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Ending the Tobacco Problem: A Blueprint for the Nation (2007)

Chapter: Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures

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Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

K
Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures

David Mendez

University of Michigan

School of Public Health


Kenneth E. Warner

University of Michigan

School of Public Health


The statement of work requested by the committee can be divided into three tasks:

  1. An analysis of future U.S. smoking prevalence under “status quo,” “best-case” and “worst-case” scenarios. The best-case scenario was defined by the committee as the United States achieving the State of California’s current smoking initiation and cessation rates. The worst case scenario was defined by the committee as the United States achieving the State of Kentucky’s current initiation and cessation rates.

  2. An analysis of different combinations of initiation and cessation rates that would achieve an adult smoking prevalence of 10 percent by the year 2025.

  3. An analysis of the impact on smoking prevalence of increases in specific age group cessation rates.

For all three analysis tasks, the committee requested reports of current, former, and neversmokers’ prevalence by age group and year. Current smokers are defined as individuals who have smoked more than 100 cigarettes during their entire lives and who smoke now every day or some days.

To carry out the analysis we used the model of U.S. smoking prevalence that we developed, which has been described elsewhere (Mendez et al. 1998). We introduced the following modifications to the model:

  1. Age-specific population figures were updated using the 2000 U.S. Census.

  2. Death rates were updated with year 2000 figures (from the Statistical Abstract of the United States).

  3. Overall adult prevalence for the year 2005 was fixed at 20.6 percent. This figure is a projection, because the year 2005 smoking prevalence figure is not known yet. For reference, the Center for Disease Control and Prevention’s (CDC) preliminary estimate (from National Health Interview Survey [NHIS] data) of the adult smoking prevalence in 2004 is 20.9 percent.

  4. Output was modified to conform to the committee’s specification.

Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

DESCRIPTION OF ANALYSES

Pages 1 through 11 in the Results section show the outcomes from the model when subject to status quo as well as California and Kentucky’s initiation and cessation rates.

Status quo initiation rate was taken to be 25 percent, consistent with the prevalence for the 18–24 age group observed in 2003 (CDC 2005). Cessation rates for the status quo scenario were taken to be the ones estimated by Mendez and colleagues (1998): 0.21 percent for the 18–30 age group; 2.15 percent for the 31–50 age group; and 5.97 percent for individuals aged 51 and older. By using these age group-specific cessation rates we obtained an estimated 2.59 percent overall cessation rate in 2005 for the United States.

California and Kentucky rates were estimated with data from the Behavioral Risk Factor Surveillance System (BRFSS) from recent years (2000–2003). California’s initiation rate was estimated to be 20 percent, an average of the 18–24 age group prevalence from 2000 to 2003. Kentucky’s smoking initiation rate was estimated to be 39 percent.

Cessation rates for California and Kentucky were estimated in the following way: first, we obtained from BRFSS adult smoking prevalence by age group for each state from 2000 to 2003. We also obtained, from the Statistical Abstract of the United States, population size by age for each of the two states for the year 2000. We aged the population from 2000 to 2003 according to age-specific death rates and, for every year, computed the adult smoking prevalence assuming a single cessation rate for the population. We estimated the single cessation rate as the value that matched the calculated overall adult smoking prevalence with the prevalence reported from BRFSS for a specific year. These years, 2001 for Kentucky and 2002 for California, were chosen to highlight the high cessation in California and the low cessation in Kentucky. This procedure yielded an estimated cessation rate of 3.33 percent for California and 1.00 percent for Kentucky. We should note that this is a crude estimation procedure that ignores the effect of migration into and out of the states. The procedure is aimed to produce a rough estimate of the cessation rates in the states.

To obtain national age-specific cessation rates consistent with the aggregate quit rates obtained for California and Kentucky, we multiplied the status quo age-specific cessation rates by the ratio of the estimated cessation rates for California and Kentucky to the overall U.S. cessation rate: that is, 3.33/2.59 for California and 1.00/2.59 for Kentucky.

Page 1 in Results presents the status quo scenario. Pages 2 through 11 show scenarios in which the United States attains California and Kentucky rates at different times: almost instantaneously (in 2006) and gradually (linearly), by 2010, 2015, and 2020.

Pages 12 through 26 in Results describe different scenarios in which the country will move from a current adult smoking prevalence of 20.6 percent in 2005 to a 10 percent adult smoking prevalence in 2025. These scenarios describe necessary changes in initiation and/or cessation rates to achieve the 2025 10 percent target prevalence. These changes in initiation and cessation rates are assumed to happen instantaneously by 2006 or gradually (linearly) by 2010, 2015, and 2020. Once target cessation and initiation rates are reached, they are kept constant at the target levels for the remainder of the analysis period.

Finally, pages 27 through 38 present the percentage decrease in adult smoking prevalence (from the status quo) due to a 10 percent increase in cessation for each of the age groups reported in the analysis.

Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

Page

Description

4

Status Quo Scenario

5

Country moves from Status Quo rates to California rates – California rates are reached by 2006

6

California rates are reached by 2010

7

California rates are reached by 2015

8

California rates are reached by 2020

9

Country moves from Base Case rates to Kentucky rates – Kentucky rates are reached by 2006

10

Kentucky rates are reached by 2010

11

Kentucky rates are reached by 2015

12

Kentucky rates are reached by 2020

13

Smoking prevalence under California, Kentucky and Base Case rates – Rates are reached by 2006

14

Smoking prevalence under California, Kentucky and Base Case rates – Rates are reached by 2010

15

If initiation drops to 5.9% by 2006, prevalence will drop to 10% by 2025

16

If initiation drops to 4.1% by 2010, prevalence will drop to 10% by 2025

17

If initiation drops to 0.5% by 2015, prevalence will drop to 10% by 2025

18

If initiation is fixed at 30% in 2006 and cessation increases 4.39-fold by 2006, prevalence will drop to 10% by 2025

19

If initiation is fixed at 30% in 2006 and cessation increases 4.54-fold by 2010, prevalence will drop to 10% by 2025

20

If initiation is fixed at 30% in 2006 and cessation increases 4.79-fold by 2015, prevalence will drop to 10% by 2025

21

If initiation is fixed at 30% in 2006 and cessation increases 5.23-fold by 2020, prevalence will drop to 10% by 2025

22

If initiation is fixed at 25% in 2006 and cessation increases 3.21-fold by 2006, prevalence will drop to 10% by 2025

23

If initiation is fixed at 25% in 2006 and cessation increases 3.24-fold by 2010, prevalence will drop to 10% by 2025

24

If initiation is fixed at 25% in 2006 and cessation increases 3.48-fold by 2015, prevalence will drop to 10% by 2025

25

If initiation is fixed at 25% in 2006 and cessation increases 3.81-fold by 2020, prevalence will drop to 10% by 2025

26

If initiation is fixed at 20% in 2006 and cessation increases 2.36-fold by 2006, prevalence will drop to 10% by 2025

27

If initiation is fixed at 20% in 2006 and cessation increases 2.38-fold by 2010, prevalence will drop to 10% by 2025

28

If initiation is fixed at 20% in 2006 and cessation increases 2.55-fold by 2015, prevalence will drop to 10% by 2025

29

If initiation is fixed at 20% in 2006 and cessation increases 2.78-fold by 2020, prevalence will drop to 10% by 2025

30

Combinations of initiation and cessation rates to reach 10% prevalence by 2025

31

Sensitivity analysis – 10% increase in cessation rate for the 18-24 group in 2005

32

Sensitivity analysis – 10% increase in cessation rate for the 25-30 group in 2005

33

Sensitivity analysis – 10% increase in cessation rate for the 31-35 group in 2005

34

Sensitivity analysis – 10% increase in cessation rate for the 36-40 group in 2005

35

Sensitivity analysis – 10% increase in cessation rate for the 41-45 group in 2005

36

Sensitivity analysis – 10% increase in cessation rate for the 46-50 group in 2005

37

Sensitivity analysis – 10% increase in cessation rate for the 51-55 group in 2005

38

Sensitivity analysis – 10% increase in cessation rate for the 56-60 group in 2005

39

Sensitivity analysis – 10% increase in cessation rate for the 61-65 group in 2005

40

Sensitivity analysis – 10% increase in cessation rate for the 66-70 group in 2005

41

Sensitivity analysis – 10% increase in cessation rate for the 71+ group in 2005

Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×

REFERENCES

CDC (Centers for Disease Control and Prevention). 2005. Cigarette smoking among adults—United States, 2003. Morbidity and Mortality Weekly Report 54(20):509-528.

Mendez D, Warner KE, Courant PN. 1998. Has smoking cessation ceased? Expected trends in the prevalence of smoking in the United States. American Journal of Epidemiology 148(3):249-258.

Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 599
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 600
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 601
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 602
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 603
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 604
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 605
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 606
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 607
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 608
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 609
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 610
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 611
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 612
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 613
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 614
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 615
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 616
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 617
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 618
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 619
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 620
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 621
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 622
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 623
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 624
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 625
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 626
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 627
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 628
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 629
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 630
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 631
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 632
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 633
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
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Page 634
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 635
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 636
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 637
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 638
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
×
Page 639
Suggested Citation:"Appendix K: Commissioned Simulation Modeling of Smoking Prevalence as an Outcome of Selected Tobacco Control Measures." Institute of Medicine. 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. doi: 10.17226/11795.
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Page 640
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The nation has made tremendous progress in reducing tobacco use during the past 40 years. Despite extensive knowledge about successful interventions, however, approximately one-quarter of American adults still smoke. Tobacco-related illnesses and death place a huge burden on our society.

Ending the Tobacco Problem generates a blueprint for the nation in the struggle to reduce tobacco use. The report reviews effective prevention and treatment interventions and considers a set of new tobacco control policies for adoption by federal and state governments. Carefully constructed with two distinct parts, the book first provides background information on the history and nature of tobacco use, developing the context for the policy blueprint proposed in the second half of the report. The report documents the extraordinary growth of tobacco use during the first half of the 20th century as well as its subsequent reversal in the mid-1960s (in the wake of findings from the Surgeon General). It also reviews the addictive properties of nicotine, delving into the factors that make it so difficult for people to quit and examines recent trends in tobacco use. In addition, an overview of the development of governmental and nongovernmental tobacco control efforts is provided.

After reviewing the ethical grounding of tobacco control, the second half of the book sets forth to present a blueprint for ending the tobacco problem. The book offers broad-reaching recommendations targeting federal, state, local, nonprofit and for-profit entities. This book also identifies the benefits to society when fully implementing effective tobacco control interventions and policies.

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