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G. P. RichardsonAAHB, March 2006
1
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
System Dynamics Mapping and Modeling for Tobacco Control
Working with Experts to Illustrate the Approach
George P. RichardsonRockefeller College of Public Affairs and Policy
University at Albany, SUNY
April RoggioRockefeller CollegeUniversity at Albany, SUNY
Peter OttoSchool of Business
Dowling College
G. P. RichardsonAAHB, March 2006
2
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
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
G. P. RichardsonAAHB, March 2006
3
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
The November Meeting: Initial Problem Conceptualization
• Hopes and Fears• Dynamics• Policy options
• Historical
• Speculative
G. P. RichardsonAAHB, March 2006
4
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Defining the Problem Dynamically:the Tobacco Use Sector
G. P. RichardsonAAHB, March 2006
5
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Idealized Graphs(Reference Behavior Modes)
Smokers in the US
Interest in cessation
G. P. RichardsonAAHB, March 2006
6
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Tobacco Industry
G. P. RichardsonAAHB, March 2006
7
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Idealized Graphs
Interest in cessation
Smokers in the US
Awareness of TI behavior
TI Marketing Activities
G. P. RichardsonAAHB, March 2006
8
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Tobacco Control
G. P. RichardsonAAHB, March 2006
9
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Government Intervention
G. P. RichardsonAAHB, March 2006
10
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Idealized Graphs
Interest in cessationSmokers in the US
Awareness of TI behavior
TI Marketing Activities
Funding for Tobacco Control
Strength of Tobacco Control Programs
G. P. RichardsonAAHB, March 2006
11
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
The Group’s List of Policies Tried
• Smoke-free workplaces (voluntary and state regulations)>> 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
G. P. RichardsonAAHB, March 2006
12
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
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
G. P. RichardsonAAHB, March 2006
13
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
The Group’s 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)
G. P. RichardsonAAHB, March 2006
14
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
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: “It’s addiction, stupid!”
G. P. RichardsonAAHB, March 2006
15
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
A Conceptual Map of the Tobacco Control System
The Beginnings of a Systems View of Tobacco Prevalence and Control
G. P. RichardsonAAHB, March 2006
16
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- ++
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
Any questions?
G. P. RichardsonAAHB, March 2006
17
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
Tobacco marketingactivities
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
18
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
SmokersPublic
awareness oftobacco health
risk
Tobacco marketingactivities
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
++
-
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
Trend in tobaccocompany revenues
+
-
-
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
19
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
+
+
+
-
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
++
-
Anti-tobaccoconstituencies
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
++
+
Trend in tobaccocompany revenues
+
-
-
+
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
20
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
+
+
+
-
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Anti-tobaccoconstituencies
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
++
+
+
Trend in tobaccocompany revenues
+
-
-
+
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
21
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
+
+
+
-
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
+
Trend in tobaccocompany revenues
+
-
-
+
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
22
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
+
+
+
-
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- + +
+
Tobaccotaxes
+
+
-
Trend in tobaccocompany revenues
+
-
-
+
++
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
23
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov.income
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Taxrevenues
fromsmokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- + +
+
Tobaccotaxes
++
+
-
Govt funding oftobacco control
+
Trend in tobaccocompany revenues
+
-
-
+
+
+
+
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
24
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov.income
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Taxrevenues
fromsmokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- + +
+
Tobaccotaxes
++
+
-
Govt funding oftobacco control
+
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
25
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov.income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Taxrevenues
fromsmokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobaccorevenues
+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding fortobacco health
research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- + +
+
Tobaccotaxes
++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+ <Perceived importance ofother health programs>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
<xxx>
<xxx>
G. P. RichardsonAAHB, March 2006
26
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Building Blocks of the Approach
Smokers
People quittingsmoking
-
People startingsmoking
+
A Stock and its Flows
G. P. RichardsonAAHB, March 2006
27
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking+
+
-
+
Reinforcing Loops
Four views
G. P. RichardsonAAHB, March 2006
28
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
