The Role of Public Policies in Reducing Smoking

The Minnesota SimSmoke Tobacco Policy Model


      Following the landmark lawsuit and settlement with the tobacco industry, Minnesota pursued the implementation of stricter tobacco control policies, including tax increases, mass media campaigns, smokefree air laws, and cessation treatment policies. Modeling is used to examine policy effects on smoking prevalence and smoking-attributable deaths.


      To estimate the effect of tobacco control policies in Minnesota on smoking prevalence and smoking-attributable deaths using the SimSmoke simulation model.


      Minnesota data starting in 1993 are applied to SimSmoke, a simulation model used to examine the effect of tobacco control policies over time on smoking initiation and cessation. Upon validating the model against smoking prevalence, SimSmoke is used to distinguish the effect of policies implemented since 1993 on smoking prevalence. Using standard attribution methods, SimSmoke also estimates deaths averted as a result of the policies.


      SimSmoke predicts smoking prevalence accurately between 1993 and 2011. Since 1993, a relative reduction in smoking rates of 29% by 2011 and of 41% by 2041 can be attributed to tobacco control policies, mainly tax increases, smokefree air laws, media campaigns, and cessation treatment programs. Moreover, 48,000 smoking-attributable deaths will be averted by 2041.


      Minnesota SimSmoke demonstrates that tobacco control policies, especially taxes, have substantially reduced smoking prevalence and smoking-attributable deaths. Taxes, smokefree air laws, mass media, cessation treatment policies, and youth-access enforcement contributed to the decline in prevalence and deaths averted, with the strongest component being taxes. With stronger policies, for example, increasing cigarette taxes to $4.00 per pack, Minnesota's smoking rate could be reduced by another 13%, and 7200 deaths could be averted by 2041.
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        • Humphrey 3rd, H.H.
        Winning against big tobacco.
        Public Health Rep. 1997; 112: 378-385
        • Brandt A.
        The cigarette century: the rise, fall, and deadly persistence of the product that defined America.
        Basic Books, New York2007
        • Tsoukalas T.H.
        • Glantz S.A.
        Development and destruction of the first state funded anti-smoking campaign in the USA.
        Tob Control. 2003; 12: 214-220
      1. Tobacco-Free Kids. Fact sheets: prevention programs: key elements and funding sources, 2011.
      2. Tobacco-Free Kids. Fact sheets: state cigarette excise rates and rankings, 2011.
        • Levy D.T.
        • Chaloupka F.
        • Gitchell J.
        • Mendez D.
        • Warner K.E.
        The use of simulation models for the surveillance, justification and understanding of tobacco control policies.
        Health Care Manag Sci. 2002; 5: 113-120
        • Levy D.
        • Tworek C.
        • Hahn E.
        • Davis R.
        The Kentucky SimSmoke tobacco policy simulation model: reaching Healthy People 2010 goals through policy change.
        South Med J. 2008; 101: 503-507
        • Levy D.T.
        • Hyland A.
        • Higbee C.
        • Remer L.
        • Compton C.
        The role of public policies in reducing smoking prevalence in California: results from the California tobacco policy simulation model.
        Health Policy. 2007; 82: 153-166
        • Levy D.T.
        • Ross H.
        • Powell L.
        • Bauer J.E.
        • Lee H.R.
        The role of public policies in reducing smoking prevalence and deaths caused by smoking in Arizona: results from the Arizona tobacco policy simulation model.
        J Public Health Manag Pract. 2007; 13: 59-67
        • Levy D.
        • Benjakul S.
        • Ross H.
        • Ritthiphakdee B.
        The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model.
        Tobacco Control. 2008; 17: 53-59
        • Levy D.
        • Cho S.
        • Kim Y.-M.
        • Park S.
        • Suh M.-K.
        • Kam S.
        SimSmoke model evaluation of the effect of tobacco control policies in Korea: the unknown success story.
