Background
Methods
Input | Source | Specifications |
---|---|---|
I. Population
| ||
A. Population
| Institute of Health Information and Statistics of Italy (ISTAT) | Breakdowns by age and gender groups |
B. Fertility rates
| ISTAT | Breakdowns by age and gender groups |
C. Mortality rates
| ISTAT | Breakdowns by age and gender groups |
II. Smoking and attributable deaths
| ||
A. Baseline smoking rates
| Multipurpose Surveys “Aspects of daily living”, carried out from 1993 onwards by ISTAT | Breakdown of current, former and never smokers by age and gender groups. |
B. Initiation rates
| Change in smoking rates between contiguous age groups | Breakdowns by age and gender groups. |
C. First year cessation rates
| Multipurpose Surveys “Aspects of daily living” | Breakdowns by age and gender groups. |
D. Relapse rates
| USDHHS (1989) and other studies | Breakdowns by age |
E. Relative risks of current and ex-smokers
| Cancer Prevention Study II (NCI 1997) | Breakdowns by age and gender. |
III. Policies
| ||
A. Taxes
| Eurostat, and MPOWER Reports (2008. 2010) | Prices and taxes |
B. Clean air laws
| Past studies, MPOWER Report (2008, 2010), and labor force participation rates | Types of laws (worksite, restaurant, and other places) and their stringency |
C. Media & other educational campaigns
| Tobacco control staff in Italy and MPOWER Reports (2008. 2010) | Classification based on expenditures per capita and audience |
D. Marketing bans
| Past studies, and MPOWER Reports (2008. 2010) | Extent of bans |
E. Warning Labels
| Past studies, and MPOWER Reports (2008. 2010) | Strictness of labels |
F. Cessation Treatment Policies
| Past studies, and MPOWER Reports (2008. 2010) | Financial reimbursement, quitlines, and brief interventions |
G. Youth access
| Past studies, and MPOWER Reports (2008. 2010) | Enforcement checks, penalties, community campaigns, self-service and vending machine bans |
Population model
Smoking model
Smoking-Attributable Deaths
Policy effects
Policy | Description | Potential percentage effect* |
---|---|---|
Through price elasticity: | ||
Tax Policy
| Cigarette price index | −0.3 ages 15–24 |
−0.2 ages 25–34 | ||
−0.1 ages 35 and above | ||
Clean Air Policies
| ||
Worksite total Ban
| Ban in all areas | 6% with variations by age and gender |
Worksite ban except ventilated areas
| Smoking restricted to ventilated areas in all indoor workplaces | 4% with variations by age and gender |
Worksite ban limited to common area
| Smoking limited to non ventilated common area | 2% with variations by age and gender |
Restaurant total ban
| Ban in all indoor restaurants in all areas | 1% effect |
Restaurant ban except separate areas | Ban in all restaurants except in designated areas | 0.5% effect |
Other places total ban | Ban in 3 of 4 (malls, retail stores, public transportation and elevators) | 1% effect |
Enforcement and publicity
| Government agency is designated to enforce and publicize the laws | Effects reduced by as much as 50% if 0 enforcement |
Mass Media Campaigns
| ||
Highly publicized campaign
| Campaign publicized heavily on TV (at least two months of the year) and at least some other media | 3.25% effect (doubled when accompanied by local programs) |
Moderately publicized campaign
| Campaign publicized sporadically on TV and in at least some other media, and a local program | 1.8% effect (doubled when accompanied by local programs) |
Low publicity campaign
| Campaign publicized only sporadically in newspaper, billboard or some other media. | 0.5% effect (doubled when accompanied by local programs) |
Marketing Ban
| ||
Comprehensive marketing ban
| Ban is applied television, radio, print, billboard, in-store displays, sponsorships and free samples | 5% reduction in prevalence, |
6% reduction in initiation, | ||
3% increase in cessation rates | ||