-
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
-
+
Reinforcing Loops
Four views
G. P. RichardsonAAHB, March 2006
29
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
Tobacco marketingactivities
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
-
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
-
+
Reinforcing Loops
Four views
G. P. RichardsonAAHB, March 2006
30
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
SmokersPublic
awareness oftobacco health
risk
People quittingsmoking
-
Researchersawarness of
tobacco healthrisk
++
+
Balancing orCounteracting Loops
Three views
G. P. RichardsonAAHB, March 2006
31
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Gov. income
SmokersPublic
awareness oftobacco health
risk
Tax revenuesfrom smokers
+
People quittingsmoking
-
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
++
+
+
Balancing orCounteracting Loops
Three views
G. P. RichardsonAAHB, March 2006
32
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
Tax revenuesfrom smokers
+
+
+
People quittingsmoking
-
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
++
+
+
Govt funding oftobacco control
+
+
Balancing orCounteracting Loops
Three views
G. P. RichardsonAAHB, March 2006
33
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Publicawareness oftobacco health
risk
Researchersawarness of
tobacco healthrisk
Anti-tobaccoconstituencies
++
Anti-tobacco Constituencies
Two views
G. P. RichardsonAAHB, March 2006
34
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Tobacco controlprograms
Publicawareness oftobacco health
risk
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Anti-tobaccoconstituencies
++
+
+
Anti-tobacco Constituencies
Two views
G. P. RichardsonAAHB, March 2006
35
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
Smoking as asocial norm
Tobacco revenues+
Pro-tobaccocontituencies
+ +
Tobaccoproductioncapacity
+
Pro-tobacco Constituencies
Two views
G. P. RichardsonAAHB, March 2006
36
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
Tobacco marketingactivities
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
-
Pro-tobaccocontituencies
++ +
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
-
+
Pro-tobacco Constituencies
Two views
G. P. RichardsonAAHB, March 2006
37
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers
Tobacco marketingactivities
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
-
Pro-tobaccocontituencies
++ +
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
Trend in tobaccocompany revenues
+
-
-
+
Pro-tobacco Constituencies
Two views
G. P. RichardsonAAHB, March 2006
38
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
SmokersPublic
awareness oftobacco health
risk
Health care costs
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk +
+
+
Government Awareness of Health Risks
Three views
G. P. RichardsonAAHB, March 2006
39
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
SmokersPublic
awareness oftobacco health
risk
Health care costs
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk +
+
+
Government Awareness of Health Risks
Three views
G. P. RichardsonAAHB, March 2006
40
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
SmokersPublic
awareness oftobacco health
risk
+
+
Health care costs
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk +
+
Govt willingness toact against tobacco
+
+
Govt funding oftobacco control
+
Government Awareness of Health Risks
Three views
G. P. RichardsonAAHB, March 2006
41
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tax revenuesfrom smokers
+
Funding for tobaccohealth research
Govt awarenessof tobaccohealth risk
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
+
Govt willingness toact against tobacco
- ++
Tobacco taxes++
Govt funding oftobacco control
+
Anti-tobaccolegislation
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
Government Willingness to Act Against Tobacco
Two views
G. P. RichardsonAAHB, March 2006
42
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
Health care costs
+
Health insurerscoverage of tobacco
quitting costs
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk +
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccoproductioncapacity
+
+
+
++
+
Govt willingness toact against tobacco
- ++
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
G. P. RichardsonAAHB, March 2006
43
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
What Can One Say at This Point?
G. P. RichardsonAAHB, March 2006
44
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
Health care costs
+
Funding to supporttobacco quitting
efforts
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk
+
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccogrowers
+
+
+
++
+
Govt willingness toact against tobacco
-+ +
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
yyy
G. P. RichardsonAAHB, March 2006
45
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
Health care costs
+
Funding to supporttobacco quitting
efforts
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk
+
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccogrowers
+
+
+
++
+
Govt willingness toact against tobacco
-+ +
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
yyy
G. P. RichardsonAAHB, March 2006
46
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
+
+
+
+
Health care costs
+
Funding to supporttobacco quitting
efforts
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk
+
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccogrowers
+
+
+
++
+
Govt willingness toact against tobacco
-+ +
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
yyy
G. P. RichardsonAAHB, March 2006
47
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Funding for tobaccocontrol programs
Gov. income
Tobacco controlprograms
Smokers
Perceived importance ofother health programs
Publicawareness oftobacco health
risk
Pressure on tobaccocompanies to reducemarketing activities
Tobacco marketingactivities
Tax revenuesfrom smokers
+
+
+
-
+
People quittingsmoking
-
Smoking as asocial norm
People startingsmoking
Tobacco revenues+
++
+
+
Health care costs
+
Funding to supporttobacco quitting
