The SHG relies on a variety of data sources, including the National Health Interview Survey , to determine the probability that a never smoker becomes a smoker and that a smoker quits per year. Mortality rates and the relative risks of death by smoking status are then used to generate the probability of death based on age, gender, birth cohort, and smoking status.
From these individual simulations, the SHG is able to model smoking prevalence and deaths in the US population. These modifiers account for different policy effects by age and for the tendency for the impact of a policy to decline over time. Note that the model only simulates the impact of a policy on smoking behavior, and does not consider the health benefits of reduced secondhand smoke exposure. Policy scenarios simulate the potential impact of interventions at the individual level, and this information is aggregated to evaluate the effect of a specific policy on adult smoking prevalence, the number of life-years gained, and the number of deaths avoided.
To date, the SHG policy module has been developed for four types of tobacco control policies: Researchers at the University of Michigan, Georgetown University, Yale University, Massachusetts General Hospital, Stanford University and Erasmus University collaborate and aim to quantify the impact of tobacco control policies on smoking, lung cancer, and mortality.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Other policies have also helped diminish the toll of smoking. The successes of tobacco control notwithstanding, future progress will occur slowly unless society finds new, possibly radical "endgame" strategies to hasten the arrival of a smoke-free society. National Center for Biotechnology Information , U.
Didn't get the message? Most commonly, clean air bylaws are defined as simply present or absent across a range of settings. Finally, most of these policy studies focus on a single outcome variable, typically smoking status, 11 18 25 amount smoked 19 or per capita sales. Few studies have examined two or more policies simultaneously while controlling for individual characteristics, and these have their own limitations. Chaloupka and colleagues 20 21 have studied the association of price, clean air ordinances bylaws , and purchasing restrictions on smoking by high school and college students.
Stephens and associates examined the association of both price and clean air regulation on smoking in a national population, 18 but smoking status was the only outcome variable and only a rough indicator was used for the regulations. The individual level variables that were controlled for in the sex specific analyses were: Using a standard set of questions on smoking and other health behaviours and issues , interviewers completed in-home computer assisted data collection in June, August, and November , and March Data of interest to this study were collected from one individual per household age 12 years or older, who was selected at random although we analysed data for adults only in this case.
These variables were taken from three distinct data sources, described below, and added to the NPHS data file according to respondent's place of residence. All are from sources overlapping the 12 month data collection period of the NPHS.
Table 1 summarises these variables. The retail price of cigarettes and other commodities in 26 major Canadian cities is monitored regularly by Statistics Canada.
This study illustrates the value of multi-level analysis in epidemiology 35 and has added to the body of knowledge in assessing the associations of three tobacco control policies with smoking patterns in a general population. Indeed, a huge share of tobacco taxes is borne by adults. This study is therefore intended to answer the following questions about tobacco control: But they are meant as a caution against excessive reliance on this one policy instrument. Yet, even in California, considerably more could be done to promote the free or inexpensive availability of effective smoking cessation or smoking reduction products and programs. That is why some have argued that tobacco taxes should be set by formula in relation to price.
For current price, we used the value for July for a carton of cigarettes. We used municipality specific values for all the major cities in Canada and provincial averages for other locations within the same province within-province variation is much smaller than inter-province variation in price.
It should be noted that the federal government and five provincial governments reduced their excise taxes on cigarettes in February , just before the period under study. After the initial reduction in February, prices were stable for the balance of the survey data collection period. In Canada, the provinces play a major role in the delivery of tobacco control programmes, primarily in the form of health education and bylaw enforcement.
Conclusive analysis of tobacco control policies is complicated by the fact that the policy measures exist at a variety ofaggregate levels (federal, state/province. This website provides decision-makers and health professionals with estimates of the projected impact of four specific tobacco control policies.
In order to quantify this role, which varies substantially from province to province and over time, we used dollar figures for expenditures during the fiscal year April through March collected from each of the 10 provincial health departments. A federal government survey provided a detailed description of restrictions on public smoking in place in The 30 municipalities that did not respond to the survey were scored as zero in restrictiveness; the vast majority of these were small communities, which are less likely to have any restrictions on public smoking.
Signs may heighten a bylaw's effectiveness by increasing its visibility. Our scoring scheme gave points for measures that raise the likelihood of self enforcement, which is relied upon in a wide variety of settings.
The average score was low, as municipalities out of had no provision for signage. While self regulation of public smoking is important for compliance, it is seldom adequate. Official enforcement is thus fundamental for bylaw effectiveness. Since of municipalities had no provisions for enforcement and there was little variation among the remainder, we treated this variable as binary in the analyses.
Data on these five tobacco control policies were added to every survey record in the NPHS data file, using detailed geographic codes for the municipal level data prices and bylaws. Since these were not available on the public use file, the linkage was carried out by Statistics Canada on their master file. Per capita tobacco control expenditures were added to the survey file using the respondent's province of residence.
Because the coverage of the bylaw study had been extensive, we suspected that these cases of missing data were from communities with no bylaws. To confirm this, we contacted a random sample of 40 of these communities, stratified by size and region, to ascertain their bylaw status.
As the distribution of expenditures per capita was highly skewed, we used the square root of this value in the regressions. Because of the complex sample design underlying the survey, we calculated exact variances using the bootstrap method. We found significant associations between each of these tobacco control policies and the odds of being a non-smoker—while controlling for individual differences and the other policies.
The associations were all in the expected directions but were often different for men and women. Tobacco taxation price was positively related to the odds of being a non-smoker for both sexes—that is, as price increases, the odds of an individual being a non-smoker also increase. This was the only policy to have the same association for both men and women, although it was stronger for men table 2.
Tobacco control expenditure per capita was positively related to the odds of being a non-smoker for men, but not for women.
In contrast, the restrictiveness severity and extent of municipal bylaws limiting public smoking was positively related to the odds of being a non-smoker for women, but not for men. Interestingly, however, requiring prominent signs to inform the public of the non-smoking bylaw and having written provisions for enforcement designating an enforcement authority, escalating fines for repeat offences were both significantly related to the odds of being a non-smoker for men, but not for women.
The associations between these policies and the amount smoked by daily smokers table 3 were similar to those just described for smoking status. The substantial tax cut in February , affecting about two thirds of the population, was significantly related to the amount smoked by both men and women—that is, the larger the drop, the more the amount smoked, from 9. While there was no direct association between the current price of cigarettes and amount smoked, there was an interaction of the tax cut and current price of cigarettes.
In the five provinces that experienced a recent tobacco tax cut but still retained some variation in price , there was a negative association between price and amount smoked by male daily smokers. There was a similar tendency for women.
In a fashion similar to the association with smoking status, health education expenditures were significantly inversely related to the amount smoked by men, but not women, while the restrictiveness of bylaws was significantly inversely related to the amount smoked by women, but not men.
Neither bylaw sign requirements nor enforcement provisions were related to the amount smoked daily by men or women smokers.