Chapter 4: Development of the Counterfactual Smoking Histories Used to Assess the Effects of Tobacco Control

Abstract

Publication of the Surgeon General’s Report in 1964 marshaled evidence of the harm to public health caused by cigarette smoking, including lung cancer mortality, and provided an impetus for introducing control programs. The purpose of this paper is to develop estimates of their effect on basic smoking exposure input parameters related to introduction of the Report, Fundamental inputs used to generate exposure to cigarettes are initiation and cessation rates for men and women, as well as the distribution of the number of cigarettes smoked per day. These fundamental quantities are presented for three scenarios: actual tobacco control in the US; no tobacco control in which the experience before 1955 was assumed to continue; and, complete tobacco control in which all smoking ceased following publication of the Report. These results were derived using data from National Health Interview Surveys, and they provide basic input parameters for the Smoking History Generator used by each of the lung cancer models developed by the Cancer Intervention and Surveillance Modeling Network (CISNET).

Comparison of Smoking History Patterns Among African American and White Cohorts in the United States Born 1890 to 1990

“…The analytical approach enhanced the initial estimates of smoking history parameters by making use of a more comprehensive age-period-cohort model that considered all of the data in a single analysis, instead of separate analyses for 5-year birth cohorts that were subsequently smoothed in a secondary analysis of the results for each cohort. 17,18 Combining these two steps into a single modeling framework provided greater statistical power, which made it feasible to obtain yearly estimates with smaller sample sizes. In this analysis we made use of that power to consider smoking histories in the African American population, which represents only 13% or 131 125 (47 782 male and 83 343 female) out of 1 000 387 subjects in the NHIS data set.…”

Evaluating the impact of varied compliance to lung cancer screening recommendations using a microsimulation model

“…The lifetime smoking histories and other cause of mortality of 100,000 female and 100,000 male in this cohort were simulated using Smoking History Generator as input variables for microsimulations [17]. Our analysis focuses on individuals who are alive and without a cancer diagnosis at age 50.…”

Tobacco Control and the Reduction in Smoking-Related Premature Deaths in the United States, 1964-2012

“…For the no tobacco control counterfactuals, Holford and Clarke’s method 4 was modified to estimate smoking prevalence, initiation, and cessation rates that could be expected had the era of tobacco control following the 1964 Surgeon General’s Report 1 (SGR) not occurred. Ever-smoker prevalence by cohort was considered to develop a plausible range of counterfactuals.…”

“…3 CISNET used a common set of smoking history and mortality parameters in population cancer models to estimate the expected difference in the number of lung cancer deaths between smoking rates under actual tobacco control and under no tobacco control, i.e., if smoking behavior subsequent to 1964 had not been affected by tobacco control. 4,5 These results were extended to consider all deaths rather than just lung cancer deaths and expand the examined time period from 1975–2000 to 1964–2012 to estimate the number of early deaths avoided and life-years saved that were associated with reduced cigarette smoking during this period. The relationship between tobacco control and life expectancy was also estimated.…”