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Malevolti MC, Baccini M, Caldarella A, Garofalo G, Gorini G, Levi M, Manneschi G, Masala G, Monasta L, Profili F, Carreras G. Lung cancer and smoking: years lived with disability in Tuscany (Italy). An analysis from the ACAB study. BMC Public Health 2024; 24:2696. [PMID: 39363189 PMCID: PMC11447970 DOI: 10.1186/s12889-024-20109-4] [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: 03/28/2024] [Accepted: 09/17/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Lung cancer (LC) is among the most common neoplasms, mostly caused by smoking. This study, carried out within the ACAB project, aims to provide local, updated and systematic estimates of years lived with disability (YLD) from LC due to smoking in the Tuscany region, Italy. METHODS We estimated YLD for the year 2022 for the whole region and at subregional level by local health unit (LHU) using data from the Tuscany Cancer Registry and local surveys. YLD were calculated by applying the severity-specific LC prevalence, estimated with an incidence-based disease model, to the corresponding disability weight. The burden from smoking was computed by: modelling the prevalence of smokers with a Bayesian Dirichlet-Multinomial regression model; estimating the distribution of smokers by pack-years simulating individual smoking histories; collecting relative risks from the literature. RESULTS In 2022 in Tuscany, LC caused 7.79 (95% uncertainty interval [UI] = 2.26, 17.27) and 25.50 (95% UI = 7.30, 52.68) YLDs per 100,000 females and males, respectively, with slight variations by LHU, and 53% and 66% of the YLDs were caused by smoking. CONCLUSION The updated estimates of the burden of LC attributable to smoking for the Tuscany region as a whole and for each LHU provide indications to inform strategic prevention plans and set public health priorities. The impact of smoking on YLDs from LC is not negligible and heterogeneous by LHU, thus requiring local interventions.
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Affiliation(s)
- Maria Chiara Malevolti
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Michela Baccini
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Florence, Italy
| | - Adele Caldarella
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Giorgio Garofalo
- Public Hygiene and Nutrition Unit, Department of Prevention, Local Health Authority Tuscany Centre, Florence, Italy
| | - Giuseppe Gorini
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Miriam Levi
- Epidemiology Unit, Department of Prevention, Local Health Authority Tuscany Centre, Florence, Italy
| | - Gianfranco Manneschi
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Giovanna Masala
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Via Cosimo il Vecchio 2, Florence, 50139, Italy.
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Lachi A, Viscardi C, Cereda G, Carreras G, Baccini M. A compartmental model for smoking dynamics in Italy: a pipeline for inference, validation, and forecasting under hypothetical scenarios. BMC Med Res Methodol 2024; 24:148. [PMID: 39003462 PMCID: PMC11245805 DOI: 10.1186/s12874-024-02271-w] [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: 08/28/2023] [Accepted: 06/27/2024] [Indexed: 07/15/2024] Open
Abstract
We propose a compartmental model for investigating smoking dynamics in an Italian region (Tuscany). Calibrating the model on local data from 1993 to 2019, we estimate the probabilities of starting and quitting smoking and the probability of smoking relapse. Then, we forecast the evolution of smoking prevalence until 2043 and assess the impact on mortality in terms of attributable deaths. We introduce elements of novelty with respect to previous studies in this field, including a formal definition of the equations governing the model dynamics and a flexible modelling of smoking probabilities based on cubic regression splines. We estimate model parameters by defining a two-step procedure and quantify the sampling variability via a parametric bootstrap. We propose the implementation of cross-validation on a rolling basis and variance-based Global Sensitivity Analysis to check the robustness of the results and support our findings. Our results suggest a decrease in smoking prevalence among males and stability among females, over the next two decades. We estimate that, in 2023, 18% of deaths among males and 8% among females are due to smoking. We test the use of the model in assessing the impact on smoking prevalence and mortality of different tobacco control policies, including the tobacco-free generation ban recently introduced in New Zealand.
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Affiliation(s)
- Alessio Lachi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy.
- Epidemiology and Health Research Lab, Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Via Giuseppe Moruzzi 1, Pisa, 56124, Italy.
| | - Cecilia Viscardi
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy
| | - Giulia Cereda
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy
| | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Servizio Sanitario della Toscana, Via Cosimo il Vecchio 2, Florence, 50139, Italy
| | - Michela Baccini
- Department of Statistics, Computer Science, Applications "Giuseppe Parenti" (DiSIA), University of Florence, Viale Giovanni Battista Morgagni 59/65, Florence, 50134, Italy.
