Luz María Sánchez-Romero - Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
Eugene Yuan - Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
Yameng Li - Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
David T. Levy - Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA

BackgroundSmokeless tobacco (SLT) prevalence was decreasing in Kentucky before ۲۰۰۷, but has since increased. This study examines the impact of policies on cigarette and SLT use by applying the SimSmoke tobacco control policy simulation model. MethodsUsing data from the large-scale Tobacco Use Supplement of the Current Population Survey (TUS-CPS) and information on state-specific tobacco policies, Kentucky SimSmoke is updated and extended to incorporate exclusive SLT and dual cigarette and SLT use. The model is validated using survey data through ۲۰۱۷. The model was used to estimate the impact on smoking and SLT prevalence and attributable deaths of policies implemented between ۱۹۹۳ and ۲۰۱۸ and the impact of stronger future policies implemented in ۲۰۱۸ and maintained through ۲۰۶۰. ResultsSimSmoke generally reflects trends in exclusive cigarette use from the TUS-CPS and the Behavioral Risk Factor Surveillance System (BRFSS), but underestimated the increase in SLT prevalence in recent years. SimSmoke projects that policies implemented between ۱۹۹۳ and ۲۰۱۸ reduced male and female cigarette use by ۲۳.۷% and ۲۳.۰%, and male and female SLT use by ۴.۹% by ۲۰۱۸, averting ۹۰۱۸ tobacco-attributable deaths by ۲۰۱۸, increasing to ۸۹ ۵۴۷ by ۲۰۶۰. The largest reductions in cigarette and SLT use were attributed to cigarette price increases. Strengthening tobacco control policies could reduce smoking prevalence by ۴۱% and ۴۰%, and reduce SLT prevalence by ۳۳% and ۲۵% for males and females by ۲۰۶۰. ConclusionOur results suggest that cigarette-oriented policies were effective in reducing SLT use but have been less successful in recent years. Future use rates can be further reduced through more restrictive statewide policies, which also target non-combustible nicotine products.

Smokeless Tobacco, Cigarette, Tobacco Policy, Simulation