Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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Appendix D: Supplemental Information About the Models
Appendix D: Supplemental Information About the Models
Pages 327-368
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From page 327... ...
. The CISNET smoking and lung cancer models were used to estimate the number of lung cancer deaths in the United States prevented by historical tobacco control efforts from 1975 to 2000 (Moolgavkar et al., 2012)
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The SimSmoke model explores the potential effects of raising the minimum age of legal access to tobacco (MLA) on smoking initiation rates in order to make predictions of the policy effects on future smoking prevalence and smoking-attributable deaths and maternal and child health outcomes (i.e., low birth weight, pre-term births and sudden infant deaths)
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Yearly smoking initiation probabilities for never smokers; e. Yearly smoking cessation probabilities for current smokers; and f.
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Later smoking initiation would also tend to postpone the effect of differential mortality in the cohort. We assumed that the differential mortality resulting from cigarette smoking occurred at ages, a ≥ a0, and PE*
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. Former smokers are those who have smoked at some point in their lives, but quit before age a, and the proportion of these individuals is PF(a,c)
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Values used for subsequent cohorts were set to be identical to those for the 1982 birth cohort. Smoking initiation probability Unadjusted estimates of annual agespecific smoking initiation probabilities for a given cohort, p *
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is given by a constrained natural spline. We were only interested in the fitted values for the initiation probabilities, which were not affected by the well-known identifiability problem in ageperiod-cohort models.
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Knots were specified as: age: 25, 30, 35, 40, 45, 50, 55, 60, 65, 70 period: 1970, 1975, 1980, 1985, 2000, 2005 cohort: 1910, 1920, 1930, 1940, 1950, 1960, 1970, 1980 The fitted estimates of the probabilities for each category of smoking dose for each cohort for ages 0 to 99 were used as parameters for the smoking history generator. Estimates for cohorts born before 1920 were constrained to be the same as for the 1920 birth cohort.
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In addition, using the methods described, we obtained estimates of current and former smoker prevalence estimates. The distribution of smoking intensity categories was assumed to remain the same in future birth cohorts.
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These were then used to obtain the mean lung cancer mortality rate for current smokers. Similarly, for former smokers we obtain the mean lung cancer mortality rate for a particular age of interest by first determining the joint distribution of age at initiation, age at cessation, and smoking intensity.
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This captures the life course of different generations, and it provides useful summaries of the groups that would have experienced a change in the MLA at a point in life in which they are most likely to initiate cigarette smoking. Viewed from this perspective, we determined life expectancy, premature deaths from smoking, and excess lung cancer deaths caused by smoking from the temporal perspective of following these individuals through life.
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. The SimSmoke model status quo initiation and cessation rates are available on the CISNET resources website.2 2 See https://resources.cisnet.cancer.gov/projects/#shg/iomr.
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. Mortality rates for former smokers decrease progressively from the current smoker toward the never-smoker level as years since quitting increase, according to CPS-II data (Burns et al., 1997)
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Existence of fairness Airing of antismoking messages 39% reduction in doctrine on radio and television from July initiation rates, 8% 1, 1967, to January 1, 1971, and increase in cessation rates banning of cigarette advertising on radio in 1970 and television in 1971 Tobacco Control Campaigns (Levy and Friend, 2001) Well-funded campaign Campaign expenditures meeting 6.5% reduction the pre-2009 CDC minimum recommended Moderately funded Campaign expenditures meeting 3.6% reduction campaign 50% of the pre-2009 minimum recommended Low funded campaign Campaign expenditures meeting 1.2% reduction <25% of the pre-2009 minimum recommended
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Strongly enforced and Compliance checks are conducted 20% reduction for those publicized 4 times per year per outlet, ages 16–17 and 30% penalties are potent and enforced, reduction for those and with heavy publicity and age <16c community involvement Moderate enforcement Compliance checks are conducted 10% reduction for those at least once per year per outlet, ages 16–17 and 15% penalties are moderate, and with reduction for those some publicity age <16c Low enforcement Compliance checks are conducted 2.5% reduction for sporadically, penalties are weak, those ages 16–17 and there is little merchant awareness 4% reduction for those and minimal community age <16c participation a The effect sizes are shown relative to the absence of any policy. Unless otherwise specified, the same percentage effect is applied as a percentage reduction in the prevalence in the initial year and as a percentage reduction in initiation rate and a percentage increase in the cessation rate in future years, and is applied to all ages and both genders.
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Baseline smoking 1965 National Health Interview Survey 100+ cigarettes rates for current (NHIS) for age 10+ lifetime, distinguished and ex-smokers by current and former smokers.
