The US SimSmoke tobacco control policy model of smokeless tobacco and cigarette use. 2018

David T Levy, and Zhe Yuan, and Yameng Li
Lombardi Comprehensive Cancer Center, Georgetown University, 3300 Whitehaven St., Suite 4100, Washington DC, USA. dl777@georgetown.edu.

Smokeless tobacco (SLT) prevalence had been declining in the US prior to 2002 but has since increased. Knowledge about the impact of tobacco control policies on SLT and cigarette use is limited. This study examines the interrelationship between policies, cigarette use, and SLT use by applying the SimSmoke tobacco control policy simulation model. Using data from large-scale Tobacco Use Supplement and information on policies implemented, US SimSmoke was updated and extended to incorporate SLT use. The model distinguishes between exclusive SLT and dual use of SLT and cigarettes, and considers the effect of implementing individual and combined tobacco control policies on smoking and SLT use, and on deaths attributable to their use. After validating against Tobacco Use Supplement (TUS) survey data through 2015, the model was used to estimate the impact of policies implemented between 1993 and 2017. SimSmoke reflected trends in exclusive cigarette use from the TUS, but over-estimated the reductions, especially among 18-24 year olds, until 2002 and under-estimated the reductions from 2011 to 2015. By 2015, SimSmoke projections of exclusive SLT and dual use were close to TUS estimates, but under-estimated reductions in both from 1993 to 2002 and failed to estimate the growth in male exclusive SLT use, especially among 18-24 year olds, from 2011 to 2015. SimSmoke projects that policies implemented between 1993 and 2017 reduced exclusive cigarette use by about 35%, dual use by 32.5% and SLT use by 16.5%, yielding a reduction of 7.5 million tobacco-attributable deaths by 2067. The largest reductions were attributed to tax increases. Our results indicate that cigarette-oriented policies may be effective in also reducing the use of other tobacco products. However, further information is needed on the effect of tobacco control policies on exclusive and dual SLT use and the role of industry.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D008962 Models, Theoretical Theoretical representations that simulate the behavior or activity of systems, processes, or phenomena. They include the use of mathematical equations, computers, and other electronic equipment. Experimental Model,Experimental Models,Mathematical Model,Model, Experimental,Models (Theoretical),Models, Experimental,Models, Theoretic,Theoretical Study,Mathematical Models,Model (Theoretical),Model, Mathematical,Model, Theoretical,Models, Mathematical,Studies, Theoretical,Study, Theoretical,Theoretical Model,Theoretical Models,Theoretical Studies
D011640 Public Policy A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. Social Policy,Affirmative Action,Migration Policy,Population Policy,Social Protection,Action, Affirmative,Migration Policies,Policies, Migration,Policies, Population,Policies, Public,Policies, Social,Policy, Migration,Policy, Population,Policy, Public,Policy, Social,Population Policies,Protection, Social,Public Policies,Social Policies
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000074606 Smoking Prevention Efforts directed at preventing SMOKING of TOBACCO and non-tobacco products. Anti-Smoking Campaign,Anti-Smoking Education,Anti Smoking Campaign,Anti Smoking Education,Anti-Smoking Campaigns,Anti-Smoking Educations,Campaign, Anti-Smoking,Campaigns, Anti-Smoking,Education, Anti-Smoking,Prevention, Smoking,Preventions, Smoking,Smoking Preventions
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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