- Florence Center for Data Science, University of Florence, Viale Giovanni Battista Morgagni 59, Florence, 50134, Italy.
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Possenti I, Scala M, Rognoni M, Lugo A, Cattaruzza MS, Molinaro S, Odone A, Smits LJM, Zagà V, Gallus S, d’Oro LC. Analysis of the direct economic impact of smoking-related hospitalizations in Italy. Tob Induc Dis 2024; 22:TID-22-96. [PMID: 38832050 PMCID: PMC11145629 DOI: 10.18332/tid/188111] [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: 03/11/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 06/05/2024] Open
Abstract
INTRODUCTION Tobacco-related diseases have a substantial economic impact in terms of medical expenses, loss of productivity, and premature death. Tobacco use is estimated to be responsible for more than 90000 deaths each year in Italy. We aimed to evaluate the annual direct economic impact on the National Health System of hospitalizations attributable to tobacco smoking in Italy. METHODS We analyzed data from all the hospitalizations of patients aged ≥30 years that occurred in Italy for 12 selected tobacco-related diseases, during 2018. These diseases included oropharyngeal cancer, esophageal cancer, gastric cancer, lung cancer, pancreatic cancer, bladder cancer, laryngeal cancer, ischemic heart disease, stroke, diseases of arteries, arterioles, and capillaries, pneumonia and influenza, and chronic obstructive pulmonary disease. We obtained information on 984322 hospital discharge records, including each hospitalization's direct costs. Using relative risk estimates from the scientific literature, we computed the population attributable fraction for various tobacco-related diseases to estimate the economic impact attributable to tobacco smoking. RESULTS One-third of all hospitalizations occurred in 2018 in Italy among people aged ≥30 years for 12 tobacco-related diseases were found to be attributable to smoking, accounting for a total cost of €1.64 billion. Among the diseases considered, those with the highest expenditures attributable to tobacco smoking were ischemic heart disease, cerebrovascular disease, and lung cancer, accounting for €556 million, €290 million, and €229 million, respectively. CONCLUSIONS Tobacco has a substantial economic impact in Italy, accounting for around 6% of the total cost of hospitalizations in 2018. This figure is expected to be largely underestimated due to several conservative assumptions adopted in the statistical analyses. It is imperative to prioritize comprehensive tobacco control measures to counteract the huge healthcare costs due to tobacco smoking.
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Affiliation(s)
- Irene Possenti
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Marco Scala
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Magda Rognoni
- Epidemiology Unit, Local Health Authority (ATS - Agenzia per la Tutela della Salute) Brianza, Monza, Italy
| | - Alessandra Lugo
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Maria S. Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Luc J. M. Smits
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Silvano Gallus
- Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Luca Cavalieri d’Oro
- Epidemiology Unit, Local Health Authority (ATS - Agenzia per la Tutela della Salute) Brianza, Monza, Italy
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Rana K, Goel S, Prinja S. Effect of tobacco taxation on smoking prevalence and smoking-attributable deaths in India. Indian J Public Health 2023; 67:278-283. [PMID: 37459025 DOI: 10.4103/ijph.ijph_93_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Background Higher taxes are the single most effective way to encourage tobacco users to quit tobacco use and prevent youth from initiation. Objectives The present study aims to estimate the effect of raising the tax on smoked tobacco products on its consumption and smoking-attributable deaths in India. Materials and Methods A mathematical model was developed which used the projected population of India, taxation rates on smoked tobacco products, smoking prevalence, and price elasticity of demand of cigarette and bidi from 2017 to 2025. Four scenarios of tax increment (0%, 25%, 50%, and 100%) on smoked tobacco products were created which were modeled to calculate smoking prevalence and smoking-attributable deaths due to respiratory diseases, heart diseases, stroke tuberculosis, and cancer in country till 2025. Results A relative decrease of 6.2% in the prevalence of smoking was observed between the existing tax rates and its increment to 100% over the last increment of 6%. Similarly, smoking-attributable deaths (SAD) decreased by 6.04% on increasing the tax rates to 100% of the existing taxation rates. There has been a steady increase in SAD in scenario 1 which decreases effectively in scenario 4, which in turn leads to the saving of around 33,000 lives due to tobacco-related diseases by 2025. Conclusion The consumption of cigarettes and bidis can be reduced by raising the price of these products. The model will help policymakers in deciding to fix the tax and ultimately the price of cigarettes and bidi to reduce its consumption and smoking-attributable mortality.
