The model has been used to estimate the population health effects of various risk factors including the effect of differences in smoking initiation and cessation rates on smoking prevalence, disease prevalence, and mortality in baseline and tobacco control policy scenarios [ 43 ]. Statistical and computational modeling can be used to assess the potential impacts of tobacco regulatory actions. The model simulation results indicated that decreased cigarette use and increased snus use would not lead to reduction in population harm from tobacco products. The group has developed detailed smoking histories for US birth cohorts from analysis of cross-sectional National Health Interview Survey NHIS data [ 33 ], analyzed trends in these cohort smoking histories [ 34 ], and modeled the impact of tobacco policies and smoking behavior on lung cancer and all-cause mortality in the US [ 35 , 36 ]. Copyright notice This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. Methods and Findings We present a multi-state, dynamical systems population structure model that can be used to assess the effects of tobacco product use behaviors on population health. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. Other models have been developed to represent the population health effects of various health risk factors such as smoking for a variety of countries. The model produced cohort life tables that are comparable to US and Swedish period life tables [ 45 ].
Further model development will include refinement of data inputs for non-cigarette tobacco products and inclusion of health outcomes such as morbidity and disability. As such, it can evaluate the population health impacts associated with the introduction of new tobacco products or policies that may result in product switching or dual use. SimSmoke has been used to model smoking prevalence and smoking-attributable deaths for the US from to under different intervention scenarios [ 11 ] and to model the effect of tobacco control policies on smoking outcomes in various countries, including, for example, Albania [ 12 ], Argentina [ 13 ], Brazil [ 14 ], Europe [ 15 ], Finland [ 16 ], Germany [ 17 ], Ireland [ 18 ], Italy [ 19 ], the Netherlands [ 20 ], South Korea [ 21 ], Sweden [ 22 ], Taiwan [ 23 ], Thailand [ 24 ] United Kingdom [ 25 ] and Vietnam [ 26 ]. The model can also be used to estimate differences in these outcomes between scenarios by varying input parameter values. The highest prevalence of cigar use occurs among youth and young adults [ 5 , 6 ], and cigars are now the most commonly used tobacco product among non-Hispanic black middle and high school students [ 6 ]. Statistical and computational modeling can be used to assess the potential impacts of tobacco regulatory actions. Conclusion Our model incorporates the variety of tobacco use behaviors and risks that occur with multiple products. In the present study, we demonstrate the use of this model by 1 projecting cigarette smoking prevalence and attributable mortality for the US population overall and by sex and age group and 2 simulating the introduction of a hypothetical new tobacco product with a range of values for product use and harm. The model also updates the size of population subgroups at each time step based on changes in tobacco product use and mortality by means of a first order, discrete Markov process. Model results show that population health benefits are particularly sensitive to product risks and initiation, switching, and dual use behaviors. We demonstrate model capabilities by projecting future cigarette smoking prevalence and smoking-attributable mortality and then simulating the effects of introduction of a hypothetical new lower-risk tobacco product under a variety of assumptions about product use. In doing so, we demonstrate how the model can be used to examine the relative impacts of different assumptions about product use and risk and to identify those factors that most influence population health. Multiple product tobacco models can help assess the population health impacts associated with use of a wide range of tobacco products. The current formulation of the model can be used to compare the effects of various potential scenarios on future population health, as measured by all-cause mortality. In the US, recent declines in cigarette smoking prevalence have coincided with an increase in the use of other traditional and non-traditional tobacco products. The model has generally been used with Canadian data. These models, although very useful, have typically focused on cigarette use in a population. This article has been cited by other articles in PMC. The model incorporates transition behaviors, such as initiation, cessation, switching, and dual use, related to the use of multiple products. Modeling efforts that have included two types of tobacco products have been much more limited. Introduction Despite decades of public health information about the health risks of cigarette smoking, smoking remains the cause of an estimated , premature deaths in the US each year [ 1 ] and is the leading cause of preventable disease and death throughout the world [ 2 , 3 ]. More recently, use of electronic cigarettes e-cigarettes has increased in popularity. This model uses age-specific initiation and cessation rates as well as birth and death rates to project smoking prevalence over time [ 28 ]. Among youth, ever and current use of e-cigarettes doubled from to [ 6 ], following a similar pattern in adults from to [ 7 ]. As an example, the SimSmoke model has been developed to predict the effects of tobacco control policies on population health outcomes. Copyright notice This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose.
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