Reaching Healthy People 2010 by 2013: A SimSmoke Simulation

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Background

Healthy People (HP2010) set as a goal to reduce adult smoking prevalence to 12% by 2010.

Purpose

This paper uses simulation modeling to examine the effects of three tobacco control policies and cessation treatment policies—alone and in conjunction—on population smoking prevalence.

Methods

Building on previous versions of the SimSmoke model, the effects of a defined set of policies on quit attempts, treatment use, and treatment effectiveness are estimated as potential levers to reduce smoking prevalence. The analysis considers the effects of (1) price increases through cigarette tax increases, (2) smokefree indoor air laws, (3) mass media/educational policies, and (4) evidence-based and promising cessation treatment policies.

Results

Evidence-based cessation treatment policies have the strongest effect, boosting the population quit rate by 78.8% in relative terms. Treatment policies are followed by cigarette tax increases (65.9%); smokefree air laws (31.8%); and mass media/educational policies (18.2%). Relative to the status quo in 2020, the model projects that smoking prevalence is reduced by 14.3% through a nationwide tax increase of $2.00, by 7.2% through smokefree laws, by 4.7% through mass media/educational policies, and by 16.5% through cessation treatment policies alone. Implementing all of the above policies at the same time would increase the quit rate by 296%, such that the HP2010 smoking prevalence goal of 12% is reached by 2013.

Conclusions

The impact of a combination of policies led to some surprisingly positive possible futures in lowering smoking prevalence to 12% within just several years. Simulation models can be a useful tool for evaluating complex scenarios in which policies are implemented simultaneously, and for which there are limited data.

Introduction

In 2000, the U.S. government released a set of goals for the health of its people, to be achieved by 2010.1 One goal was to reduce adult smoking prevalence to 12%. The feasibility of achieving this goal has been the subject of considerable debate.2, 3, 4 One clear point of consensus, however, is that hefty increases in cessation are necessary to achieve major reductions in smoking prevalence in the next 10–15 years. Reducing initiation, even by substantial amounts, will have a relatively small impact on adult smoking prevalence in the next 15 years as initiation primarily takes place among those aged <21 years, and they make up only a small part of the adult population.5 To reach smoking prevalence goals in a timely manner, it will be important to understand how tobacco control policies affect cessation.

Using the SimSmoke tobacco policy simulation model, the effects of three public health tobacco control policies (tobacco tax/price increases, smokefree air laws, mass media/educational policies) on the three components of population quit rates (quit attempts, treatment use, treatment effectiveness) are estimated. The effects of the five cessation treatment policies are also estimated to understand how they might complement the effects of tax, smokefree air, and mass media policies. By creating potential synergies, the Healthy People 2010 (HP2010) prevalence goal may be attainable within the next 5 years. Moreover, this study may serve as an exemplar for the utility of simulation modeling for informing policy and goal setting in a variety of other health domains.

Section snippets

Methods

Previous iterations of SimSmoke have modelled the direct effects of a variety of tobacco control policies on smoking prevalence in the first year following their implementation.6, 7, 8, 9, 10, 11, 12 This paper builds on that work by estimating the effects of a wider array of tobacco control and cessation treatment policies on three components of population cessation (quit attempts, treatment use, long-term treatment effectiveness) as pathways to reduce smoking prevalence.

Baseline Year and Validation

From the TUS-CPS data, quit attempts in 2003 averaged 42.3% for all smokers aged ≥18 years, decreasing with age from a rate of 52% among those aged 18–24 years to 31% among those aged ≥75 years. Among all smokers who made a quit attempt in the past year, TxUse averaged 72% for NoEBT, 24.9% for pharmacologic treatment, 1.2% for behavioral treatment, and 2.0% for pharmacologic treatment and behavioral treatment. Treatment use increased to age 45 years and then decreased after age 65 years.

To

Discussion

Results from this study suggest that the HP2010 goal of 12% smoking prevalence can be reached before 2020 if a comprehensive set of policies related to tobacco tax/price increases, smokefree air laws, mass media/educational campaigns, and cessation treatment (including improved web-based treatments and policies to improve the effectiveness of evidence-based treatments) are implemented. With all of these policies in effect simultaneously, the model projects that the HP2010 goal of 12% can be

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