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Affiliation(s)
- Kirtan Rana
- Assistant Professor, Community Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Sonu Goel
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shankar Prinja
- Professor, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Levy DT, Sánchez-Romero LM, Travis N, Yuan Z, Li Y, Skolnick S, Jeon J, Tam J, Meza R. US Nicotine Vaping Product SimSmoke Simulation Model: The Effect of Vaping and Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4876. [PMID: 34063672 PMCID: PMC8124578 DOI: 10.3390/ijerph18094876] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022]
Abstract
The public health impact of nicotine vaping products (NVPs) is subject to a complex set of uncertain transitions between NVP and cigarette use. Instead, we apply an indirect method to gauge the impact of NVP use on smoking prevalence and smoking-attributable deaths (SADs) using the well-established SimSmoke tobacco control policy simulation model. Upon validating the model before NVPs were more widely used, we project a No-NVP (i.e., in the absence of NVPs) while controlling for the impact of cigarette-oriented policies. The net impact of NVPs on smoking prevalence is inferred by comparing the projected No-NVP smoking trends to corresponding trends from two US national surveys. Using the TUS-CPS estimates for the period 2012-2018, we estimate that adult smoking prevalence declined in relative terms by 9.7% (95% CI: 7.5-11.7%) for males and 10.7% (95% CI: 9.1-13.0%) for females. Compared to NHIS, smoking prevalence declined by 10.7% (95% CI: 6.8-14.6%) for males and 11.3% (95% CI: 7.4-15.6%) for females. These impacts were confined mainly to ages 18-44. Vaping-related reductions in smoking prevalence were projected to avert nearly 0.4 million SADs between 2012 and 2052. Our analysis indicates that NVP use is associated with substantial reductions in US smoking prevalence among younger adults.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Luz María Sánchez-Romero
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA; (L.M.S.-R.); (N.T.); (Z.Y.); (Y.L.)
| | - Sarah Skolnick
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
| | - Jamie Tam
- Department of Health Policy and Management, Yale University School of Public Health, Hartford, CT 06520, USA;
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, MI 48109, USA; (S.S.); (J.J.); (R.M.)
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Levy DT, Sánchez-Romero LM, Li Y, Yuan Z, Travis N, Jarvis MJ, Brown J, McNeill A. England SimSmoke: the impact of nicotine vaping on smoking prevalence and smoking-attributable deaths in England. Addiction 2021; 116:1196-1211. [PMID: 32949419 PMCID: PMC9364758 DOI: 10.1111/add.15269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/14/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Whereas the use of nicotine vaping products (NVPs) is widespread, their impact on smoking prevalence is controversial. This study considered the potential impact of NVPs on smoking prevalence in England. DESIGN Indirect simulation model. The England SimSmoke model is validated through 2012, before NVP use became more widely used by smokers. Because information on NVP-related transitions is limited, an indirect method is used; the difference in observed smoking prevalence (reflecting NVPs) is compared with a 2012-2019 counterfactual No-NVP scenario (without NVPs) to estimate the impact of NVPs on smoking and smoking-attributable deaths. SETTING England, 2000-2019. PARTICIPANTS Nationally representative sample of population. MEASUREMENTS England's population, mortality rates and smoking prevalence estimates from three national surveys and tobacco control policies. FINDINGS Between 2000 and 2012, SimSmoke projected a decline in age 18+ smoking prevalence of 23.5% in men and 27.0% in women. These projections, as well as those by specific age groups, were generally consistent with findings from the three national surveys. Comparing 2012-2019 relative reduction in age 18+ prevalence from the Annual Population Survey (males, 27.5%) with the model-predicted No-NVP reduction (males, 7.3%), the implied NVP-attributable relative reduction in adult smoking prevalence was 20.2% (95% CI, 18.8%-22.0%) for males and 20.4% (18.7%-22.2%) for females. The NVP-attributable reduction was 27.2% (22.8%-31.6%) for males and 31.7% (27.4%-36.5%) for females ages 18-24 and 18.6% (15.2%-21.8%) for males and 15.0% (11.1%-18.8%) for females ages 25-34, with similar reductions for ages 35+. The implied reduction in smoking prevalence between 2012 and 2019 equates to 165 660 (132 453-199 501) averted deaths by 2052. Other surveys yielded smaller, but relatively consistent results. CONCLUSIONS An indirect method of simulation modelling indicates that substantial reductions in smoking prevalence occurred in England from 2012-2019 coinciding with the growth in nicotine vaping product use.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | | | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Nargiz Travis
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Martin J Jarvis
