Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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8 Health Benefits of Raising the Minimum Age of Legal Access to Tobacco Products
8 Health Benefits of Raising the Minimum Age of Legal Access to Tobacco Products
Pages 219-240
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From page 219... ...
The committee uses SimSmoke and Cancer Intervention and Surveillance Modeling Network (CISNET) simulation modeling to project numerical estimates of how, through to the year 2100, these effects on initiation would affect cigarette smoking prevalence, as the cohorts affected by an MLA increase age into adulthood and, in fact, through middle and older ages.
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From page 220... ...
The projections show that for each MLA the percentage reduction in premature deaths appears to be consistent across birth cohorts; this makes sense because all the cohorts would reach adulthood after -- sometimes substantially after -- implementation of the law. Nonetheless, the number of deaths prevented for each birth cohort varies because of differences in the projected size of these different cohorts, with more lives saved in a larger cohort than in a smaller cohort even with the same proportionate reductions.
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From page 221... ...
TABLE 8-1 Lifetime Premature Deaths by Birth Cohort -- CISNET Model Deaths Deaths Deaths Averted Under Averted Under Averted Under MLA 19 MLA 19 % MLA 21 MLA 21 % MLA 25 MLA 25 % Status Quo Mid-Scenario Reduction Mid-Scenario Reduction Mid-Scenario Reduction 2000–2019 2,160,000 59,000 2.7% 223,000 10.3% 296,000 13.7% 2020–2039 1,996,000 58,000 2.9% 218,000 10.9% 289,000 14.5% 2040–2059 2,024,000 58,000 2.9% 222,000 10.9% 293,000 14.5% 2060–2079 2,097,000 60,000 2.9% 229,000 10.9% 304,000 14.5% 2080–2099 2,171,000 63,000 2.9% 238,000 10.9% 315,000 14.5% NOTE: Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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From page 222... ...
Table 8-2 shows the predicted number of premature deaths due to smoking for selected periods as well as the corresponding number of deaths prevented and the percentage reduction for each of the MLA mid- stimate e scenarios. According to the CISNET model, raising the MLA to 19, 21, or 25 would save approximately 66,000, 250,000, or 330,000 lives, respectively, by 2100.
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From page 223... ...
The model projects more prevented deaths than the CISNET model primarily because of the higher future smoking prevalence predicted by the SimSmoke model and the model differences in assumed mortality rates for current smokers. The CISNET model also allows for differential age-specific mortality by smoking intensity, which is particularly relevant due to the significant decreases in smoking intensity levels projected by the CISNET model under the status quo (see Appendix D)
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From page 224... ...
Table 8-3 shows the SimSmoke model's projected number of premature deaths due to smoking for selected periods as well as the corresponding number of deaths prevented and the percentage reduction for each of the MLA mid-scenarios. The table shows that the SimSmoke model estimates that the percentage reduction in smoking-attributed mortality increases progressively with time, from approximately 0.1 percent, 0.8 percent, and 1.5 percent in 2040–2059 to 2.5 percent, 9.9 percent, and 14.5 percent in 2080–2100 for MLA 19, MLA 21, and MLA 25, respectively.
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From page 225... ...
. Finding 8-1: Model results suggest that reductions in smoking-related mortality will not be observed for at least 30 years following the in crease in the minimum age of legal access to tobacco products.
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From page 226... ...
TABLE 8-5 Lifetime Years of Life Lost (YLL) by Cohort -- CISNET Model YLL Under YLL Under YLL Under MLA 19 MLA 19 % MLA 21 MLA 21 % MLA 25 MLA 25 % Status Quo Mid-Scenario Reduction Mid-Scenario Reduction Mid-Scenario Reduction 2000–2019 40,116,000 1,180,000 2.9% 4,163,000 10.4% 5,560,000 13.9% 2020–2039 36,447,000 1,134,000 3.1% 4,000,000 11.0% 5,343,000 14.7% 2040–2059 36,084,000 1,123,000 3.1% 3,962,000 11.0% 5,291,000 14.7% 2060–2079 37,412,000 1,164,000 3.1% 4,108,000 11.0% 5,486,000 14.7% 2080–2099 38,874,000 1,210,000 3.1% 4,268,000 11.0% 5,700,000 14.7% NOTE: Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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From page 227... ...
The figures show that the reductions in lung cancer mortality would not become observable until the late 2040s because of the time delay between smoking exposure and lung cancer risk. As in the case with 4,000 MLA 19 MLA 21 MLA 25 Lung cancer deaths prevented per year 3,000 2,000 1,000 0 2020 2040 2060 2080 2100 Year FIGURE 8-3 CISNET model estimates of the number of lung cancer deaths prevented per year for the three MLAs (mid-scenario)
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From page 228... ...
. overall mortality, the model predicts that raising the MLA to 21 or 25 would lead to a considerably higher number of lung cancer deaths prevented than if the MLA was raised only to 19.
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From page 229... ...
