Table 1.
Tobacco control policies, specifications and effect sizes applied in US SimSmoke.
| Policy | Description | Policy Effect Size | Policy Level, 1993–2019 | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Cigarette Excise Taxes | |||||||||
| Cigarette price/tax | The effect of taxes is directly incorporated through the average price after tax. The price elasticity is used to convert the price changes (%) into effect sizes | Elasticities | The inflation-adjusted cigarette price increased from $1.75 per pack in 1993 to $3.6 in 2002 to $5.60 in 2012 and $6.60 in 2019. | ||||||
| −0.6 for ages 14–17 | |||||||||
| −0.4 for ages 18–24 | |||||||||
| −0.2 for ages 25–34 | |||||||||
| −0.1 for ages 35–64 | |||||||||
| −0.2 for ages 65+ | |||||||||
| Smoke-Free Air Laws | |||||||||
| Worksite smoking ban | Ban in all indoor worksites, with strong enforcement of laws (reduced by 1/3 if allowed in ventilated areas and by 2/3 if allowed in common areas) | −6% prevalence and initiation, +6% cessation | Worksite ban was at 37% low 7% mid and 1.5% high with little increase through 2002 and gradually increased to 76.1% high and 10.4% mid and 13.5% low in 2019. Restaurant ban were less than 1% before 2002 and gradually increased to 77% by 2014 with little further change. Bars ban was 0 until 2001 and gradually increased to 65% by 2014. Ban in other places was 50% before 1999 increasing to 94.8% by 2012. | ||||||
| Restaurant smoking ban | Ban in all indoor restaurants (scaled for lower coverage), with strong enforcement of laws | −2% prevalence and initiation, +2% cessation | |||||||
| Pubs and bars smoking ban | Ban in all indoor in pubs and bars (scaled for lower coverage), with strong enforcement of laws | −1% prevalence and initiation, +1% cessation | |||||||
| Other place bans | Ban in 3 out of 4 government buildings (scaled for lower coverage), retail stores, public transportation, and elevators, with strong enforcement of laws | −1% prevalence and initiation, +1% cessation | |||||||
| Enforcement and Publicity | Government agency enforces the laws and publicity via tobacco control campaigns | Enforcement is ranked on a 1–10 scale converted to percentage terms and publicity is based on indicator = 1 if media campaigns are at a medium level. Effects reduced 50% absent publicity and enforcement; Effect sizes are deflated by: 0.5*(1 + 0.5* Publicity Indicator + 0.5* Enforcement Level). |
The enforcement level is 8 out of 10 in all years and the publicity level is based on the level of the media campaigns. | ||||||
| Media Campaigns | |||||||||
| High level media campaign | Campaign publicized heavily with state and local programs with strong funding (>$0.50 USD) | −6.5% prevalence and initiation, +6.5% cessation | Campaigns at 90% minimal and 10% moderate level, increasing to 100% moderate level in 2003, and reduced back to 50% minimal and 50% moderate level from 2011 to 2017, then returning to a 25% minimal and 75% moderate level in the period 2018–2019. | ||||||
| Medium level media campaign | Campaign publicized with funding of at least $0.10 USD per capita | −3.25% prevalence and initiation, +3.25% cessation | |||||||
| Low level media campaign | Campaign publicized only sporadically with minimal funding (<$0.10 USD per capita) | −1.63% prevalence and initiation, +1.63% cessation | |||||||
| Marketing Restrictions | |||||||||
| Comprehensive marketing ban | Ban on all forms of direct advertising including point of sale and indirect marketing | −5% prevalence, −8% initiation, +4% cessation |
Restrictions on marketing were at minimal level from 1993 through 2009, then increased to 25% moderate and 75% minimal level in 2010 with added FDA restrictions. | ||||||
| Moderate marketing ban | Ban on broadcast media, newspapers and billboards marketing and at least some indirect marketing (sponsorship, branding, giveaways) | −3% prevalence, −4% initiation, +2% cessation |
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| Minimal marketing ban | Ban on broadcast media advertising | −1% prevalence and −1% initiation only | |||||||
| Enforcement | Government agency enforces the laws | Effects reduced 50% absent enforcement | Level 9 out of 10 for all years. | ||||||
| Cessation Treatment Policies | |||||||||
| Availability of pharmaco-therapies | Legality of nicotine replacement therapy (NRT) and/or Bupropion and Varenicline | −1% prevalence, +4% cessation |
Availability of NRT since 1993, and Bupropion with a prescription since 1998. Treatment coverage increased in stages from 30% coverage in 1997 to 40% in 2002, to 50% in 2007, and to 75% in 2014. A national quitline was implemented at 50% in 2003 increasing in stages to 90% in 2007. Brief interventions are set at 50% coverage for all years. | ||||||
| Cessation treatment financial coverage | Coverage of pharmacotherapy and behavioral cessation treatment with high publicity | −2.25% prevalence, +8% cessation |
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| Quit line | Three quit line types: passive, proactive and active with follow-up | −1% prevalence, +6% cessation |
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| Brief interventions | Advice by health care provider to quit and methods provided | −1% prevalence, +6% cessation |
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| All cessation policies combined | Complete availability and reimbursement of pharmaco- and behavioral treatments, quit lines, and fully implemented brief interventions | −5.68% prevalence, +29.4% cessation |
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| Youth Access Policies | |||||||||
| Strong enforcement and well publicized | Compliance checks conducted 4 times per year per outlet, penalties are potent and enforced with heavy publicity | −16% initiation and prevalence for ages 16–17 and −24% for ages 10–15 | Low level in 1998 increasing to mid-level in 2003 and remaining at that level. | ||||||
| Moderate enforcement with some publicity | Compliance checks conducted regularly, penalties are potent, and publicity and merchant training are included | −8% initiation and prevalence ages 16–17 and −12% for ages 10–15 | |||||||
| Low enforcement | Compliance checks are conducted sporadically, penalties are weak | −2% initiation and prevalence ages 16–17 and −3% ages 10–15 | |||||||
Notes: Policy effect sizes are based on previous SimSmoke analyses as cited in the main text. Unless otherwise indicated, the effects are in terms of the reduction in prevalence during the first year. The reduction in initiation rates and the increase in quit rates take effects during the years that the policy is in effect. Policy levels are based on information from the literature about the levels of policy as cited in the main text.