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, Gower Street, London, UK
| | - Ann McNeill
- National Addiction Centre, King's College London, UK
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Sanna M, Gao W, Chiu YW, Chiou HY, Chen YH, Wen CP, Levy DT. Tobacco control within and beyond WHO MPOWER: outcomes from Taiwan SimSmoke. Tob Control 2020; 29:36-42. [PMID: 30397030 PMCID: PMC6952844 DOI: 10.1136/tobaccocontrol-2018-054544] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Adult smoking prevalence in Taiwan rapidly declined from 26.5% in 2005 to 20.0% in 2015. Nevertheless, future projections on smoking-attributable deaths and current per capita consumption do not paint an equally bright picture. METHODS We used SimSmoke, a tobacco control simulation model to assess the impact of tax increases and other policies by predicting past and projecting over future decades smoking rates and smoking-attributable mortality. RESULTS The model accurately depicts the decline in smoking prevalence observed in Taiwan from 2000 to 2015. Nonetheless, under the 'status quo' scenario, smoking-attributable mortality is projected to continue growing, peaking at 26 602 annual deaths in 2039 and cumulative deaths >1 million by 2044. By comparing projections with current policies with a counterfactual scenario based on the 2000 policy levels, SimSmoke estimates that tobacco control in Taiwan has been able to reduce smoking prevalence by 30% in 2015 with 450 000 fewer smoking-attributable deaths by 2060. Modified scenarios show that doubling the retail price of cigarettes and fully implementing the remaining MPOWER measures would avert approximately 45 000 lives by 2040 and 130 000 by 2060. CONCLUSIONS Tobacco will be a leading cause of death in Taiwan for the coming decades, showing yet again the long-term consequences of smoking on public health. The MPOWER package, even if adopted at the highest level with a large tax increase, is unlikely to reduce smoking prevalence to the endgame goal of 5% in the next five decades.
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Affiliation(s)
- Mattia Sanna
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Wayne Gao
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Ya-Wen Chiu
- Master’s Program in Global Health and Development, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| | - David Theodore Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
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Gorini G, Carreras G, Cortini B, Verdi S, Petronio MG, Sestini P, Chellini E. Smoke-Free Homes and Youth Smoking Behavior in Italy: Findings From the SIDRIAT Longitudinal Study. Nicotine Tob Res 2016; 18:2075-2082. [PMID: 27287390 DOI: 10.1093/ntr/ntw149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/25/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Few studies have explored whether smoke-free homes (SFH) can promote reductions of smoking onset in children, particularly in households with smoking parents. The aim of this study was to determine whether youths living in SFH were less likely to progress to smoking. METHODS We conducted a longitudinal, 11-year, two-wave study on 778 children aged 6-7 years and 985 adolescents aged 13-14 in 2002. At baseline, youths were asked whether or not adults smoked at home (SFH); at follow-up, in 2012-2014, whether a household smoking ban (HSB) had been implemented during the course of the study. Logistic regression was used to investigate SFH effects on youth smoking behaviors. RESULTS Sixty-nine percent of children and 54% of adolescents reported SFH at baseline; 80% of children and 71% of adolescents reported HSB at follow-up. Youths living in non-SFH at baseline were twice as likely to become established smokers at follow-up compared with those living in SFH (children + adolescents: odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.39-2.94; adolescents: OR = 2.15; 95% CI = 1.36-3.42; children: OR = 1.69; 95% CI = 0.80-3.56), either for youths living with nonsmoking parents at baseline and follow-up (OR for both children and adolescents = 3.06; 95% CI = 1.70-5.51) or for youths with ≥1 smoking parent at baseline and follow-up (OR = 2.12, 95% CI = 1.01-4.46). The effect was greater in youths living in the worst situation (non-SFH at baseline + non-HSB at follow-up) compared with those in the best situation (SFH at baseline + HSB at follow-up; children: OR = 3.20; 95% CI = 1.10-9.35; adolescents: OR = 5.41; 95% CI = 2.66-10.97). CONCLUSIONS Household smoke-free policies had a significant impact in protecting youths from becoming established smokers. IMPLICATIONS The results of the SIDRIAT longitudinal study showed that youths living in homes where people smoked at baseline were twice as likely to become established smokers 11 years later at follow-up, compared with youths living in SFH. The lower number of established smokers among youths living in SFH at baseline was recorded not only in households with nonsmoking parents but also in those with smoking parents. Implementing a home smoking ban is recommended in all households. Living in homes with no ban may be a risk factor for smoking initiation, which is independent of having smoking parents.