Finding 8-3: Modeling mortality outcomes by birth cohort estimates that large reductions in lifetime smoking-attributable deaths and years of life lost would be achieved by raising the minimum age of legal a ccess to tobacco products to age 21 or 25 for new generations starting with the cohort born in 2000. It also projects the prevention of a large number of lung cancer deaths under such scenarios, with most of these prevented deaths realized after 2050.
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From page 230... ...
(SimSmoke) 2015–2019 2020–2039 2040–2059 2060–2079 2080–2099 Status Quo 242,000 727,000 854,000 964,000 1,064,000 MLA 19 2,000 22,000 30,000 34,000 37,000 averted percentage 0.8% 3.0% 3.5% 3.5% 3.5% reduction MLA 21 10,000 78,000 104,000 117,000 129,000 averted percentage 4.1% 10.7% 12.2% 12.1% 12.1% reduction MLA 25 16,000 109,000 140,000 158,000 174,000 averted percentage 6.6% 15.0% 16.4% 16.4% 16.4% reduction NOTE: Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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From page 231... ...
Finding 8-4: Modeling estimates that immediate reductions in cases of low birth weight, pre-term birth, and sudden infant death syndrome will occur with changes in the minimum age of legal access to tobacco products.
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From page 232... ...
in Health Outcomes for MLA 21 by Period 2020–2039 2040–2059 2060–2079 2080–2099 Deaths prevented -- SimSmoke 0.0% 0.8% 4.6% 9.9% Deaths prevented -- CISNET 0.0% 0.2% 2.6% 8.2% Years of life lost -- CISNET 0.0% 0.5% 4.3% 9.3% Lung cancer deaths prevented 0.0% 0.3% 3.7% 10.5% Low birth weight cases 10.8% 12.2% 12.2% 12.2% Pre-term birth cases 11.6% 13.0% 13.0% 13.0% Sudden infant death syndrome 16.0% 18.5% 18.5% 18.5% cases TIME TO ACCRUE BENEFITS Tables 8-10 and 8-11 summarize the reductions in smoking prevalence for selected years and health outcomes by 20-year periods for MLA 21, showing the relative timing at which different benefits occur. The results illustrate the longer times required for chronic outcomes compared to shortterm outcomes.
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From page 233... ...
Reducing the prevalence of smoking by any amount will automatically lead to immediate population health benefits that are directly proportional to the size of the reduction. Each one of the immediate adverse health effects caused by cigarette smoking itself compromises the health status of smokers, and when combined, this constellation of immediate adverse health effects leaves the smoker with a health status that is significantly impaired and subpar compared to nonsmokers.
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From page 234... ...
Each of the intermediate adverse health effects caused by cigarette smoking compromises an individual smoker's health status; in total, they combine to exact a severe toll on individuals and on population health in general. They further widen the health status differential between smokers and nonsmokers, which commences with the immediate adverse health effects.
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From page 235... ...
For example, the fact that delayed initiation reduces the dose of cigarette toxins ingested by smokers would help to offset the population burden of intermediate health effects, and because an older age of initiation is associated with increased likelihood of cessation, this would further benefit population health by leading to further reductions in cigarette smoking prevalence during those stages of life affected by the intermediate adverse health effects of cigarette smoking. Long-Term Health Effects Cigarette smoking is causally associated with a long list of long-term health effects that includes 12 different types of cancer, vascular and heart disease outcomes, respiratory disease, eye disease, rheumatoid arthritis, and bone health (HHS, 2004, 2014)
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From page 236... ...
Unlike the case with the immediate and intermediate adverse health effects caused by cigarette smoking, the impact of increasing the MLA on long-term adverse health effects caused by cigarette smoking would not become apparent until decades after the policy change occurred because raising the MLA will primarily affect the initiation and delay of smoking among children, adolescents, and young adults. Therefore, the impact of raising the MLA on the long-term adverse health effects would not occur until the initial birth cohorts affected by an MLA increase were old enough to be in the older age groups where these chronic diseases typically occur.
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From page 237... ...
The CISNET model predicts about one-third as many premature deaths prevented as the SimSmoke model. This occurs largely because of the lower smoking prevalence projected by the CISNET model for all cases and the concomitant lower baseline smoking-attributable deaths.
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From page 238... ...
As described above and in Chapter 4, cigarette smoking causes numerous adverse health effects, and these can be categorized as immediate, intermediate, or long term. In assessing the potential public health impact of raising the MLA, it is worth keeping in mind that this lengthy catalogue of well-established consequences of cigarette smoking and SHS exposure will grow as more definitive evidence coalesces for additional health outcomes.
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From page 239... ...
Conclusion 8-3: Based on a review of the literature and on the model ing, an increase in the minimum age of legal access to tobacco products will likely improve maternal, fetal, and infant outcomes by reducing the likelihood of maternal and paternal smoking. As discussed in Chapter 7 with regard to effects of an increase in the MLA on tobacco initiation, it is an open question whether raising the MLA will have a greater or lesser impact on the health of population subgroups with a higher prevalence of cigarette smoking than on the general population.
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From page 240... ...
2012. Chapter 12: Yale Lung Cancer Model.
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