Total Advertising Ban
| Ban is applied all media television, radio, print, billboard | 3% reduction in prevalence, |
4% reduction in initiation, | ||
2% increase in cessation rates | ||
Weak advertising ban
| Ban is applied some of television, radio, print, billboard | 1% reduction in prevalence and initiation only |
Enforcement and publicity
| Government agency is designated to enforce the laws | Effects reduced by as much as 50% if 0 enforcement |
Warning Labels
| ||
Strong
| Labels are large, bold and graphic | 2% reduction in prevalence |
2% reduction in initiation | ||
4% increase in cessation rate | ||
Weak
| Laws cover less than 1/3 of package, not bold or graphic | 1% reduction in prevalence & initiation rates, 2% increase in cessation rates |
Publicity
| Health information is well publicized | 1% additional effect on prevalence and initiation rates |
Cessation Treatment Policy
| Complete availability and reimbursement of pharmaco- and behavioral treatments, quitlines, and brief interventions | 4.75% reduction in prevalence, 39% increase in cessation rate |
Youth Access Restrictions
| ||
Strongly enforced & publicized
| Compliance checks are conducted regularly, penalties are heavy, and with publicity is strong, vending machine and self-service bans | 30% reduction for age < 16 in prevalence and initiation only, |
20 % reduction for ages 16–17 in prevalence and initiation only | ||
Well enforced
| Compliance checks are conducted sporadically, penalties are potent, and little publicity | 15 % reduction for age < 16 in prevalence and initiation only, |
10 % reduction for ages 16–17 in prevalence and initiation only | ||
Low enforcement
| Compliance checks are not conducted, penalties are weak, and no publicity | 3 % reduction for age < 16 in prevalence and initiation only, |
2 % reduction for ages 16–17 in prevalence and initiation only |
The model outcomes
Results
Predictions of smoking prevalence from 2002 to 2010
Role of policies implemented in 2010 in reducing future smoking prevalence and deaths
POLICY/YEAR
|
2010
|
2011
|
2020
|
2030
|
2040
|
---|---|---|---|---|---|
Status Quo Policies
| 26.8% | 26.6% | 24.3% | 22.2% | 20.4% |
Independent Policy Effects
| |||||
Rolling Price Changes**
| 26.8% | 25.8% | 22.0% | 19.6% | 17.6% |
Complete Smoke Free Air Laws
| 26.8% | 26.5% | 24.3% | 22.2% | 20.4% |
Comprehensive Marketing Ban
| 26.8% | 26.4% | 24.1% | 22.0% | 20.2% |
High Intensity Tobacco Control Campaign
| 26.8% | 24.9% | 22.6% | 20.4% | 18.6% |
Strong Health Warnings
| 26.8% | 26.5% | 24.2% | 22.0% | 20.2% |
Strong Youth Access Enforcement
| 26.8% | 26.5% | 23.8% | 21.2% | 19.1% |
Cessation Treatment Policies
| 26.8% | 26.1% | 23.2% | 20.9% | 19.1% |
Combined Policy Effects
| |||||
All above
| 26.8% | 23.4% | 18.4% | 15.5% | 13.3% |
% Change in Smoking Prevalence from Status Quo*
| |||||
Independent Policy Effects
| |||||
Rolling Price Changes**
| −2.7% | −9.6% | −11.6% | −13.5% | |
Complete Smoke Free Air Laws
| −0.2% | −0.2% | −0.1% | −0.1% | |
Comprehensive Marketing Ban
| −0.7% | −0.8% | −0.9% | −1.0% | |
High Intensity Tobacco Control Campaign
| −6.1% | −7.2% | −8.1% | −8.7% | |
Strong Health Warnings
| −0.2% | −0.7% | −1.0% | −1.2% | |
Strong Youth Access Enforcement
| −0.4% | −2.3% | −4.3% | −6.2% | |
Cessation Treatment Policies
| −1.9% | −4.6% | −5.9% | −6.5% | |
Combined Policy Effects
| |||||
All above
| −12.0% | −24.5% | −30.3% | −34.6% |
POLICIES
|
2010
|
2011
|
2020
|
2030
|
2040
|
---|---|---|---|---|---|
Status Quo Policies
| 14.9% | 14.8% | 14.1% | 13.2% | 12.0% |
Independent Policy Effects
| |||||
Rolling Price Changes**
| 14.9% | 14.4% | 12.8% | 11.7% | 10.5% |
Complete Smoke Free Air Laws
| 14.9% | 14.8% | 14.1% | 13.2% | 12.0% |
Comprehensive Marketing Ban
| 14.9% | 14.7% | 14.0% | 13.1% | 11.9% |