        Am J Public Health. 2010; 100: 1267-1273
        • Levy D.T.
        • Bauer J.E.
        • Lee H.R.
        Simulation modeling and tobacco control: creating more robust public health policies.
        Am J Public Health. 2006; 96: 494-498
        • Levy D.T.
        • Nikolayev N.
        • Mumford E.A.
        Recent trends in smoking and the role of public policies: results from the SimSmoke Tobacco Control Policy Simulation Model.
        Addiction. 2005; 10: 1526-1537
        • CDC
        Fertility rates by age and gender, 2011.
        • CDC, National Center for Health Statistics
        Deaths by age and gender.
        • U.S. Bureau of the Census
        Current population survey, September 1998: tobacco use supplement file, technical documentation CPS-01.
        (Internet website) U.S. Bureau of the Census, Washington DC2001
        • Hughes J.R.
        • Keely J.
        • Naud S.
        Shape of the relapse curve and long-term abstinence among untreated smokers.
        Addiction. 2004; 99: 29-38
        • DHHS
        The health benefits of smoking cessation: a report of the Surgeon General.
        USDHHS, Public Health Service, CDC, Office on Smoking and Health, Atlanta GA1990
        • National Cancer Institute
        Cigarette smoking behavior in the U.S..
        in: Burns D. Lee L. Shen L. Changes in cigarette-related disease risks and their implication for prevention and control, smoking and tobacco control monograph 8. National Cancer Institute, NIH, Bethesda MD1997: 13-112
        • DHHS
        Reducing the health consequences of smoking: 25 years of progress: a report of the Surgeon General.
        CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta GA1989 (DHHS Publication No. [CDC] 89–8411)
        • Orzechowski and Walker
        The tax burden on tobacco, historical compilation, 2011. Arlington VA.
        2012 (Volume 46)
        • Levy D.T.
        • Friend K.
        • Polishchuk E.
        Effect of clean indoor air laws on smokers: the clean air module of the SimSmoke computer simulation model.
        Tob Control. 2001; 10: 345-351
      3. (ImpacTeen Website)
        Tobacco Control Policy and Prevalence: 1991–2008.
        University of Illinois at Chicago Institute for Health Research and Policy, 2011
        • ClearWay Minnesota and Minnesota Department of Health
        Tobacco use in Minnesota: 2010 update.
        (Minneapolis MN)2011
        • Alesci N.L.
        • Forster J.L.
        • Erickson D.J.
        Did youth smoking behaviors change before and after the shutdown of Minnesota Youth Tobacco Prevention Initiative?.
        Nicotine Tob Res. 2009; 11: 1196-1204
        • An L.C.
        • Schillo B.A.
        • Kavanaugh A.M.
        • et al.
        Increased reach and effectiveness of a statewide tobacco quitline after the addition of access to free nicotine replacement therapy.
        Tob Control. 2006; 15: 286-293
        • Schillo B.A.
        • Wendling A.
        • Saul J.
        • et al.
        Expanding access to nicotine replacement therapy through Minnesota's QUITLINE partnership.
        Tob Control. 2007; 16: i37-i41
        • Abrams D.
        • Graham A.
        • Levy D.
        • Mabry P.
        • Orleans C.
        Boosting population quits through evidence-based cessation treatment and policy.
        Am J Prev Med. 2010; 38: S351-S363
        • CDC
        Decrease in smoking prevalence—Minnesota, 1999-2010.
        MMWR Morb Mortal Wkly Rep. 2011; 60: 138-141
        • CDC
        Annual smoking-attributable mortality, years of potential life lost, and economic costs— U.S., 1995–1999.
        MMWR Morb Mortal Wkly Rep. 2002; 51: 300-303
        • Hopkins D.P.
        • Briss P.A.
        • Ricard C.J.
        • et al.
        Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke.
        Am J Prev Med. 2001; 20: 16-66
        • Levy D.T.
        • Gitchell J.G.
        • Chaloupka F.
        The effects of tobacco control policies on smoking rates: a tobacco control scorecard.
        J Public Health Manag Pract. 2004; 10: 338-351
        • Healthy People 2020