The development of a microsimulation decision-support tool for national and regional nicotine and tobacco control policies

Huang, Wanjing ORCID: 0000-0002-2569-0701 (2024) The development of a microsimulation decision-support tool for national and regional nicotine and tobacco control policies. Doctor of Philosophy thesis, University of Liverpool.

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Abstract

In England, smoking prevalence has almost halved over the past four decades. However, substantial inequalities remain. Furthermore, electronic cigarette usage is rapidly increasing, especially among young people. I therefore aimed to develop a microsimulation model to help inform future tobacco control decision-making, both locally and nationally. I first systematically reviewed previously published tobacco control Policy Simulation Models (PSMs) (Chapter 2). Based on that analysis, I proposed a quality framework (Chapter 3) to facilitate the development of a new, high-quality tobacco control PSM explicitly addressing model inputs, structure, and outputs. I then developed and refined a novel tobacco control microsimulation model, IMPACTHINT (Chapter 4), which sought to meet these quality criteria. I then used it to quantify and compare the 50-year health, economics and equity impacts of five potential tobacco control policies: simply continuing the status quo; increasing the minimum age of access to tobacco to 21 years; increasing tobacco duty by 30%; improving smoking cessation services; or combining improved smoking cessation services with a 30% tobacco duty increase. Combining increased taxation and improved smoking cessation services appeared to be the best strategy applied nationally (Chapter 5). However, none of the enhanced policies would reduce smoking prevalence below 5% by 2030 (tobacco-free generation definition). Furthermore, the most deprived fifth of the population might take 6 years longer to achieve that ‘tobacco-free’ 5% target than the most affluent quintile. In Chapter 6, I focused on England’s North West region, which historically has an even higher smoking-related disease burden. All additional policies would reduce smoking prevalence, with the combined policy again representing the most effective and equitable approach. I then considered electronic cigarettes (eCigs), and reviewed the methodologies used by existing eCigs PSMs (Chapter 7). Few considered any possible ‘gateway effect’ in youngsters, and none assessed equity outcomes. Furthermore, a quarter of the models were industry-funded mostly just reporting mortality and morbidity outcomes. Lastly, I extended IMPACTHINT to project eCigs trends in England over the next 15 years (Chapter 8). By 2027, vaping prevalence is likely to overtake smoking prevalence. Furthermore, by 2038, eCig use could double to approximately 20% overall, perhaps exceeding 23% in more deprived groups. In conclusion, building on earlier tobacco and eCigs policy simulation models, I developed, calibrated and validated IMPACTHINT . I demonstrated its utility for simulating health, economic and equity impacts, and generated outputs of potential value for regional and national policymaking.

Item Type:	Thesis (Doctor of Philosophy)
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health
Depositing User:	Symplectic Admin
Date Deposited:	18 Sep 2024 13:31
Last Modified:	18 Sep 2024 13:32
DOI:	10.17638/03181787
Supervisors:	Kypridemos, Chris Buchan, iain Capewell, Simon
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3181787