Advertisement

The Minnesota SimSmoke Tobacco Control Policy Model of Smokeless Tobacco and Cigarette Use

      Introduction

      A previous Minnesota SimSmoke tobacco control policy model is extended to more recent years and to include smokeless tobacco use.

      Methods

      Using data from the 1993 Tobacco Use Supplement and information on state policies, the Minnesota SimSmoke model was updated and extended to incorporate smokeless tobacco (both exclusive and dual use) and smokeless tobacco–attributable deaths. The model was then validated against the 2002, 2006/2007, and 2014/2015 Tobacco Use Supplement and the 1999, 2007, 2014, and 2018 Minnesota Adult Tobacco Survey and used to estimate the impact of policies implemented between 1993 and 2018. Analysis was conducted in April 2019.

      Results

      The model validated well for cigarette and earlier smokeless tobacco use, but it predicted smokeless tobacco use less well in recent years. The model projected that male (female) smoking prevalence was 35% (36%) lower in relative terms by 2018 and 43% (44%) lower by 2040 owing to policies, with lesser reductions projected for male smokeless tobacco use. Tobacco-attributable deaths were reduced by 7,800 by 2018 and 46,900 by 2040. Price increases, primarily through taxes, were projected to have had the greatest impact on cigarette use followed by smoke-free air laws, cessation treatment policies, tobacco control campaign expenditures, and youth access enforcement. Similar effects were projected for smokeless tobacco use, except that smoke-free air laws had smaller effects.

      Conclusions

      As cigarettes remain the dominant form of nicotine delivery product, cigarette-oriented policies may be an effective means of reducing the use of all nicotine delivery products. However, noncigarette-oriented policies may also play an important role.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Holford TR
        • Meza R
        • Warner KE
        • et al.
        Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964‒2012.
        JAMA. 2014; 311: 164-171
        • Levy DT
        • Meza R
        • Zhang Y
        • Holford TR
        Gauging the effect of U.S. tobacco control policies from 1965 through 2014 using SimSmoke.
        Am J Prev Med. 2016; 50: 535-542
        • HHS
        The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General.
        HHS, Atlanta, GA2014
        • Lightwood J
        • Glantz S
        Effect of the Arizona tobacco control program on cigarette consumption and healthcare expenditures.
        Soc Sci Med. 2011; 72: 166-172
        • Lightwood J
        • Glantz SA
        The effect of the California tobacco control program on smoking prevalence, cigarette consumption, and healthcare costs: 1989‒2008.
        PLoS One. 2013; 8: e47145
        • Levy D
        • Fergus C
        • Rudov L
        • McCormick-Ricket I
        • Carton T
        Tobacco policies in Louisiana: recommendations for future tobacco control investment from SimSmoke, a policy simulation model.
        Prev Sci. 2016; 17: 199-207
        • Levy DT
        • Boyle RG
        • Abrams DB
        The role of public policies in reducing smoking: the Minnesota SimSmoke tobacco policy model.
        Am J Prev Med. 2012; 43: S179-S186
        • Levy DT
        • Huang AT
        • Havumaki JS
        • Meza R
        The role of public policies in reducing smoking prevalence: results from the Michigan SimSmoke tobacco policy simulation model.
        Cancer Causes Control. 2016; 27: 615-625
        • Levy DT
        • 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: 167-185
        • Levy DT
        • Ross H
        • Powell L
        • Bauer JE
        • Lee HR
        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 DT
        • Tworek C
        • Hahn EJ
        • Davis RE
        The Kentucky SimSmoke tobacco policy simulation model: reaching Healthy People 2010 goals through policy change.
        South Med J. 2008; 101: 503-507
        • Boyle RG
        • St Claire AW
        • Kinney AM
        • D'Silva J
        • Carusi C
        Concurrent use of cigarettes and smokeless tobacco in Minnesota.
        J Environ Public Health. 2012; 2012493109
        • Freiberg M
        • Boyle RG
        • Moilanen M
        • St Claire AW
        • Weisman SR
        The land of 10,000 tobacco products: how Minnesota led the way in regulating tobacco products.
        Am J Public Health. 2014; 104: e10-e12
        • Brock B
        • Choi K
        • Boyle RG
        • Moilanen M
        • Schillo BA
        Tobacco product prices before and after a statewide tobacco tax increase.
        Tob Control. 2016; 25: 166-173
        • Levy DT
        • Yuan Z
        • Li Y
        The US SimSmoke tobacco control policy model of smokeless tobacco and cigarette use.
        BMC Public Health. 2018; 18: 696
      1. U.S. Census Bureau. Population estimates 1993-1999. www2.census.gov/programs-surveys/popest/tables/1990-2000/state/asrh/. Accessed June 14, 2019.

