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The role of tobacco control policies in reducing smoking and deaths in a middle income nation: results from the Thailand SimSmoke simulation model
  1. D T Levy1,
  2. S Benjakul2,
  3. H Ross3,
  4. B Ritthiphakdee4
  1. 1
    Pacific Institute for Research and Evaluation, University of Baltimore, Calverton, Maryland, USA
  2. 2
    Tobacco Control Research and Knowledge Management Center, Mahidol University, Bangkok, Thailand
  3. 3
    American Cancer Society, Atlanta, Georgia, USA
  4. 4
    Southeast Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand
  1. D T Levy, Pacific Institute for Research and Evaluation, University of Baltimore, 11720 Beltsville Drive, Suite 900, Calverton, Maryland 20705, USA; Levy{at}


Objectives: With the male smoking prevalence near 60% in 1991, Thailand was one of the first Asian nations to implement strict tobacco control policies. However, the success of their efforts has not been well documented.

Methods: The role of tobacco control policies are examined using the “SimSmoke” tobacco control model. We first validated the model against survey data on smoking prevalence. We then distinguished the effect of policies implemented between 1991 and 2006 from long-term trends in smoking rates. We also estimated smoking attributable deaths and lives saved as a result of the policies.

Results: The model validates well against survey data. The model shows that by the year 2006, policies implemented between 1991 and 2006 had already decreased smoking prevalence by 25% compared to what it would have been in the absence of the policies. Tax increases on cigarettes and advertising bans had the largest impact, followed by media anti-smoking campaigns, clean air laws and health warnings. The model estimates that the policies saved 31 867 lives by 2006 and will have saved 319 456 lives by 2026.

Conclusions: The results document the success of Thailand in reducing smoking prevalence and reducing the number of lives lost to smoking, thereby showing the potential of tobacco control policies specifically in a middle-income country. Additional improvements can be realised through higher taxes, stronger clean air policies, comprehensive cessation treatment policies, and targeted media campaigns.

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  • Funding: The Roswell Park Cancer Institute (P50 CA111236 “Building the Evidence Base for Tobacco Control Policies” per RFA-CA-04-012 “Transdisciplinary Tobacco Use Research Centers”), and the Southeast Asia Tobacco Control Alliance funded development of the SimSmoke model and writing of this article. The funding sources had no direct role in study design or in the collection, analysis, and interpretation of data.

  • Competing interests: None.