Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model

Objectives: To develop a simulation model to predict the effects of different smoking treatment policies on quit rates, smoking rates, and smoking attributable deaths. Methods: We first develop a decision theoretic model of quitting behaviour, which incorporates the decision to quit and the choice of treatment. A model of policies to cover the costs of different combinations of treatments and to require health care provider intervention is then incorporated into the quit model. The policy model allows for the smoker to substitute between treatments and for policies to reduce treatment effectiveness. The SimSmoke computer simulation model is then used to examine policy effects on smoking rates and smoking attributable deaths. Results: The model of quit behaviour predicts a population quit rate of 4.3% in 1993, which subsequently falls and then increases in recent years to 4.5%. The policy model suggests a 25% increase in quit rates from a policy that mandates brief interventions and the coverage of all proven treatments. Smaller effects are predicted from policies that mandate more restricted coverage of treatments, especially those limited to behavioural treatment. These policies translate into small reductions in the smoking rate at first, but increase to as much as a 5% reduction in smoking rates. They also lead to substantial savings in lives. Conclusions: Tobacco treatment policies, especially those with broad and flexible coverage, have the potential to increase smoking cessation substantially and decrease smoking rates in the short term, with fairly immediate reductions in deaths.

[1]  G. Oster,et al.  The benefits and risks of over-the-counter availability of nicotine polacrilex ("nicotine gum"). , 1996, Medical care.

[2]  W. Bickel,et al.  Effect of cost on the self-administration and efficacy of nicotine gum: a preliminary study. , 1991, Preventive medicine.

[3]  M. Goolsby,et al.  Treating Tobacco Use and Dependence , 2008, Pediatrics.

[4]  H. Schauffler,et al.  Variations in treatment benefits influence smoking cessation: results of a randomised controlled trial , 2001, Tobacco control.

[5]  D. C. J. D. D. R. C. R. Wilbanks.  Physician and other health-care professional counseling of smokers to quit--United States, 1991. , 1993, MMWR. Morbidity and mortality weekly report.

[6]  A. Kamen,et al.  Rationale for tobacco cessation interventions for youth. , 1998, Preventive medicine.

[7]  Jeffrey Wasserman,et al.  Investing in youth tobacco control: a review of smoking prevention and control strategies , 2000, Tobacco control.

[8]  M. Fiore,et al.  Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. , 2002, Chest.

[9]  K. Cummings,et al.  Use of the nicotine skin patch by smokers in 20 communities in the United States, 1992-1993. , 1997, Tobacco control.

[10]  Cigarette smoking-attributable mortality and years of potential life lost--United States, 1990. , 1993, MMWR. Morbidity and mortality weekly report.

[11]  S. Glantz.  Preventing tobacco use--the youth access trap. , 1996, American journal of public health.

[12]  M. Fiore,et al.  The effectiveness of the nicotine patch for smoking cessation. A meta-analysis. , 1994, JAMA.

[13]  T. Lancaster,et al.  Group behaviour therapy programmes for smoking cessation. , 2002, The Cochrane database of systematic reviews.

[14]  K. Cummings,et al.  A simulation of the effects of youth initiation policies on overall cigarette use. , 2000, American journal of public health.

[15]  D T Levy,et al.  A computer simulation model of mass media interventions directed at tobacco use. , 2001, Preventive medicine.

[16]  D T Levy,et al.  Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model. , 2000, Preventive medicine.

[17]  C. Orleans,et al.  Tobacco treatment services should be covered under Medicaid , 1998, Tobacco control.

[18]  Cigarette smoking among adults--United States, 1992, and changes in the definition of current cigarette smoking. , 1994, MMWR. Morbidity and mortality weekly report.

[19]  K. Cummings,et al.  Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves. , 1989, The American psychologist.

[20]  M. Fiore,et al.  Methods used to quit smoking in the United States. Do cessation programs help? , 1990, JAMA.

[21]  R. Heidel,et al.  Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. , 1989 .

[22]  S. Shiffman,et al.  Use of FDA-approved pharmacologic treatments for tobacco dependence--United States, 1984-1998. , 2000, MMWR. Morbidity and mortality weekly report.

[23]  S. Glantz,et al.  Short-term health and economic benefits of smoking cessation: low birth weight. , 1999, Pediatrics.

[24]  J. Pierce,et al.  Smoking cessation with and without assistance: a population-based analysis. , 2000, American journal of preventive medicine.

[25]  C. McPhillips-Tangum.  Results from the first annual survey on addressing tobacco in managed care. , 1998, Tobacco control.

[26]  D. Schroeder,et al.  Over-the-counter nicotine patch therapy for smoking cessation: results from randomized, double-blind, placebo-controlled, and open label trials. , 1999, American journal of public health.

[27]  L. Grothaus,et al.  Use and cost effectiveness of smoking-cessation services under four insurance plans in a health maintenance organization. , 1998, The New England journal of medicine.

[28]  K. Warner,et al.  Health and economic implications of a work-site smoking-cessation program: a simulation analysis. , 1996, Journal of occupational and environmental medicine.

[29]  Use of clinical preventive services by adults aged <65 years enrolled in health-maintenance organizations--United States, 1996. , 1998, MMWR. Morbidity and mortality weekly report.

[30]  D. Rice,et al.  Quantifying the disease impact of cigarette smoking with SAMMEC II software. , 1991, Public health reports.

[31]  E. Gilpin,et al.  Duration of smoking abstinence and success in quitting. , 1997, Journal of the National Cancer Institute.

[32]  J. Hughes.  Four beliefs that may impede progress in the treatment of smoking , 1999, Tobacco control.

[33]  Smoking cessation during previous year among adults--United States, 1990 and 1991. , 1993, MMWR. Morbidity and mortality weekly report.

[34]  J. Hughes.  Reduced smoking: an introduction and review of the evidence. , 2000, Addiction.

[35]  S. Glantz,et al.  Short-term economic and health benefits of smoking cessation: myocardial infarction and stroke. , 1997, Circulation.

[36]  D. Mant,et al.  Meta-analysis on efficacy of nicotine replacement therapies in smoking cessation , 1994, The Lancet.

[37]  Patricia Dolan Mullen,et al.  Treating tobacco use and dependence: clinical practice guideline , 2000 .

[38]  S. Shiffman,et al.  Public health benefit of over-the-counter nicotine medications. , 1997, Tobacco control.

[39]  Recent advances in the pharmacotherapy of smoking. , 1999, JAMA.

[40]  A. Munzer.  Smoking and Health in the Americas: A 1992 Report of the Surgeon General, in collaboration with the Pan American Health Organization , 1993 .

[41]  G. Boyd,et al.  Predictors of quitting smoking: the NHANES I followup experience. , 1990, Journal of clinical epidemiology.

[42]  M. Gail,et al.  Community intervention trial for smoking cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. , 1995, American journal of public health.

[43]  E. Gilpin,et al.  Nicotine patch use in the general population: results from the 1993 California Tobacco Survey. , 1995, Journal of the National Cancer Institute.

[44]  D T Levy,et al.  Effect of policies directed at youth access to smoking: results from the SimSmoke computer simulation model , 2001, Tobacco control.

[45]  Sam.  Smoking-attributable mortality and years of potential life lost--United States, 1988. , 1991, MMWR. Morbidity and mortality weekly report.