      2. U.S. Census Bureau. Population estimates 2010-2015. http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed June 14, 2019.

      3. U.S. Census Bureau. Population estimates 2000-2009. www2.census.gov/programs-surveys/popest/datasets/2000-2010/intercensal/state/st-est00int-agesex.csv. Accessed June 14, 2019.

      4. Minnesota State Demographic Center. Population projections for 2016-2067. https://mn.gov/admin/demography/data-by-topic/population-data/our-projections/. Accessed April 5, 2018.

      5. CDC. Fertility rates, mortality and birth rates by age and gender. http://wonder.cdc.gov/cmf-icd10.html. Accessed August 15, 2015.

        • U.S. Census Bureau
        Current Population Survey, September 1993: Tobacco Use Supplement File, Technical Documentation CPS-01.
        U.S. Census Bureau, Washington, DC2001
        • Hatsukami DK
        • Henningfield JE
        • Kotlyar M
        Harm reduction approaches to reducing tobacco-related mortality.
        Annu Rev Public Health. 2004; 25: 377-395
        • Hatsukami DK
        • Lemmonds C
        • Tomar SL
        Smokeless tobacco use: harm reduction or induction approach.
        Prev Med. 2004; 38: 309-317
        • Phillips CV
        • Heavner KK
        Smokeless tobacco: the epidemiology and politics of harm.
        Biomarkers. 2009; 14: 79-84
        • Tomar SL
        Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience.
        Nicotine Tob Res. 2003; 5: 561-569
        • Tomar SL
        Epidemiologic perspectives on smokeless tobacco marketing and population harm.
        Am J Prev Med. 2007; 33: S387-S397
        • Burns DM
        • Anderson CM
        • Johnson M
        • Major JM
        • Biener L
        • Vaughn J
        • Shanks TG
        Cessation and cessation measures among daily adult smokers: national- and state-specific data.
        Monograph 12: Population Based Smoking Cessation Proceedings of a Conference on What Works to Influence Cessation in the General Population. NIH, National Cancer Institute, Washington, DC2000
        • Zhu SH
        • Wang JB
        • Hartman A
        • et al.
        Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results?.
        Tob Control. 2009; 18: 82-87
        • Tam J
        • Day HR
        • Rostron BL
        • Apelberg BJ
        A systematic review of transitions between cigarette and smokeless tobacco product use in the United States.
        BMC Public Health. 2015; 15: 258
        • Chang JT
        • Levy DT
        • Meza R
        Examining the transitions between cigarette and smokeless tobacco product use in the United States using the 2002-2003 and 2010-2011 longitudinal cohorts.
        Nicotine Tob Res. 2018; 20: 1412-1416
        • Schauer GL
        • Pederson LL
        • Malarcher AM
        Past year quit attempts and use of cessation resources among cigarette-only smokers and cigarette smokers who use other tobacco products.
        Nicotine Tob Res. 2016; 18: 41-47
        • Messer K
        • Vijayaraghavan M
        • White MM
        • et al.
        Cigarette smoking cessation attempts among current U.S. smokers who also use smokeless tobacco.
        Addict Behav. 2015; 51: 113-119
        • McWhorter WP
        • Boyd GM
        • Mattson ME
        Predictors of quitting smoking: the NHANES I followup experience.
        J Clin Epidemiol. 1990; 43: 1399-1405
        • Gilpin EA
        • Pierce JP
        • Farkas AJ
        Duration of smoking abstinence and success in quitting.
        J Natl Cancer Inst. 1997; 89: 572-576
        • HHS
        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
        • HHS
        The Health Benefits of Smoking Cessation: a Report of the Surgeon General.
        HHS, Public Health Service, CDC, Office on Smoking and Health, Atlanta, GA1990
        • Thun MJ
        • Myers DG
        • Day-Lally C
        • et al.
        Age and the exposure-response relationships between cigarette smoking and premature death in Cancer Prevention Study II.
        Monograph 8: Changes in Cigarette Related Disease Risks and Their Implication for Prevention and Control. National Cancer Institute, Bethesda, MD1997: 383-475
      6. Burns D Garfinkel L Samet J Changes in Cigarette-Related Disease Risks and Their Implication for Prevention and Control. NIH, National Cancer Institute, Bethesda, MD1997
        • Henley SJ
        • Thun MJ
        • Connell C
        • Calle EE
        Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States).
        Cancer Causes Control. 2005; 16: 347-358
        • Levy DT
        • Cummings KM
        • Hyland A
        Increasing taxes as a strategy to reduce cigarette use and deaths: results of a simulation model.
        Prev Med. 2000; 31: 279-286
        • Levy DT
        • Mays D
        • Boyle RG
        • Tam J
        • Chaloupka FJ
        The effect of tobacco control policies on US Smokeless Tobacco use: a structured review.
        Nicotine Tob Res. 2017; 20: 3-11
        • Huang J
        • Gwarnicki C
        • Xu X
        • Caraballo RS
        • Wada R
        • Chaloupka FJ
        A comprehensive examination of own- and cross-price elasticities of tobacco and nicotine replacement products in the U.S.
        Prev Med. 2018; 117: 107-114
        • Zheng Y
        • Zhen C
        • Dench D
        • Nonnemaker JM
        U.S. demand for tobacco products in a system framework.
        Health Econ. 2017; 26: 1067-1086
        • Levy DT
        • Tam J
        • Kuo C
        • Fong GT
        • Chaloupka F
        The impact of implementing tobacco control policies: the 2017 Tobacco Control Policy Scorecard.
        J Public Health Manag Pract. 2018; 24: 448-457
        • Orzechowski and Walker
        The Tax Burden on Tobacco Volume 51, 1970-2016.
        Orzechowski and Walker, Arlington, VA2017
      7. Federal Trade Commission. Smokeless tobacco report for 2017. www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2017-federal-trade-commission-smokeless-tobacco-report/ftc_smokeless_tobacco_report_2017.pdf. Accessed January 5, 2019.

