Application of a system dynamics model to inform investment in smoking cessation services in New Zealand.

OBJECTIVES We estimated the long-term effects of smoking cessation interventions to inform government decision-making regarding investment in tobacco control. METHODS We extracted data from the 2006 New Zealand Tobacco Use Survey and other sources and developed a system dynamics model with the iThink computer simulation package. The model derived estimates of population cessation rates from smoking behaviors and applied these over a 50-year period, from 2001 to 2051, under business-as-usual and enhanced cessation intervention scenarios. RESULTS The model predicted larger effects by 2051 with the enhanced cessation than with the business-as-usual scenario, including: an 11% greater decline in adult current smoking prevalence (9 versus 10 per 100 people), 16% greater decline in per capita tobacco consumption (370 versus 440 cigarette equivalents per year), and 11% greater reduction in tobacco-attributable mortality (3000 versus 3300 deaths per year). CONCLUSIONS The model generated reliable estimates of the effects on health and on tobacco use of interventions designed to enhance smoking cessation. These results informed a decision announced in May 2007 to increase funding for smoking cessation by NZ $42 million over 4 years.

[1]  J. Forrester.  Industrial Dynamics , 1997 .

[2]  Sajjad Ahmad,et al.  The AMA proposal to mandate nicotine reduction in cigarettes: a simulation of the population health impacts. , 2005, Preventive medicine.

[3]  R. Perera,et al.  Nicotine replacement therapy for smoking cessation. , 2012, The Cochrane database of systematic reviews.

[4]  R. Scragg,et al.  Influence of smoking by family and best friend on adolescent tobacco smoking: results from the 2002 New Zealand national survey of Year 10 students , 2007, Australian and New Zealand journal of public health.

[5]  Sajjad Ahmad,et al.  Increasing excise taxes on cigarettes in California: a dynamic simulation of health and economic impacts. , 2005, Preventive medicine.

[6]  E. Gilpin,et al.  The California Tobacco Control Program’s effect on adult smokers: (2) Daily cigarette consumption levels , 2007, Tobacco Control.

[7]  G. Giovino.  Epidemiology of tobacco use in the United States , 2002, Oncogene.

[8]  T O Tengs,et al.  Public Health Impact of Changes in Smoking Behavior: Results From the Tobacco Policy Model , 2001, Medical care.

[9]  K. Warner,et al.  Setting a challenging yet realistic smoking prevalence target for Healthy People 2020: learning from the California experience. , 2008, American journal of public health.

[10]  R G Coyle,et al.  System Dynamics Modelling: A Practical Approach , 1996 .

[11]  Sajjad Ahmad,et al.  Estimating the Health Impacts of Tobacco Harm Reduction Policies: A Simulation Modeling Approach , 2005, Risk analysis : an official publication of the Society for Risk Analysis.

[12]  David T Levy,et al.  Simulation modeling and tobacco control: creating more robust public health policies. , 2006, American journal of public health.

[13]  R. West,et al.  Relapse prevention interventions for smoking cessation. , 2009, The Cochrane database of systematic reviews.

[14]  Sajjad Ahmad,et al.  Federal policy mandating safer cigarettes: a hypothetical simulation of the anticipated population health gains or losses. , 2004, Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management].

[15]  D. Mant,et al.  Nicotine replacement therapy for smoking cessation. , 2004, The Cochrane database of systematic reviews.

[16]  Steffen Bayer,et al.  Business dynamics: Systems thinking and modeling for a complex world , 2004 .

[17]  David T Levy,et al.  The role of public policies in reducing smoking and deaths caused by smoking in Vietnam: results from the Vietnam tobacco policy simulation model. , 2006, Social science & medicine.

[18]  Robert Y. Cavana,et al.  Integrated System Dynamics: Analysis of Policy Options for Tobacco Control in New Zealand , 2007 .

[19]  T. Blakely,et al.  The smoking-mortality association varies over time and by ethnicity in New Zealand. , 2005, International journal of epidemiology.

[20]  H. H. Richardson,et al.  Introduction to system dynamics , 1967 .

[21]  P. Courant,et al.  Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States. , 1998, American journal of epidemiology.

[22]  J. Homer,et al.  System dynamics modeling for public health: background and opportunities. , 2006, American journal of public health.

[23]  Robert Y. Cavana,et al.  Systems Thinking, System Dynamics , 2007 .

[24]  K. Warner,et al.  Smoking prevalence in 2010: why the healthy people goal is unattainable. , 2000, American journal of public health.

[25]  E B Roberts,et al.  A systems view of the smoking problem: perspective and limitations of the role of science in decision-making. , 1982, International journal of bio-medical computing.

[26]  R. Cavana,et al.  Demonstrating the utility of system dynamics for public policy analysis in New Zealand: the case of excise tax policy on tobacco , 2006 .

[27]  S. Glantz,et al.  World's best practice in tobacco control , 2000, Tobacco control.