty interval 8.6% to 8.9%) by 2025. This is compared to 9.9% without any further tax rises. With annual tax increases of 20%, the prevalence is projected to fall to 7.6% (7.5% to 7.7%) by 2025. The potential reductions in smoking prevalence are substantial for both Māori and non-Māori populations, although annual tax increases as high as 20% will still only see Māori smoking prevalence in 2025 approaching the non-Māori smoking levels for 2013. Scenario analyses did not suggest that growth of the illicit tobacco market would substantively undermine the impact of tobacco tax rises. Nevertheless, unknown factors such as the gradual denormalisation of smoking and changes to the 'nicotine market' may influence sensitivity to changes in tobacco prices in the future. CONCLUSIONS Regular increases in tobacco taxation could play an important role in helping to achieve tobacco endgames. However, this modelling in New Zealand suggests that a wider range of tobacco endgame strategies will be needed to achieve a smoke-free goal of less than 5% prevalence for all social groups--a conclusion that could also apply in other countries.
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Affiliation(s)
- Linda J Cobiac
- School of Population Health, University of Queensland, Brisbane, Australia Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tak Ikeda
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Edwards R, Hoek J, van der Deen F. Smokefree 2025 - use of mass media in New Zealand lacks alignment with evidence and needs. Aust N Z J Public Health 2014; 38:395-6. [DOI: 10.1111/1753-6405.12246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Richard Edwards
- Department of Public Health; University of Otago; New Zealand
| | - Janet Hoek
- Department of Marketing; University of Otago; New Zealand
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Near AM, Blackman K, Currie LM, Levy DT. Sweden SimSmoke: the effect of tobacco control policies on smoking and snus prevalence and attributable deaths. Eur J Public Health 2013; 24:451-8. [PMID: 24287030 DOI: 10.1093/eurpub/ckt178] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study examines the effect of past tobacco control policies and projects the effect of future policies on smoking and snus use prevalence and associated premature mortality in Sweden. METHODS The established SimSmoke model was adapted with population, smoking rates and tobacco control policy data from Sweden. SimSmoke evaluates the effect of taxes, smoke-free air, mass media, marketing bans, warning labels, cessation treatment and youth access policies on smoking and snus prevalence and the number of deaths attributable to smoking and snus use by gender from 2010 to 2040. RESULTS Sweden SimSmoke estimates that significant inroads to reducing smoking and snus prevalence and premature mortality can be achieved through tax increases, especially when combined with other policies. Smoking prevalence can be decreased by as much as 26% in the first few years, reaching a 37% reduction within 30 years. Without effective tobacco control policies, almost 54 500 lives will be lost in Sweden due to tobacco use by the year 2040. CONCLUSION Besides presenting the benefits of a comprehensive tobacco control strategy, the model identifies gaps in surveillance and evaluation that can help better focus tobacco control policy in Sweden.
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Affiliation(s)
- Aimee M Near
- 1 Department of Oncology, Georgetown University, Lombardi Cancer Center, Washington, DC, USA
| | | | - Laura M Currie
- 3 Division of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David T Levy
- 1 Department of Oncology, Georgetown University, Lombardi Cancer Center, Washington, DC, USA
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Levy DT, Huang AT, Currie LM, Clancy L. The benefits from complying with the framework convention on tobacco control: a SimSmoke analysis of 15 European nations. Health Policy Plan 2013; 29:1031-42. [PMID: 24262281 DOI: 10.1093/heapol/czt085] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This article compares the predicted impact of tobacco tax increases alone and as part of a comprehensive tobacco control strategy on smoking prevalence and smoking-attributable deaths (SADs) across 15 European countries. METHODS Country-specific population, smoking prevalence and policy data with modified parameter values have been applied to the previously validated SimSmoke model for 10 high-income and 5 middle-income European nations. The impact of past and potential future policies is modelled. RESULTS Models generally validated well across the 15 countries, and showed the impact of past policies. Without stronger future policies, 44 million lives would be lost due to smoking across the 15 study countries between 2011 and 2040, but effective policies could avert 7.7 million of those premature deaths. CONCLUSIONS Results suggest that past policies have been effective in reducing smoking rates, but there is also a strong potential for future policies consistent with the Framework Convention on Tobacco Control. When specific taxes are increased to 70% of retail price, strong smoke-free air laws, youth access laws and marketing restrictions are enforced, stronger health warnings are implemented, and cessation treatment and media campaigns are supported, smoking prevalence and SADs will fall substantially in European countries.
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Affiliation(s)
- David T Levy
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - An-Tsun Huang
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - Laura M Currie
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
| | - Luke Clancy
- Cancer Prevention & Control Program, Department of Oncology, Georgetown University, Washington, DC 20007, USA, Royal College of Surgeons in Ireland, Dublin 2, Ireland and TobaccoFree Research Institute Ireland, Dublin 8, Ireland
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Ikeda T, Cobiac L, Wilson N, Carter K, Blakely T. What will it take to get to under 5% smoking prevalence by 2025? Modelling in a country with a smokefree goal. Tob Control 2013; 24:139-45. [DOI: 10.1136/tobaccocontrol-2013-051196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Levy DT, Ellis JA, Mays D, Huang AT. Smoking-related deaths averted due to three years of policy progress. Bull World Health Organ 2013; 91:509-18. [PMID: 23825878 PMCID: PMC3699793 DOI: 10.2471/blt.12.113878] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 03/25/2013] [Accepted: 03/27/2013] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the global impact of adopting highest-level MPOWER tobacco control policies in different countries and territories from 2007 to 2010. METHODS Policy effect sizes based on previously-validated SimSmoke models were applied to determine the reduction in the number of smokers as a result of policy adoption during this period. Based on previous research suggesting that half of all smokers die from smoking, we also derived the estimated smoking-attributable deaths (SADs) averted due to MPOWER policy implementation. The results from use of this simple yet powerful method are consistent with those predicted by using previously validated SimSmoke models. FINDINGS In total, 41 countries adopted at least one highest-level MPOWER policy between 2007 and 2010. As a result of all policies adopted during this period, the number of smokers is estimated to have dropped by 14.8 million, with a total of 7.4 million SADs averted. The largest number of SADs was averted as a result of increased cigarette taxes (3.5 million), smoke-free air laws (2.5 million), health warnings (700,000), cessation treatments (380,000), and bans on tobacco marketing (306,000). CONCLUSION From 2007 to 2010, 41 countries and territories took action that will collectively prevent nearly 7.5 million smoking-related deaths globally. These findings demonstrate the magnitude of the actions already taken by countries and underscore the potential for millions of additional lives to be saved with continued adoption of MPOWER policies.
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Affiliation(s)
- David T Levy
- Department of Oncology, Georgetown University, 3300 Whitehaven Street NW, suite 4100, Washington, DC 20007, USA.
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Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model: the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med 2012; 9:e1001336. [PMID: 23139643 PMCID: PMC3491001 DOI: 10.1371/journal.pmed.1001336] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 09/26/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have. METHODS AND FINDINGS The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted. CONCLUSIONS Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- David Levy
- Population Sciences, Department of Oncology, Georgetown University, Washington DC, USA.
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