SimSmoke model evaluation of the effect of tobacco control policies in Korea: the unknown success story.

OBJECTIVES We evaluated the effect of strict tobacco control policies, implemented beginning in 1995 in the Republic of Korea, on smoking prevalence and deaths. METHODS SimSmoke is a simulation model of the effect of tobacco control policies over time on smoking initiation and cessation. It uses standard attribution methods to estimate lives saved as a result of new policies. After validating the model against smoking prevalence, we used it to determine the Korean policies' effect on smoking prevalence. RESULTS The model predicted smoking prevalence accurately between 1995 and 2006. We estimated that 70% of the 24% relative reduction in smoking rates over that period was attributable to tobacco control policies, mainly tax increases and a strong media campaign, and that the policies will prolong 104 812 male lives by the year 2027. CONCLUSIONS Our results document Korea's success in reducing smoking prevalence and prolonging lives, which may serve as an example for other Asian nations. Further improvements may be possible with higher taxes and more comprehensive smoke-free laws, cessation policies, advertising restrictions, and health warnings.

[1]  D T Levy,et al.  Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model , 2002, Tobacco control.

[2]  Tammy O. Tengs,et al.  The cost-effectiveness of intensive national school-based anti-tobacco education: results from the tobacco policy model. , 2001, Preventive medicine.

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

[4]  J. Wardle,et al.  An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries. , 2002, Addiction.

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

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

[7]  S. Jee,et al.  Smoking-Attributable Mortality Among Korean Adults: 1981-2003 , 2006 .

[8]  D. Levy,et al.  The Kentucky SimSmoke Tobacco Policy Simulation Model: Reaching Healthy People 2010 Goals Through Policy Change , 2008, Southern medical journal.

[9]  K. Warner,et al.  Adult cigarette smoking prevalence: declining as expected (not as desired). , 2004, American journal of public health.

[10]  Richard Doll,et al.  Mortality in relation to smoking: 22 years' observations on female British doctors. , 1980, British medical journal.

[11]  Majid Ezzati,et al.  Estimates of global mortality attributable to smoking in 2000 , 2003, The Lancet.

[12]  D. Levy,et al.  A Simulation Model of Policies Directed at Treating Tobacco Use and Dependence , 2002, Medical decision making : an international journal of the Society for Medical Decision Making.

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

[14]  D. Levy,et al.  The role of public policies in reducing smoking prevalence and deaths caused by smoking in Arizona: results from the Arizona tobacco policy simulation model. , 2007, Journal of public health management and practice : JPHMP.

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

[16]  D. Levy,et al.  The Healthy People 2010 smoking prevalence and tobacco control objectives: results from the SimSmoke tobacco control policy simulation model (United States) , 2005, Cancer Causes & Control.

[17]  J. Stockman,et al.  Mortality in Relation to Smoking: 50 Years' Observations on Male British Doctors , 2006 .

[18]  D. Levy,et al.  The effects of tobacco control policies on smoking rates: a tobacco control scorecard. , 2004, Journal of public health management and practice : JPHMP.

[19]  Josue P. Keely,et al.  Shape of the relapse curve and long-term abstinence among untreated smokers. , 2004, Addiction.

[20]  A. Hyland,et al.  The role of public policies in reducing smoking prevalence in California: results from the California tobacco policy simulation model. , 2007, Health policy.

[21]  D. Levy,et al.  The effects of clean indoor air laws: what do we know and what do we need to know? , 2003, Health education research.

[22]  Karen B Friend,et al.  A Simulation Model of Tobacco Youth Access Policies , 2000, Journal of health politics, policy and law.

[23]  K. Jung-Choi,et al.  Explaining age-specific inequalities in mortality from all causes, cardiovascular disease and ischaemic heart disease among South Korean male public servants: relative and absolute perspectives , 2007, Heart.

[24]  F. Chaloupka,et al.  Tobacco Control in Developing Countries , 2001 .

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

[26]  David T Levy,et al.  Reductions in smoking prevalence and cigarette consumption associated with mass-media campaigns. , 2002, Health education research.

[27]  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].

[28]  G. Fong,et al.  Impact of the graphic Canadian warning labels on adult smoking behaviour , 2003, Tobacco control.

[29]  Sunmi Lee,et al.  [The effect of cigarette price on smoking behavior in Korea]. , 2007, Journal of preventive medicine and public health = Yebang Uihakhoe chi.

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

[31]  D. Levy,et al.  Recent trends in smoking and the role of public policies: results from the SimSmoke tobacco control policy simulation model. , 2005, Addiction.

[32]  D. Levy,et al.  A framework for evaluating and improving clean indoor air laws. , 2001, Journal of public health management and practice : JPHMP.

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

[34]  D. Levy,et al.  Smoking treatment interventions and policies to promote their use: a critical review. , 2001, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[35]  Sajjad Ahmad The Cost-Effectiveness of Raising the Legal Smoking Age in California , 2005, Medical decision making : an international journal of the Society for Medical Decision Making.

[36]  J. Severens,et al.  Healthcare financing systems for increasing the use of tobacco dependence treatment. , 2005, The Cochrane database of systematic reviews.

[37]  Geoffrey T Fong,et al.  Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study. , 2007, American journal of preventive medicine.

[38]  D. Levy,et al.  The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model , 2008, Tobacco Control.