Chapter 4: Development of the counterfactual smoking histories used to assess the effects of tobacco control

Abstract

Publication of the Surgeon General's Report in 1964 marshaled evidence of the harm to public health caused by cigarette smoking, including lung cancer mortality, and provided an impetus for introducing control programs. The purpose of this article is to develop estimates of their effect on basic smoking exposure input parameters related to introduction of the report. Fundamental inputs used to generate exposure to cigarettes are initiation and cessation rates for men and women, as well as the distribution of the number of cigarettes smoked per day. These fundamental quantities are presented for three scenarios: actual tobacco control in the United States; no tobacco control in which the experience before 1955 was assumed to continue; and complete tobacco control in which all smoking ceased following publication of the report. These results were derived using data from National Health Interview Surveys, and they provide basic input parameters for the Smoking History Generator used by each of the lung cancer models developed by the Cancer Intervention and Surveillance Modeling Network.

Figure 1

Temporal relationships between ages and periods of interest, cohorts with available smoking history data, appearance of Surgeon General’s (SG) Report, and years before tobacco control.

Figure 2

Smoking initiation rates for the US: Observed (dots and broken line), fitted (light solid line) and and counterfactual source data (shaded region).

Figure 3

Smoking cessation rates by age and selected birth cohorts.

Figure 4

Smoking initiation rates for US white males: Observed (dots and broken line), fitted (light solid line) and counterfactual source data (shaded region).

Figure 5

Smoking cessation rates for US white males.

Figure 6

Mean cigarettes per day for third quintile by year and cohort.