        • Levy DT
        • Yuan Z
        Prices and Taxes of Smokeless Tobacco.
        Georgetown University, Washington, DC2017 ([working paper])
      8. Bureau of Labor Statistics. Consumer price index. www.bls.gov. Accessed January 5, 2019.

        • Levy DT
        • 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
      9. American Nonsmokers’ Rights Foundation. Chronological table of U.S. population protected by 100% smokefree state or local laws. https://no-smoke.org/wp-content/uploads/pdf/EffectivePopulationList.pdf. Accessed March 2, 2019.

        • Levy DT
        • Friend K
        A computer simulation model of mass media interventions directed at tobacco use.
        Prev Med. 2001; 32: 284-294
        • Huang J
        • Walton K
        • Gerzoff RB
        • King BA
        • Chaloupka FJ
        State tobacco control program spending‒United States, 2011.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 673-678
      10. Tobacco free-kids. History of Spending for State Tobacco Prevention Programs. www.tobaccofreekids.org/research/factsheets/pdf/0209.pdf. Accessed July 4, 2019.

        • Levy DT
        • Graham AL
        • Mabry PL
        • Abrams DB
        • Orleans CT
        Modeling the impact of smoking cessation treatment policies on quit rates.
        Am J Prev Med. 2010; 38: S364-S372
      11. North American Quitline Consortium. Quitline stats. www.naquitline.org/?page=800QUITNOWstats. Accessed August 30, 2015.

        • ClearWay Minnesota SM, Minnesota Department of Health
        Tobacco Use in Minnesota: 2014 Update.
        ClearWay MinnesotaSM, Minnesota Department of Health, Minneapolis, MNJanuary 2015
      12. Clearway Minnesota. Minnesota adult tobacco survey (MATS) 2014. http://clearwaymn.org/minnesota-adult-tobacco-survey-mats-2014/. Accessed May 15, 2018.