efforts
+
+
Researchersawarness of
tobacco healthrisk
Funding for tobaccohealth research+
+
Govt awarenessof tobaccohealth risk
+
+
-
Pro-tobaccocontituencies
Anti-tobaccoconstituencies
++ +
+
Tobacco productsavailability
+
Tobaccogrowers
+
+
+
++
+
Govt willingness toact against tobacco
-+ +
+
Tobacco taxes++
+
-
Govt funding oftobacco control
+
-
Trend in tobaccocompany revenues
+
-
Anti-tobaccolegislation
-
+
+
+<Perceived importance
of other healthprograms>
+
Anti-tobaccolitigation
<Anti-tobaccolitigation>
xxx
yyy
G. P. RichardsonAAHB, March 2006
48
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
A “Shard” of a Tobacco Model
The Aging Chain of Smokers
G. P. RichardsonAAHB, March 2006
49
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
Adultsmokers
dying
<Fraction smoking>
G. P. RichardsonAAHB, March 2006
50
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
adult death rate
Adultsmokers
dying
<Fraction smoking>
Simple arithmetic for the flows
G. P. RichardsonAAHB, March 2006
51
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
teen birthrate
adult birthrateadult births
teen births
adult death rate
Adultsmokers
dying
<Fraction smoking>
Endogenous structure
G. P. RichardsonAAHB, March 2006
52
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
teen birthrate
adult birthrateadult births
teen births
teens notsmoking
<Teens>fraction of teensinitiated per year
adult death rate
Adultsmokers
dying
<Fraction smoking>
Smoking initiation arithmetic
G. P. RichardsonAAHB, March 2006
53
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
teen birthrate
adult birthrateadult births
teen births
teens notsmoking
<Teens>fraction of teensinitiated per year
adult death rate
Adultsmokers
dying
<Fraction smoking>
Smoking behavior carries along as population ages
G. P. RichardsonAAHB, March 2006
54
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
teen birthrate
adult birthrateadult births
teen births
children notsmoking teens not
smoking
adults notsmoking
elderly notsmoking
<Children>
<Teens> <Adults> <Elderly>fraction of children
initiated p yrfraction of teensinitiated per year
fraction of adultsinitiatied per year
fraction of elderlyinitiated per year
adult death rate
Adultsmokers
dying
<Fraction smoking>
G. P. RichardsonAAHB, March 2006
55
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children Teens Adultsbirths p year children maturing teens aging
Elderlyadults aging
elderly dyingadults dying
Childrensmoking
Teenssmoking
Adultssmoking
Elderlysmoking
new childrensmoking
child smokersmaturing
teen smokersaging
adult smokersaging
elderlysmokers
dying
fraction childrensmoking
fraction teenssmoking
fraction adultssmoking
fraction elderlysmoking
new teenssmoking
newadults
smoking
new elderlysmoking
child years teen years adult yearselderly years
teen birthrate
adult birthrateadult births
teen births
children notsmoking teens not
smoking
adults notsmoking
elderly notsmoking
<Children>
<Teens> <Adults> <Elderly>fraction of children
initiated p yrfraction of teensinitiated per year
fraction of adultsinitiatied per year
fraction of elderlyinitiated per year
adult death rate
Adultsmokers
dying
adult smokingdeath multiplier
elderly smokingdeath multplier
<adults dying>
<Fraction smoking>
Adult and elderly smokers have shorter lifespans
G. P. RichardsonAAHB, March 2006
56
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Cumulative Populations400 M
300 M
200 M
100 M
0
1980 1984 1988 1992 1996 2000 2004 2008 2012 2016 2020Time (Year)
Children : smoking chain baseTeens : smoking chain baseAdults : smoking chain baseElderly : smoking chain base
G. P. RichardsonAAHB, March 2006
57
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Fractions smoking0.4
0.3
0.2
0.1
0
1980 1985 1990 1995 2000 2005 2010 2015 2020Time (Year)
fraction children smoking : smoking chain basefraction teens smoking : smoking chain basefraction adults smoking : smoking chain basefraction elderly smoking : smoking chain base
G. P. RichardsonAAHB, March 2006
58
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers40 M
30 M
20 M
10 M
0
1980 1985 1990 1995 2000 2005 2010 2015 2020Time (Year)
Children smoking : smoking chain baseTeens smoking : smoking chain baseAdults smoking : smoking chain baseElderly smoking : smoking chain base
G. P. RichardsonAAHB, March 2006
59
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Total fraction smoking0.5
0.375
0.25
0.125
0
1980 1985 1990 1995 2000 2005 2010 2015 2020Time (Year)
Fraction smoking : smoking chain base dmnl
G. P. RichardsonAAHB, March 2006
60
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children smoking600,000
500,000
400,000
300,000
200,000
1980 1990 2000 2010 2020Time (Year)
Children smoking : cut child init in halfChildren smoking : smoking chain base
Cutting childhood initiation per year in half drops the children
smoking population in half, but it takes a long time.
G. P. RichardsonAAHB, March 2006
61
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Teens smoking5 M
4.75 M
4.5 M
4.25 M
4 M
1980 1990 2000 2010 2020Time (Year)
Teens smoking : cut child init in halfTeens smoking : smoking chain base
Cutting Childhood initiation has some effect on the Teen smoking population (but note the y-scale)
G. P. RichardsonAAHB, March 2006
62
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Adults smoking40 M
37.5 M
35 M
32.5 M
30 M
1980 1990 2000 2010 2020Time (Year)
Adults smoking : cut child init in halfAdults smoking : smoking chain base
…Almost no effect on the Adult smoking population
G. P. RichardsonAAHB, March 2006
63
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Elderly smoking30 M
27.5 M
25 M
22.5 M
20 M
1980 1990 2000 2010 2020Time (Year)
Elderly smoking : cut child init in halfElderly smoking : smoking chain base
…No discernable effect on the Elderly smoking population
G. P. RichardsonAAHB, March 2006
64
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Fraction smoking1
0.75
0.5
0.25
0
1980 1990 2000 2010 2020Time (Year)
Fraction smoking : cut child init in half dmnlFraction smoking : smoking chain base dmnl
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.
