The Brazil SimSmoke Policy Simulation Model: The Effect of Strong Tobacco Control Policies on Smoking Prevalence and Smoking-Attributable Deaths in a Middle Income Nation

Population Sciences, Department of Oncology, Georgetown University, Washington, District of Columbia, United States of America.
PLoS Medicine (Impact Factor: 14.43). 11/2012; 9(11):e1001336. DOI: 10.1371/journal.pmed.1001336
Source: PubMed


Brazil has reduced its smoking rate by about 50% in the last 20 y. During that time period, strong tobacco control policies were implemented. This paper estimates the effect of these stricter policies on smoking prevalence and associated premature mortality, and the effect that additional policies may have.
The model was developed using the SimSmoke tobacco control policy model. Using policy, population, and smoking data for Brazil, the model assesses the effect on premature deaths of cigarette taxes, smoke-free air laws, mass media campaigns, marketing restrictions, packaging requirements, cessation treatment programs, and youth access restrictions. We estimate the effect of past policies relative to a counterfactual of policies kept to 1989 levels, and the effect of stricter future policies. Male and female smoking prevalence in Brazil have fallen by about half since 1989, which represents a 46% (lower and upper bounds: 28%-66%) relative reduction compared to the 2010 prevalence under the counterfactual scenario of policies held to 1989 levels. Almost half of that 46% reduction is explained by price increases, 14% by smoke-free air laws, 14% by marketing restrictions, 8% by health warnings, 6% by mass media campaigns, and 10% by cessation treatment programs. As a result of the past policies, a total of almost 420,000 (260,000-715,000) deaths had been averted by 2010, increasing to almost 7 million (4.5 million-10.3 million) deaths projected by 2050. Comparing future implementation of a set of stricter policies to a scenario with 2010 policies held constant, smoking prevalence by 2050 could be reduced by another 39% (29%-54%), and 1.3 million (0.9 million-2.0 million) out of 9 million future premature deaths could be averted.
Brazil provides one of the outstanding public health success stories in reducing deaths due to smoking, and serves as a model for other low and middle income nations. However, a set of stricter policies could further reduce smoking and save many additional lives. Please see later in the article for the Editors' Summary.

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Available from: David Theodore Levy, Oct 10, 2015
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    • "Studies exploring isolated risk behaviors in the occupational domain described positive association of low levels of OPA with systolic and diastolic blood pressure and diabetes mellitus [25,26]. Likewise, it is known that although decreasing over the last years [27], tobacco and other legal drugs are more frequent among people with lower education level [28], which composed a great part of our sample. Furthermore, the use of legal drugs is frequent during tension relief [29], as experienced by employees of administrative sessions, which are less physically active at work. "
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    • "The SimSmoke model has been shown to predict smoking prevalence well for different states and nations, though relatively little work has been focused on tobacco use prevention per se. The model appears to predict best in states and nations with strong tobacco control policies (e.g., [80-82]). "
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