Progress, challenges and the need to set concrete goals in the global tobacco endgame

Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea

INTRODUCTION

We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies.

METHODS

The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates.

RESULTS

The implementation of tobacco-control policies in accordance with the WHO MPOWER (Μonitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results.

CONCLUSIONS

For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products.

Éradiquer sans prohiber ? Évolutions internationales des politiques publiques de contrôle du tabac au xxi e siècle

This article offers an analytical synthesis of international trends in public policies to regulate tobacco in the first quarter of the twenty-first century. It begins with a review of the densification of the repertoire of public action and the affirmation of a strategy that consists of encircling tobacco (designated as an enemy) and attacking it through a variety of material and symbolic tactics. Tobacco regulation is a constantly dynamic process, due to the intensity of the exchanges of blows between protagonists: these agonistic interactions are reflected in framing struggles that lead to a diversification of tobacco qualifications. Tobacco is thus framed as a health issue, but also as an environmental problem and a challenge for social justice. Finally, the article shows how, at the end of a quarter-century of diverse mobilizations, the gradual formulation of a paradigm shift is taking shape, in which the objective of public action is no longer simply to control tobacco, but to eliminate it as a commodity.