G. P. RichardsonAAHB, March 2006
65
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Teens smoking6 M
5 M
4 M
3 M
2 M
1980 1990 2000 2010 2020Time (Year)
Teens smoking : cut teen init in halfTeens smoking : cut child init in halfTeens smoking : smoking chain base
Cutting Teen smoking initiation per year in half
G. P. RichardsonAAHB, March 2006
66
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Adults smoking40 M
35 M
30 M
25 M
20 M
1980 1990 2000 2010 2020Time (Year)
Adults smoking : cut teen init in halfAdults smoking : cut child init in halfAdults smoking : smoking chain base
Cutting Teen smoking initiation significantly reduces the Adult smoking population over time
G. P. RichardsonAAHB, March 2006
67
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Elderly smoking30 M
27.5 M
25 M
22.5 M
20 M
1980 1990 2000 2010 2020Time (Year)
Elderly smoking : cut teen init in halfElderly smoking : cut child init in halfElderly smoking : smoking chain base
Cutting Teen smoking initiation significantly cuts the Elderly smoking population
G. P. RichardsonAAHB, March 2006
68
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Fraction smoking0.4
0.325
0.25
0.175
0.1
1980 1990 2000 2010 2020Time (Year)
Fraction smoking : cut teen init in half dmnlFraction smoking : cut child init in half dmnlFraction smoking : smoking chain base dmnl
…and significantly lowers the fraction of the population who smoke
(Cutting Adult smoking initiation behaves similarly)
G. P. RichardsonAAHB, March 2006
69
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Fraction smoking0.4
0.325
0.25
0.175
0.1
1980 1990 2000 2010 2020Time (Year)
Fraction smoking : cutting all initiation dmnlFraction smoking : cut adult init in half dmnlFraction smoking : cut teen init in half dmnlFraction smoking : cut child init in half dmnlFraction smoking : smoking chain base dmnl
Cutting all initiation rates by half significantly cuts the fraction of the population who smoke
G. P. RichardsonAAHB, March 2006
70
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers dying2 M
1.75 M
1.5 M
1.25 M
1 M
1980 1990 2000 2010 2020Time (Year)
Smokers dying : cutting all initiation people/YearSmokers dying : cut adult init in half people/YearSmokers dying : cut teen init in half people/YearSmokers dying : cut child init in half people/YearSmokers dying : smoking chain base people/Year
Cutting all initiation by half has a significant impact on deaths from smoking
G. P. RichardsonAAHB, March 2006
71
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Children smoking800,000
700,000
600,000
500,000
400,000
1980 1990 2000 2010 2020Time (Year)
Children smoking : safer tobacco peopleChildren smoking : smoking chain base people
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.
G. P. RichardsonAAHB, March 2006
72
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Teens smoking6 M
5.5 M
5 M
4.5 M
4 M
1980 1990 2000 2010 2020Time (Year)
Teens smoking : safer tobacco peopleTeens smoking : smoking chain base people
…More Teens smoking
G. P. RichardsonAAHB, March 2006
73
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Adults smoking40 M
37.5 M
35 M
32.5 M
30 M
1980 1990 2000 2010 2020Time (Year)
Adults smoking : safer tobacco peopleAdults smoking : smoking chain base people
…More Adults smoking
G. P. RichardsonAAHB, March 2006
74
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Elderly smoking40 M
32.5 M
25 M
17.5 M
10 M
1980 1990 2000 2010 2020Time (Year)
Elderly smoking : safer tobacco peopleElderly smoking : smoking chain base people
…More Elderly smoking
G. P. RichardsonAAHB, March 2006
75
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Fraction smoking0.4
0.35
0.3
0.25
0.2
1980 1990 2000 2010 2020Time (Year)
Fraction smoking : safer tobacco dmnlFraction smoking : smoking chain base dmnl
…Greater fraction of the population smoking
G. P. RichardsonAAHB, March 2006
76
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
Smokers dying2 M
1.75 M
1.5 M
1.25 M
1 M
1980 1990 2000 2010 2020Time (Year)
Smokers dying : safer tobacco people/YearSmokers dying : smoking chain base people/Year
…Lower death rate for a while, but more smokers eventually mean more smoking-related deaths
G. P. RichardsonAAHB, March 2006
77
Rockefeller College of Public Affairs and PolicyRockefeller College of Public Affairs and PolicyUniversity at AlbanyUniversity at Albany
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