High Intensity Tobacco Control Campaign
| 14.9% | 13.9% | 13.1% | 12.1% | 11.0% |
Strong Health Warnings
| 14.9% | 14.8% | 14.0% | 13.1% | 11.9% |
Strong Youth Access Enforcement
| 14.9% | 14.8% | 13.8% | 12.6% | 11.3% |
Cessation Treatment Policies
| 14.9% | 14.5% | 13.5% | 12.4% | 11.3% |
Combined Policy Effects
| |||||
All above
| 14.9% | 13.0% | 10.8% | 9.4% | 8.0% |
Relative Change in Smoking Prevalence from Status Quo*
| |||||
Independent Policy Effects
| |||||
Rolling Price Changes**
| −2.7% | −9.2% | −10.9% | −12.6% | |
Complete Smoke Free Air Laws
| −0.2% | −0.2% | −0.2% | −0.1% | |
Comprehensive Marketing Ban
| −0.7% | −0.8% | −0.9% | −0.9% | |
High Intensity Tobacco Control Campaign
| −6.2% | −7.2% | −7.9% | −8.5% | |
Strong Health Warnings
| −0.2% | −0.7% | −0.9% | −1.1% | |
Strong Youth Access Enforcement
| −0.3% | −2.2% | −4.1% | −6.1% | |
Cessation Treatment Policies
| −1.9% | −4.4% | −5.7% | −6.4% | |
Combined Policy Effects
| |||||
All above
| −12.0% | −23.5% | −28.9% | −33.2% |
Policies
| 2010 | 2020 | 2030 | 2040 | Cumulative |
---|---|---|---|---|---|
Status Quo Policies
| 60,652 | 64,855 | 61,949 | 54,607 |
1,854,650
|
Independent Policy Effects
| |||||
Rolling Price Changes**
| 60,652 | 63,424 | 58,657 | 51,042 |
1,788,696
|
Complete Smoke Free Air Laws
| 60,652 | 64,805 | 61,837 | 54,501 |
1,852,354
|
Comprehensive Marketing Ban
| 60,652 | 64,697 | 61,598 | 54,261 |
1,847,374
|
High Intensity Tobacco Control Campaign
| 60,652 | 63,428 | 58,619 | 51,128 |
1,785,387
|
Strong Health Warnings
| 60,652 | 64,731 | 61,592 | 54,138 |
1,847,242
|
Strong Youth Access Enforcement
| 60,652 | 64,855 | 61,937 | 54,493 |
1,854,008
|
Cessation Treatment Policies
| 60,652 | 63,939 | 59,387 | 51,356 |
1,801,675
|
Combined Policy Effects
| |||||
All above
| 60,652 | 60,876 | 52,195 | 43,617 |
1,654,086
|
Absolute Change in Attributable Deaths from Status Quo
|
2011-2040
| ||||
Independent Policy Effects
| |||||
Rolling Price Changes**
| 1,431 | 3,292 | 3,565 |
65,953
| |
Complete Smoke Free Air Laws
| 50 | 112 | 105 |
2,296
| |
Comprehensive Marketing Ban
| 158 | 351 | 345 |
7,276
| |
High Intensity Tobacco Control Campaign
| 1,427 | 3,330 | 3,479 |
69,263
| |
Strong Health Warnings
| 124 | 357 | 469 |
7,407
| |
Strong Youth Access Enforcement
| 0 | 12 | 114 |
641
| |
Cessation Treatment Policies
| 916 | 2,562 | 3,250 |
52,975
| |
Combined Policies
| 3,979 | 9,754 | 10,990 |
200,563
|
POLICIES
| 2010 | 2020 | 2030 | 2040 | Cumulative |
---|---|---|---|---|---|
Status Quo Policies
| 18,433 | 24,390 | 28,632 | 29,488 |
783,587
|
Independent Policy Effects
| |||||
Rolling Price Changes**
| 18,433 | 23,816 | 27,102 | 27,695 |
753,057
|
Complete Smoke Free Air Laws
| 18,433 | 24,370 | 28,578 | 29,429 |
782,486
|
Comprehensive Marketing Ban
| 18,433 | 24,326 | 28,465 | 29,305 |
780,155
|
High Intensity Tobacco Control Campaign
| 18,433 | 23,816 | 27,072 | 27,670 |
751,293
|
Strong Health Warnings
| 18,433 | 24,348 | 28,483 | 29,260 |
780,432
|
Strong Youth Access Enforcement
| 18,433 | 24,390 | 28,629 | 29,459 |
783,432
|
Cessation Treatment Policies
| 18,433 | 24,076 | 27,546 | 27,876 |
760,709
|
Combined Policy Effects
| |||||
All above
| 18,433 | 22,849 | 24,189 | 23,890 |
692,046
|
Absolute Change in Attributable Deaths from Status Quo
|
2011-2040
| ||||
Independent Policy Effects
| |||||
Rolling Price Changes**
| 574 | 1,530 | 1,792 |
30,530
| |
Complete Smoke Free Air Laws
| 21 | 54 | 59 |
1,100
| |
Comprehensive Marketing Ban
| 65 | 167 | 182 |
3,432
| |
High Intensity Tobacco Control Campaign
| 575 | 1,560 | 1,818 |
32,294
| |
Strong Health Warnings
| 42 | 149 | 227 |
3,155
| |
Strong Youth Access Enforcement
| 0 | 3 | 29 |
155
| |
Cessation Treatment Policies
| 314 | 1,085 | 1,611 |
22,877
| |
Combined Policies
| 1,541 | 4,442 | 5,598 |
91,541
|