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Affiliation(s)
- Giuseppe Gorini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence, Italy;
| | - Giulia Carreras
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence, Italy
| | - Barbara Cortini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence, Italy
| | - Simona Verdi
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence, Italy
| | | | - Piersante Sestini
- Section of Phthisiology and Diseases of Respiratory Tract, Siena University, Siena, Italy
| | - Elisabetta Chellini
- Occupational & Environmental Epidemiology Unit-Cancer Research & Prevention Institute (ISPO), Florence, Italy
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Raña P, Pérez-Ríos M, Santiago-Pérez MI, Crujeiras RM. Impact of a comprehensive law on the prevalence of tobacco consumption in Spain: evaluation of different scenarios. Public Health 2016; 138:41-9. [PMID: 27076441 DOI: 10.1016/j.puhe.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 12/16/2015] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Since 2011, smoking legislation was hardened in Spain, banning tobacco consumption in all hospitality venues. Law 42/2010 was the first comprehensive tobacco control policy enacted in Spain. The aim of this paper is to evaluate the effect that this intervention has had in reducing the prevalence of tobacco consumption, setting up three scenarios on the basis of different theoretical levels of effect of the law. METHODS A predictive model based on Markov Chains was developed to distinguish the effect of tobacco control policies in different scenarios. STUDY DESIGN The model developed uses population, smoking rates and smoking characteristics from a non-transmissible disease surveillance system developed in Galicia (namely SICRI). RESULTS Results show that tobacco control policies hardly affect the predicted trend in a temporal frame of 10 years, with relative reduction in the predicted male smoking prevalence of 20.4% with no intervention, reaching a reduction of 26.1% under the maximum effect of the policies. CONCLUSIONS In the global population the effects of the law in the predicted prevalence have been barely perceived. For people under 25 years of age, interventions have had an important and positive effect, which proves that policies affecting this age group should be hardened.
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Affiliation(s)
- P Raña
- Department of Mathematics, University of A Coruña, Spain
| | - M Pérez-Ríos
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain; Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Spain.
| | - M I Santiago-Pérez
- Epidemiology Unit, Galician Directorate for Public Health, Galician Health Authority, Santiago de Compostela, Spain
| | - R M Crujeiras
- Department of Statistics and Operations Research, University of Santiago de Compostela, Spain
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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 2015; 18:229-42. [PMID: 25977409 DOI: 10.1093/ntr/ntv104] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [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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11
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Feirman S, Donaldson E, Pearson J, Zawistowski G, Niaura R, Glasser A, Villanti AC. Mathematical modelling in tobacco control research: protocol for a systematic review. BMJ Open 2015; 5:e007269. [PMID: 25877276 PMCID: PMC4401836 DOI: 10.1136/bmjopen-2014-007269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Tobacco control researchers have recently become more interested in systems science methods and mathematical modelling techniques as a means to understand how complex inter-relationships among various factors translate into population-level summaries of tobacco use prevalence and its associated medical and social costs. However, there is currently no resource that provides an overview of how mathematical modelling has been used in tobacco control research. This review will provide a summary of studies that employ modelling techniques to predict tobacco-related outcomes. It will also propose a conceptual framework for grouping existing modelling studies by their objectives. METHODS AND ANALYSIS We will conduct a systematic review that is informed by Cochrane procedures, as well as guidelines developed for reviews that are specifically intended to inform policy and programme decision-making. We will search 5 electronic databases to identify studies that use a mathematical model to project a tobacco-related outcome. An online data extraction form will be developed based on the ISPOR-SMDM Modeling Good Research Practices. We will perform a qualitative synthesis of included studies. ETHICS AND DISSEMINATION Ethical approval is not required for this study. An initial paper, published in a peer-reviewed journal, will provide an overview of our findings. Subsequent papers will provide greater detail on results within each study objective category and an assessment of the risk of bias of these grouped studies.
