Table 1.
Policies, description, and effect sizes of SimSmoke model and policies in China
| Policy | MPOWER policy simulated | Potential % effect of MPOWER policy | Current policies in China |
|---|---|---|---|
| Tax policy | Cigarette price index adjusted for inflation for 1996 to 2010. Future prices increase with amount of cigarette tax in absolute terms of total taxes at 75% of retail price | Through price elasticity: −0.40 ages 15-17, −0.30 ages 18-24, −0.15 ages 25-34, −0.10 ages 35-64, and −0.15 ages ≥65 | Tax rate of 40% was assumed at retail price. No tax change occurred from 2000-09. China specific price elasticities that vary by age are applied to the tracking period. Using these price elasticities, higher taxes are passed along to consumers, and applied to future active smoking prevalence |
| Smoke-free legislation: | |||
| Worksite total ban | Ban in all areas | 9.0% prevalence reduction effect | Smoke-free air laws are limited in China and determined at the municipal level, with no jurisdictions having a work ban (partial or limited) and relatively few private firms having their own bans (those few being international firms). No bans in restaurants, pubs, and bars; governmental facilities; educational facilities and universities; or healthcare facilities existed by 2010. Overall enforcement of regulation on smoke-free environments has been minimal |
| Restaurant and bar total ban | Ban in all indoor areas of restaurants | 3.0% effect | |
| Other places total ban | Ban in 3 of 4 (malls, retail stores, public transportation, and elevators) | 1.0% effect | |
| Enforcement and publicity | Government agency is designated to enforce and publicize laws. Publicity effect based on level of tobacco control funding | Effects weakened by as much as 50% if no enforcement and publicity | |
| Mass media campaigns: | |||
| Highly publicized campaign (well funded media and tobacco control campaign) | Meet requirements for medium level campaign, plus have per capita expenditures over $0.50 per capita from MPOWER, or evidence from other sources of strong, well focused media campaign and strong local campaigns | 3.25% reduction (doubled when accompanied by other policies) | Low level media campaign, with no other policies in place |
| Low publicity campaign (low funded media and tobacco control campaign) | National agency and at least some level of funding and/or employees >0 from MPOWER, or evidence from other sources of intermittent media campaign | 0.5% reduction (doubled when accompanied by other policies) | |
| Marketing bans: | |||
| Comprehensive ban | MPOWER: score 4. Ban on direct and indirect marketing. Ban applied to television, radio, print, billboard, instore displays, sponsorships, and free samples | 10.0% reduction in prevalence, 12.0% reduction in initiation, 6.0% increase in cessation | A “half way” policy between partial and complete advertising ban, with moderate enforcement (billboard and point of sale tobacco advertising is still allowed in China) |
| Weak ban | MPOWER: score 2. Partial ban on advertising. Ban applied to some of television, radio, print, and billboards | 2.0% reduction in prevalence and initiation only | |
| Enforcement and publicity | Government agency designated to enforce laws | Effects weakened by as much as 50% if no enforcement | |
| Health warnings: | |||
| Complete policy (strong health warnings) | MPOWER: score 4. Labels are large, bold, and graphic | 1.0% reduction in prevalence, 1.0% reduction in initiation, and 5.0% increase in cessation rate | Weak health warnings enforced at same level over 1996 to 2010 |
| Minimal policy (weak or minimal health warning) | MPOWER: score 2. Warning covers less than 30% of package, not bold or graphic | 0.5% reduction in prevalence and initiation rates, 0.5% increase in cessation rate | |
| Cessation treatment policy | Complete availability and reimbursement of pharmaco and behavioral treatments, “quitlines,” and brief interventions | 6.75% reduction in prevalence, 55% increase in cessation | No information found on how long ago cessation treatments became available in China. Model assumed availability started in 2004 |
| Access restrictions for youth strongly enforced and publicized | Compliance checks conducted regularly and publicized, penalties heavy, and bans on vending machines and self-service | 30.0% reduction for age <16 years in prevalence and initiation only, 20.0% reduction for ages 16 and 17 in prevalence and initiation only | No minimum legal purchase age |
MPOWER=simulated Monitor, Protect, Offer, Warn, Enforce, and Raise measures.
*Unless otherwise specified, same percentage effect is applied as percentage reduction in prevalence and initiation rate and percentage increase in cessation rate, and is applied to all ages and both sexes. Effect sizes are shown relative to absence of any policy.