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
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{"title"=>"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", "type"=>"journal", "authors"=>[{"first_name"=>"David", "last_name"=>"Levy", "scopus_author_id"=>"35488134000"}, {"first_name"=>"Liz Maria", "last_name"=>"de Almeida", "scopus_author_id"=>"7005988610"}, {"first_name"=>"Andre", "last_name"=>"Szklo", "scopus_author_id"=>"13205603400"}], "year"=>2012, "source"=>"PLoS Medicine", "identifiers"=>{"pui"=>"366156174", "sgr"=>"84870262460", "pmid"=>"23139643", "scopus"=>"2-s2.0-84870262460", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "doi"=>"10.1371/journal.pmed.1001336", "issn"=>"15491277"}, "id"=>"2642cc95-90ae-32b9-9289-9a2142a86b25", "abstract"=>"BACKGROUND: 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.\\n\\nMETHODS AND FINDINGS: 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.\\n\\nCONCLUSIONS: 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.", "link"=>"http://www.mendeley.com/research/brazil-simsmoke-policy-simulation-model-effect-strong-tobacco-control-policies-smoking-prevalence-sm", "reader_count"=>73, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Professor > Associate Professor"=>5, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>9, "Student > Ph. D. Student"=>12, "Student > Postgraduate"=>5, "Other"=>5, "Student > Master"=>15, "Student > Bachelor"=>9, "Lecturer"=>1, "Professor"=>2}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Professor > Associate Professor"=>5, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>9, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/547871"], "description"=>"a<p>Unless otherwise specified, the same percentage effect is applied as a percentage reduction in the prevalence in the initial year and as a percentage reduction in the initiation rate and a percentage increase in the cessation rate in future years. The effect sizes are shown relative to the absence of any policy. They are based on literature reviews, advice of an expert panel, and model validation.</p><p>NRT, nicotine replacement therapy; Rx, prescription.</p>", "links"=>[], "tags"=>["sizes", "brazil"], "article_id"=>218371, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.t001", "stats"=>{"downloads"=>4, "page_views"=>52, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Policies_description_and_effect_sizes_of_Brazil_SimSmoke_/218371", "title"=>"Policies, description, and effect sizes of Brazil SimSmoke.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:19:31"}
  • {"files"=>["https://ndownloader.figshare.com/files/292690"], "description"=>"<div><h3>Background</h3><p>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.</p> <h3>Methods and Findings</h3><p>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.</p> <h3>Conclusions</h3><p>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.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["brazil", "simsmoke", "simulation", "policies", "smoking", "prevalence", "smoking-attributable", "deaths", "nation"], "article_id"=>117605, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336", "stats"=>{"downloads"=>17, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/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__/117605", "title"=>"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", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:06:45"}
  • {"files"=>["https://ndownloader.figshare.com/files/547631"], "description"=>"<p>Brazil smoking prevalence for individuals aged 18 y and above, 1989–2010: SimSmoke predictions and various surveys.</p>", "links"=>[], "tags"=>["smoking", "prevalence", "individuals", "aged", "18", "simsmoke", "predictions"], "article_id"=>218121, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.g001", "stats"=>{"downloads"=>1, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Brazil_smoking_prevalence_for_individuals_aged_18_y_and_above_1989_8211_2010_SimSmoke_predictions_and_various_surveys_/218121", "title"=>"Brazil smoking prevalence for individuals aged 18 y and above, 1989–2010: SimSmoke predictions and various surveys.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-06 02:15:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/547756"], "description"=>"<p>Examples of warnings on cigarette packages in Brazil.</p>", "links"=>[], "tags"=>["warnings", "packages"], "article_id"=>218253, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.g003", "stats"=>{"downloads"=>0, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Examples_of_warnings_on_cigarette_packages_in_Brazil_/218253", "title"=>"Examples of warnings on cigarette packages in Brazil.