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: sudden infant death syndrome (SIDS) , low birth weight (LBW)
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data on adverse MCH outcomes by age and gender for 2012 were obtained from CDC Wonder, the epidemiological database o perated by the Centers for Disease Control and Prevention (CDC)
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TABLE D-3 Gestational Age and Birth Weight, 2012 PTB, PTB FTB, All All FTB, Age group LBW NW LBW PTB LBW NW Total <15 8.8% 12.1% 3.7% 20.9% 12.5% 75.4% 3,657 15–19 7.3% 7.3% 3.5% 14.6% 10.8% 81.9% 309,849 20–24 5.1% 6.4% 3.2% 11.6% 8.3% 85.2% 904,623 25–29 5.4% 5.7% 2.5% 11.2% 7.9% 86.3% 1,130,250 30–34 5.1% 5.9% 2.4% 10.9% 7.5% 86.7% 1,011,765 35–39 6.0% 6.8% 2.6% 12.8% 8.6% 84.6% 471,499 40–44 8.3% 8.7% 3.4% 17.0% 11.7% 79.6% 103,127 45–49 14.0% 10.7% 5.1% 24.7% 19.1% 70.2% 7,122 NOTE: FTB = non-preterm; LBW = low birth weight; NW = normal weight; PTB = pre-term birth.
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Many states were excluded after the 2003 revision in how TABLE D-4 Relative Risks Used in Estimating Maternal and Child Health Outcomes in SimSmoke MCH Outcome Best Estimate Lower Bound Upper Bound Pre-term Birth (PTB) 1.4 1.1 1.7 Low Birth Weight (LBW)
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. The NCHS data and also the PRAMS data are known to consistently underestimate smoking rates because of underreporting.
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Due to the assumption of a 2-year initiation rebound for MLA 19 and MLA 21, slight increases in smoking prevalence and MCH outcomes for the age of the MLA and the next age are predicted in the early years. LBW Under the status quo, in 2015 the incidence rate of smoking-attributable LBW babies is about 0.8 percent among the total births for all the women of childbearing age (ages 14–49)
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between 2015 and 2100. SIDS Under the status quo policy, the incidence rate of smoking-attributable SIDS for the maternal age group 15–49 is 0.008 percent in 2015.
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Tables D-10 through D-13 show projected years of life lost for the CISNET model. Figures D-6 and D-7 show projected cumulative lung cancer deaths prevented according to the CISNET model.
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Smoking prevalence (%) 20 14 16 10 12 8 6 8 2020 2060 2100 2020 2060 2100 Year Year FIGURE D-2 CISNET model–projected smoking prevalence for the upper scenarios of the three MLA policy options for adults (18+)
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Smoking prevalence (%) 14 1 20 16 10 1 12 8 6 8 2020 2060 2100 2020 2060 2100 Year Year FIGURE D-3 CISNET model–projected smoking prevalence for the lower scenarios of the three MLA policy options for adults (18+)
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Smoking prevalence (%) 14 12 10 8 2020 2060 2100 2020 2060 2100 Year Year FIGURE D-4 SimSmoke model–projected smoking prevalence for the upper scenarios of the three MLA policy options for adults (18+)
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Smoking prevalence (%) 14 12 10 8 2020 2060 2100 2020 2060 2100 Year Year FIGURE D-5 SimSmoke model–projected smoking prevalence for the lower scenarios of the three MLA policy options for adults (18+)
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TABLE D-7 Cumulative Premature Deaths Expected and Prevented by Period: CISNET Lower Scenarios MLA/Outcome 2020–2039 2040–2059 2060–2079 2080–2099 2015–2100 Status Quo Premature deaths 6,782,000 4,568,000 2,927,000 1,996,000 18,978,000 expected MLA 19 Deaths prevented -- 2,000 16,000 36,000 55,000 Percentage reduction 0.0% 0.0% 0.5% 1.8% 0.2% MLA 21 Deaths prevented -- 9,000 62,000 136,000 207,000 Percentage reduction 0.0% 0.2% 2.1% 6.8% 1.1% MLA 25 Deaths prevented -- 10,000 70,000 154,000 234,000 Percentage reduction 0.0% 0.2% 2.4% 7.7% 1.2% NOTE: Assumes lower scenarios and that the policy is implemented in 2015. Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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TABLE D-9 Cumulative Premature Deaths Expected and Prevented by Period: SimSmoke Lower Scenarios MLA/Outcome 2020–2039 2040–2059 2060–2079 2080–2099 2015–2100 Status Quo Premature deaths 8,108,000 6,393,000 4,963,000 4,277,000 26,840,000 expected MLA 19 Deaths prevented -- 5,000 32,000 73,000 109,000 Percentage reduction 0.0% 0.1% 0.6% 1.7% 0.4% MLA 21 Deaths prevented -- 39,000 180,000 341,000 561,000 Percentage reduction 0.0% 0.6% 3.6% 8.0% 2.1% MLA 25 Deaths prevented 4,000 92,000 339,000 550,000 985,000 Percentage reduction 0.0% 1.4% 6.8% 12.9% 3.7% NOTE: Assumes lower scenarios and that the policy is implemented in 2015. Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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TABLE D-11 Lifetime Years of Life Lost (YLL) by Cohort: CISNET Model, Upper Scenario YLL Under YLL Under YLL Under MLA 19 Upper MLA 19 % MLA 21 Upper MLA 21 % MLA 25 Upper MLA 25 % Status Quo Scenario Reduction Scenario Reduction Scenario Reduction 2000–2019 40,116,000 1,518,000 3.8% 5,082,000 12.7% 7,855,000 19.6% 2020–2039 36,447,000 1,459,000 4.0% 4,884,000 13.4% 7,547,000 20.7% 2040–2059 36,084,000 1,445,000 4.0% 4,837,000 13.4% 7,475,000 20.7% 2060–2079 37,412,000 1,498,000 4.0% 5,015,000 13.4% 7,750,000 20.7% 2080–2099 38,874,000 1,557,000 4.0% 5,211,000 13.4% 8,053,000 20.7% NOTE: Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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TABLE D-13 Lifetime Years of Life Lost (YLL) by Cohort: CISNET Model, Lower Scenario YLL Under YLL Under YLL Under MLA 19 Lower MLA 19 % MLA 21 Lower MLA 21 % MLA 25 Lower MLA 25 % Status Quo Scenario Reduction Scenario Reduction Scenario Reduction 2000–2019 40,116,000 982,000 2.4% 3,459,000 8.6% 3,946,000 9.8% 2020–2039 36,447,000 944,000 2.6% 3,324,000 9.1% 3,792,000 10.4% 2040–2059 36,084,000 935,000 2.6% 3,292,000 9.1% 3,755,000 10.4% 2060–2079 37,412,000 970,000 2.6% 3,414,000 9.1% 3,894,000 10.4% 2080–2099 38,874,000 1,007,000 2.6% 3,547,000 9.1% 4,046,000 10.4% NOTE: Although the table carries many significant figures to aid in reproducibility, precision is limited to one or two digits.
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APPENDIX D 359 MLA 19 MLA 21 Cumulative lung cancer deaths prevented MLA 25 100,000 60,000 20,000 0 2020 2040 2060 2080 2100 Year FIGURE D-6 CISNET model–estimated number of cumulative lung cancer deaths prevented per year for the three MLA policy options: Upper scenarios.
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360 MINIMUM AGE OF LEGAL ACCESS TO TOBACCO PRODUCTS MLA 19 MLA 21 Cumulative lung cancer deaths prevented MLA 25 100,000 60,000 20,000 0 2020 2040 2060 2080 2100 Year FIGURE D-7 CISNET model–estimated number of cumulative lung cancer deaths prevented per year for the three MLA policy options: Lower scenarios.
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APPENDIX D 361 140,000 Number of Premature Deaths 120,000 100,000 80,000 60,000 40,000 20,000 0 2000 2020 2040 2060 2080 2100 Year Status quo Estimate Ideal FIGURE D-8 CISNET model–projected number of female deaths prevented per year for MLA 21. Ideal represents a scenario where no smoking initiation occurs after 2015.
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12.0 Mean Pack-Years for Ages 40+ 10.0 8.0 6.0 4.0 2.0 0.0 2000 2020 2040 2060 2080 2100 Year Status quo Estimate Ideal FIGURE D-10 CISNET model–projected mean smoking pack-years for women age 40 or older for MLA 21.
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APPENDIX D 363 20 Mean Pack-Years for Ages 40+ 18 16 14 12 10 8 6 4 2 0 2000 2020 2040 2060 2080 2100 Year Status quo EsƟmate Ideal FIGURE D-11 CISNET model–projected mean smoking pack-years for men age 40 or older for MLA 21.
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2014. Benefits and harms of computed tomography lung cancer screening strategies: A comparative modeling study for the U.S.
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2002a. Examining the effects of tobacco treatment policies on smoking rates and smoking related deaths using the SimSmoke computer simulation model.
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The role of tobacco control policies in reducing smoking and deaths in the eighteen heavy burden nations: Results from the MPOWER SimSmoke tobacco control policy model. In National Cancer Institute monograph Tobacco control policies in low and middle income nations, edited by G
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2014. Comparing benefits from many possible computed tomography lung cancer screening programs: Extrapolating from the National Lung Screening Trial using comparative modeling.
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1983. Premature deaths avoided by the antismoking campaign.
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