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Affiliation(s)
- Shari Feirman
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Elisabeth Donaldson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Zawistowski
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- The George Washington University Milken Institute School of Public Health
| | - Ray Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington DC, USA
| | - Allison Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington DC, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Gielen AC, Green LW. The Impact of Policy, Environmental, and Educational Interventions. HEALTH EDUCATION & BEHAVIOR 2015; 42:20S-34S. [DOI: 10.1177/1090198115570049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Motor vehicle safety and tobacco control are among the greatest public health achievements of the 20th century, according to the Centers for Disease Control and Prevention. As the number of miles traveled in the United States multiplied 10 times from the 1920s to the 1990s, the annual motor vehicle crash death rate per vehicle mile traveled decreased by 90%. Similarly, tobacco-related deaths from heart disease, stroke, and cancer were rapidly mounting over the first two thirds of the 20th century. Then, in the last third of the century, tobacco consumption decreased by more than 50%, and rates of heart disease and stroke deaths, and later cancer deaths, declined similarly. This analysis addresses the central question of what lessons can be learned from these success stories that will help public health professionals successfully tackle new and emerging health behavior problems of today and tomorrow? Surveillance, research, multilevel interventions, environmental modifications, and strong policies were key to reducing motor vehicle- and tobacco-related health problems. Generating public support and advocacy, and changing social norms also played critical roles in promoting the safer and smoke-free behaviors. Lessons learned include the need for evidence-based practices and interventions that are ecologically comprehensive with an emphasis on changing environmental determinants and capitalizing on the concept of reciprocal determinism. The analysis concludes with a description of how the PRECEDE-PROCEED planning framework can be used to apply the lessons from motor vehicle safety and tobacco control to other public health threats.
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Affiliation(s)
- Andrea C. Gielen
- Johns Hopkins Center for Injury Research and Policy, Baltimore, MD, USA
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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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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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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, 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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Allen JA, Gritz ER, Xiao H, Rubenstein R, Kralikova E, Haglund M, Heck J, Niaura R, Vallone DM. Impact of tobacco control policy on quitting and nicotine dependence among women in five European countries. Tob Control 2012; 23:173-7. [PMID: 23152098 DOI: 10.1136/tobaccocontrol-2011-050391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe differences in and factors associated with former smoking and nicotine dependence among women in Ireland, Sweden, France, Italy and the Czech Republic. METHODS A cross-sectional, random digit dial telephone survey of 5000 women, aged 18 years and older, conducted in 2008. Analyses were conducted using logistic regression models. RESULTS Respondents from Ireland and Sweden had statistically significantly higher odds of having quit smoking within the 5 years before survey administration compared with respondents from the Czech Republic. Current smokers from Ireland, Sweden, France and Italy are more nicotine dependent than those from the Czech Republic. CONCLUSIONS Respondents from countries with stronger tobacco control policies were more likely to have quit smoking compared with those living in the Czech Republic. However, respondents in countries with some of the strongest policies (Ireland, Sweden, France and Italy) had higher odds of smoking within 30 min of waking, an established indicator of nicotine dependence. More research in this area is warranted, but this study suggests that now that the Czech Republic is beginning to implement strong tobacco control policy, they will probably achieve a rapid decline in population-level smoking. Ireland, Sweden, France, Italy and other countries with established, strong tobacco control policies would do well to consider what additional programmes they can put in place to help their highly nicotine-dependent population of smokers successfully quit.
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Affiliation(s)
- Jane A Allen
- Public Health Policy Research, RTI International, , Research Triangle Park, North Carolina, USA
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