        • Levy DT
        • Friend K
        • Holder H
        • Carmona M
        Effect of policies directed at youth access to smoking: results from the SimSmoke computer simulation model.
        Tob Control. 2001; 10: 108-116
        • Chaloupka FJ
        • Tauras JA
        • Grossman M
        Public policy and youth smokeless tobacco use.
        South Econ J. 1997; 64: 503-516
        • Tauras J
        • Powell L
        • Chaloupka F
        • Ross H
        The demand for smokeless tobacco among male high school students in the United States: the impact of taxes, prices and policies.
        Appl Econ. 2007; 39: 31-41
        • Choi K
        • Fabian LE
        • Brock B
        • Engman KH
        • Jansen J
        • Forster JL
        Availability of snus and its sale to minors in a large Minnesota city.
        Tob Control. 2014; 23: 449-451
        • Office of the Revisor of Statutes, State of Minnesota
        Minnesota Session Laws - 2013, Regular Session, Chapter 143, Article 5 (HF 677).
        Published 2013
        • ClearWay Minnesota, Minnesota Department of Health
        Tobacco Use in Minnesota: 2010 Update.
        ClearWay Minnesota, Minnesota Department of Health, Minneapolis, MN2011
        • Mumford EA
        • Levy DT
        • Gitchell JG
        • Blackman KO
        Smokeless tobacco use 1992‒2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements.
        Tob Control. 2006; 15: 166-171
        • McClave-Regan AK
        • Berkowitz J
        Smokers who are also using smokeless tobacco products in the US: a national assessment of characteristics, behaviours and beliefs of ‘dual users’.
        Tob Control. 2011; 20: 239-242
      13. National Cancer Institute, CDC. 2014 Smokeless Tobacco and Public Health: A Global Perspective.https://cancercontrol.cancer.gov/brp/tcrb/global-perspective/SmokelessTobaccoAndPublicHealth.pdf. Accessed April 5, 2018.

        • Mejia AB
        • Ling PM
        Tobacco industry consumer research on smokeless tobacco users and product development.
        Am J Public Health. 2010; 100: 78-87
        • Carpenter CM
        • Connolly GN
        • Ayo-Yusuf OA
        • Wayne GF
        Developing smokeless tobacco products for smokers: an examination of tobacco industry documents.
        Tob Control. 2009; 18: 54-59
        • Richardson A
        • Ganz O
        • Stalgaitis C
        • Abrams D
        • Vallone D
        Noncombustible tobacco product advertising: how companies are selling the new face of tobacco.
        Nicotine Tob Res. 2014; 16: 606-614
        • Koch SF
        Quasi-experimental evidence on tobacco tax regressivity.
        Soc Sci Med. 2018; 196: 19-28
        • Pesko MF
        • Licht AS
        • Kruger JM
        Cigarette price minimization strategies in the United States: price reductions and responsiveness to excise taxes.
        Nicotine Tob Res. 2013; 15: 1858-1866
        • Pesko MF
        • Xu X
        • Tynan MA
        • Gerzoff RB
        • Malarcher AM
        • Pechacek TF
        Per-pack price reductions available from different cigarette purchasing strategies: United States, 2009‒2010.
        Prev Med. 2014; 63: 13-19
        • Levy DT
        • Mabry PL
        • Graham AL
        • Orleans CT
        • Abrams DB
        Reaching Healthy People 2010 by 2013: a SimSmoke simulation.
        Am J Prev Med. 2010; 38: S373-S381
      14. Campaign for Tobacco-Free Kids. Broken promises to our children. www.tobaccofreekids.org/problem/toll-us/minnesota. Accessed June 6, 2019.

        • Levy DT
        • Pearson JL
        • Villanti AC
        • et al.
        Modeling the future effects of a menthol ban on smoking prevalence and smoking-attributable deaths in the United States.
        Am J Public Health. 2011; 101: 1236-1240
        • Lee YO
        • Hebert CJ
        • Nonnemaker JM
        • Kim AE
        Multiple tobacco product use among adults in the United States: cigarettes, cigars, electronic cigarettes, hookah, smokeless tobacco, and snus.
        Prev Med. 2014; 62: 14-19
        • Levy DT
        • Cummings KM
        • Villanti AC
        • et al.
        A framework for evaluating the public health impact of e-cigarettes and other vaporized nicotine products.
        Addiction. 2017; 112: 8-17