American Journal of Preventive Medicine
Impact of indoor-air policiesThe Role of Public Policies in Reducing Smoking: The Minnesota SimSmoke Tobacco Policy Model
Introduction
During the past 35 years, Minnesota has played a major role in U.S. tobacco control. In 1975, Minnesota became the first state to pass a statewide law that limited indoor smoking in most public places.1 This ground-breaking law set the stage for future tobacco control at the state level.2 Ten years later, the Minnesota Department of Health launched the first state-funded tobacco control program with a portion of the cigarette tax proceeds.3 In 1994, the state of Minnesota and Blue Cross Blue Shield of Minnesota filed a lawsuit against cigarette manufactures and related trade associations accusing them of failing to disclose information about the dangers and addictive qualities of cigarettes. The 1998 settlement of that lawsuit provided funds to the state health department and Blue Cross Blue Shield of Minnesota. In addition, a separate nonprofit organization, ClearWay MinnesotaSM, was established with a mission to create programs and services (QUITPLAN®) to reduce the harm caused by tobacco in Minnesota.
By 2001, almost all Minnesota residents had tobacco-cessation treatment covered as an insurance benefit by their health plans or, if they lacked insurance, quitline counseling, and cessation medication were covered by ClearWay Minnesota. Around the same time, statewide mass media campaigns began promoting ClearWay Minnesota services. In 2007, a comprehensive statewide smokefree law was passed. Minnesota has consistently spent above average on tobacco control relative to other states.4 In addition, at $1.58 per pack in 2011, Minnesota was ranked in the top half of states for cigarette taxes.5
The purpose of this paper is to estimate the effect of tobacco control policies in Minnesota on smoking prevalence and smoking-attributable deaths using the SimSmoke simulation model. SimSmoke simultaneously considers a broader array of public policies than other models6 and has been validated in other states7, 8, 9 and countries.10, 11 Specifically, both the impact of past policies and the potential impact of additional policy changes on smoking prevalence and smoking-attributable deaths are estimated.
Section snippets
Methods
SimSmoke12, 13 projects smoking prevalence and smoking-attributable deaths over time and estimates the effect of tobacco control policies on those rates. A discrete time, first-order Markov process is employed to project future population growth through fertility and deaths, and to project smoking rates through smoking initiation, cessation, and relapse.
SimSmoke begins in the baseline year 1993, with the population divided into current, never, and former smokers and distinguished by age and
Validation
Smoking prevalence (ages ≥18 years) from SimSmoke and the TUS and MATS are presented in Figure 1, Figure 2 for men and women, respectively. For both genders, smoking prevalence, as projected by SimSmoke, remained relatively constant from 1993 to 1997, then declined sharply beginning in 1998 with the steep price increase and implementation of a stronger tobacco control campaign. Another more rapid decline is seen following the $0.75 health-impact fee imposed in 2005 and with the 2007 state
Discussion
Smoking rates in Minnesota have fallen more than 34% in relative terms since 1993. Allowing for trends in the absence of policy, SimSmoke indicates that policies played a major role in Minnesota's steep decline in smoking rates, leading to a 29% relative reduction between 1993 and 2011 and reaching a 41% reduction by 2041. About 43% of the reduction in prevalence is explained by price increases, with about 20% from smokefree air laws and mass media campaign spending, 6.5% from youth-access
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