System Dynamics Mapping and Modeling for Tobacco Control Working with Experts to Illustrate the Approach

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System Dynamics Mapping and Modeling for Tobacco
ControlWorking with Experts to Illustrate the
Approach

• George P. RichardsonRockefeller College of
  Public Affairs and PolicyUniversity at Albany,
  SUNY

April Roggio Rockefeller CollegeUniversity at
Albany, SUNY
Peter Otto School of Business Dowling College
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System Dynamics in ISIS

• Initial problem definition meeting, November 2003
• Rapid mapping and illustrative modeling, reported
  on in December 2003
• Further modeling over spring and summer 2004, but
  without further expert input
• Report writing led by the ISIS Team

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The November Meeting Initial Problem
Conceptualization

• Hopes and Fears
• Dynamics
• Policy options
• Historical
• Speculative

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Defining the Problem Dynamicallythe Tobacco Use
Sector
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Idealized Graphs(Reference Behavior Modes)
Interest in cessation
Smokers in the US
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Tobacco Industry
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Idealized Graphs
Awareness of TI behavior
Interest in cessation
TI Marketing Activities
Smokers in the US
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Tobacco Control
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Government Intervention
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Idealized Graphs
Awareness of TI behavior
Interest in cessation
Smokers in the US
TI Marketing Activities
Funding for Tobacco Control
Strength of Tobacco Control Programs
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The Groups List of Policies Tried

• Smoke-free workplaces (voluntary and state
  regulations)gtgt changes in social norms
• Increased unit cost through taxes (industry
  compensated, variability between states)
• Decreased agricultural subsidies
• Warning labels
• Youth access restrictions
• Advertising restrictions (TV, outdoors)

• Ad campaigns (counteradvertising)
• Availability of cessation meds
• Product regulation
• Comprehensive school and educational programs
• State bans on cigarette sales
• Purchase, use, and possession prosecution
• Federal funding

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More Policies tried

• Licensing merchants
• Removed from k-rations (military)
• Military parity prices
• Behavioral programs to help people quit (24 of
  adults smoke now -- a decrease)
• Less smoking in movies (this goes up and down)
• Litigation (move from laws to litigation)

• Public health service guidelines, CDC best
  practices, sgrs, NCI monographs
• Fire safe cigarettes
• Tar and nicotine testing methods/ harm reduction
• FTC monitoring of advertising and promotion ()
• Increased research funding
• Coalition development

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The Groups List of Policies to Try

• Federal support for national quitlines
• Criminal charges against the tobacco industry
• Repeal of federal cigarette labeling in
  advertising
• Ratify and implement FCTCFDA regulation of
  tobacco

• Modify FTC testing methods
• Total ban on advertising
• Increased federal excise taxes to a minimum of 2
  per pack
• Reform campaign finance laws (unclear tobacco
  industry could retaliate)

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More Policies to Try

• Earmark MSA and excise taxes for tobacco control
  (increase tobacco control funding)
• Health trumps trade (change social/political
  norms government and advocate support)

• Require health care providers to give smoking
  cessation treatment (may help people quit)
• Require tobacco industry to pay for all
  tobacco-related health
• Ad campaign Its addiction, stupid!

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A Conceptual Map of the Tobacco Control System

• The Beginnings of a Systems View of Tobacco
  Prevalence and Control

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Any questions?
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Building Blocks of the Approach
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What Can One Say at This Point?
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A Shard of a Tobacco Model

• The Aging Chain of Smokers

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Simple arithmetic for the flows
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Endogenous structure
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Smoking initiation arithmetic
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Smoking behavior carries along as population ages
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Adult and elderly smokers have shorter lifespans
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Cutting childhood initiation per year in half
drops the children smoking population in half,
but it takes a long time.
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Cutting Childhood initiation has some effect on
the Teen smoking population (but note the y-scale)
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Almost no effect on the Adult smoking population
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No discernable effect on the Elderly smoking
population
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Cutting childhood initiation in half has almost
no discernable effect on the fraction smoking,
even after 40 years.
Implication Cutting childhood initiation saves
individual kids, but is not a high leverage
policy for the population.
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Cutting Teen smoking initiation per year in half
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Cutting Teen smoking initiation significantly
reduces the Adult smoking population over time
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Cutting Teen smoking initiation significantly
cuts the Elderly smoking population
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and significantly lowers the fraction of the
population who smoke
(Cutting Adult smoking initiation behaves
similarly)
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Cutting all initiation rates by half
significantly cuts the fraction of the population
who smoke
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Cutting all initiation by half has a significant
impact on deaths from smoking
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What happens if the tobacco industry introduces
safe tobacco products, cutting the health risk
in half?
More children will start smoking since the risk
is less.
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More Teens smoking
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More Adults smoking
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More Elderly smoking
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Greater fraction of the population smoking
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Lower death rate for a while, but more smokers
eventually mean more smoking-related deaths
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Further Work

• An illustration of the system dynamics approach,
  working with experts to build a robust,
  endogenous view of tobacco prevalence and control
  policies
• Further ISIS modeling at the University at Albany
  carried on by April Roggio reported on in the
  ISIS report
• Potential future collaborative work with the
  Network and Knowledge Management experts of ISIS
• Realize the promise of ISIS