Abstract
Background: Smokeless tobacco (SLT) prevalence was decreasing in Kentucky before 2007, 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. Methods: Using 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 2017. The model was used to estimate the impact on smoking and SLT prevalence and attributable deaths of policies implemented between 1993 and 2018 and the impact of stronger future policies implemented in 2018 and maintained through 2060. Results: SimSmoke 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 1993 and 2018 reduced male and female cigarette use by 23.7% and 23.0%, and male and female SLT use by 4.9% by 2018, averting 9018 tobacco-attributable deaths by 2018, increasing to 89 547 by 2060. The largest reductions in cigarette and SLT use were attributed to cigarette price increases. Strengthening tobacco control policies could reduce smoking prevalence by 41% and 40%, and reduce SLT prevalence by 33% and 25% for males and females by 2060. Conclusion: Our 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.
Highlights
Kentucky has one of the highest rates of cigarette smoking prevalence in the United States at about 24.6% in 2017,1 compared to 14.0% for the United States as a whole.[2]
With smokeless tobacco (SLT) use increasing in recent years, policies directed at SLT may play a role
With cigarette manufacturers having acquired major SLT firms, it is important to monitor the role of the cigarette industry, as it has strong incentives to protect the high profits from cigarettes
Summary
Kentucky has one of the highest rates of cigarette smoking prevalence in the United States at about 24.6% in 2017,1 compared to 14.0% for the United States as a whole.[2]. While much of SLT use takes the traditional forms of snuff and chewing tobacco, new forms of smokeless, such as different varieties of snus and other oral tobacco products, have become available in recent years.[10,11] With lower health risks than cigarettes,[12,13,14] these products may reduce the harms associated with cigarettes Their impact will depend on the relationship of SLT use to smoking.[15] If SLT use reduces smoking initiation or helps smokers who would not have otherwise quit to either quit or entirely switch to SLTs, public health improves. A better understanding of patterns of SLT use, especially among youth and young adults, and of the effects of tobacco control policies on SLT use may be helpful in understanding the public health impact of e-cigarette vis-à-vis cigarette use and the potential impact of policies on that use
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