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-06 02:17:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/547699"], "description"=>"<p>Cessation tx, cessation treatment. *Smoking prevalence is for both genders combined.</p>", "links"=>[], "tags"=>["2010", "smoking", "policies", "implemented", "brazil"], "article_id"=>218196, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.g002", "stats"=>{"downloads"=>1, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Percent_of_the_reduction_in_2010_smoking_prevalence_due_to_individual_policies_implemented_since_1989_estimated_by_Brazil_SimSmoke_/218196", "title"=>"Percent of the reduction in 2010 smoking prevalence* due to individual policies implemented since 1989, estimated by Brazil SimSmoke.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2012-11-06 02:16:36"}
  • {"files"=>["https://ndownloader.figshare.com/files/547939"], "description"=>"a<p>Represents the percent change in prevalence due to a particular policy or all policies relative to the counterfactual with all policies maintained at their 1989 level.</p>", "links"=>[], "tags"=>["counterfactuals", "policies", "changed", "1989", "individually", "implemented", "brazil"], "article_id"=>218428, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.t003", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Smoking_prevalence_counterfactuals_of_no_policies_changed_since_1989_versus_policies_individually_implemented_and_combined_Brazil_SimSmoke_1989_8211_2050_/218428", "title"=>"Smoking prevalence, counterfactuals of no policies changed since 1989 versus policies individually implemented and combined, Brazil SimSmoke, 1989–2050.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:20:28"}
  • {"files"=>["https://ndownloader.figshare.com/files/547815"], "description"=>"a<p>SADs under counterfactual of policies maintained at 1989 level minus SADs with policy (or policies) in place.</p>", "links"=>[], "tags"=>["counterfactuals", "policies", "changed", "1989", "individually", "implemented", "brazil"], "article_id"=>218301, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.t004", "stats"=>{"downloads"=>0, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Smoking_attributable_deaths_counterfactuals_of_no_policies_changed_since_1989_versus_policies_individually_implemented_and_combined_Brazil_SimSmoke_1989_8211_2050_/218301", "title"=>"Smoking-attributable deaths, counterfactuals of no policies changed since 1989 versus policies individually implemented and combined, Brazil SimSmoke, 1989–2050.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:18:21"}
  • {"files"=>["https://ndownloader.figshare.com/files/547849"], "description"=>"a<p>Deaths averted is SADs under status quo policy minus SADs with FCTC-consistent policy (or policies) in place.</p>", "links"=>[], "tags"=>["prevalence", "ages", "18", "smoking-attributable", "deaths", "averted", "quo", "fctc-consistent", "brazil"], "article_id"=>218334, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.t005", "stats"=>{"downloads"=>5, "page_views"=>53, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Smoking_prevalence_for_ages_18_and_above_smoking_attributable_deaths_and_deaths_averted_under_status_quo_and_FCTC_consistent_policy_scenarios_Brazil_SimSmoke_2010_8211_2050_/218334", "title"=>"Smoking prevalence for ages 18 and above, smoking-attributable deaths, and deaths averted under status quo and FCTC-consistent policy scenarios, Brazil SimSmoke, 2010–2050.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:18:54"}
  • {"files"=>["https://ndownloader.figshare.com/files/547900"], "description"=>"<p>The prevalence estimates are expressed as rates of current smokers per population, and percentage change values are over time relative to initial values, e.g., “percentage change 1989–2008” represents the difference in prevalence between 2008 and 1989 divided by the 1989 prevalence.</p>a<p>Survey data are from the 1989 National Survey of Health and Nutrition, the 2003 World Health Survey, and the 2008 GATS.</p>b<p>Predictions are from the Brazil SimSmoke model as described in the text.</p>", "links"=>[], "tags"=>["brazil", "predictions"], "article_id"=>218405, "categories"=>["Medicine", "Sociology"], "users"=>["David Levy", "Liz Maria de Almeida", "Andre Szklo"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001336.t002", "stats"=>{"downloads"=>4, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Validation_of_the_Brazil_SimSmoke_predictions_versus_survey_estimates_1989_8211_2008_/218405", "title"=>"Validation of the Brazil SimSmoke: predictions versus survey estimates, 1989–2008.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2012-11-06 02:20:05"}

PMC Usage Stats | Further Information

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Relative Metric

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