What measures are needed to achieve a tobacco endgame target? A Singapore-based simulation study

Abstract

BackgroundAn increasing number of countries are pursuing a tobacco ‘endgame’. We sought to determine the combination of measures it would take to achieve a tobacco endgame in the city-state of Singapore.MethodsUsing an open-cohort microsimulation model, we estimated the impact of existing measures (quit programmes, tobacco taxes, flavours ban) and more novel measures (very low nicotine cap, tobacco-free generation, raising the minimum legal age to 25 years), and combinations thereof, on smoking prevalence in Singapore over a 50-year horizon. We used Markov Chain Monte Carlo to estimate transition probabilities between the states of never smoker, current smoker and former smoker, updating each individual’s state across each year with prior distributions derived from national survey data.ResultsWithout new measures, smoking prevalence is expected to rebound from 12.2% (2020) to 14.8% (2070). The only scenarios to achieve a tobacco endgame target within a decade are those combining a very low nicotine cap with a flavours ban. A nicotine cap or tobacco-free generation alone also achieve endgame targets, but after 20 and 39 years, respectively. Taxes, quit programmes, a flavours ban and minimum legal age increase do augment the impact of other measures, but even when combined are insufficient to achieve a tobacco endgame target within 50 years.ConclusionIn Singapore, achieving a tobacco endgame within a decade requires a very low nicotine cap coupled with a tobacco flavours ban, although this target can also be achieved in the long term (within 50 years) with a tobacco-free generation.

Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea

“…Singh et al 11 reported that residents of the Solomon Islands would be expected to gain 798 HALYs per 1000 people if smoking was restricted to those ≤20 years of age from 2016 11 . Furthermore, the tobacco endgame goal was predicted to be attained by the TFG alone, which was expected to be more effective than gradually raising the minimum legal age of smoking to 25 years 10 . However, it will take a long time to lower smoking prevalence and reap health gains because current smokers are unaffected by the TFG 10,12 .…”

“…Furthermore, the tobacco endgame goal was predicted to be attained by the TFG alone, which was expected to be more effective than gradually raising the minimum legal age of smoking to 25 years 10 . However, it will take a long time to lower smoking prevalence and reap health gains because current smokers are unaffected by the TFG 10,12 . Therefore, we suggest introducing the TFG together with aggressive tax increases and implementation of MPOWER policies to end the tobacco epidemic.…”

“…Using simulation modeling, prior studies have predicted the effect of the TFG strategy or annual tobacco tax increases in Singapore 9,10 , the Solomon Islands 11 , and New Zealand 4, 12 . The Singapore study simulated smoking prevalence and qualityadjusted life years (QALYs) based on the TFG strategy, e-cigarette use, and tax increases 9 .…”