How many cigarettes a day in an endgame? Michael Chaiton Ontario Tobacco Research Unit (OTRU) Dalla Lana School of Public Health University of Toronto

Acknowledgements Emmanuel Guindon, McMaster University A Tobacco Endgame For Canada Summit; Elizabeth Eisenhauer Canadian Cancer Society #702160

What does a tobacco endgame look like? Dispelling Myths What does a tobacco endgame look like?

As prevalence declines, population of smokers “hardens” Dispelling Myths Hardcore Hypothesis: As prevalence declines, population of smokers “hardens”

What should our expectations be? Dispelling Myths What should our expectations be?

Methods A population change model for the Province of Ontario, Canada Population predictions from Statistics Canada for the period 2016-2035 including expected births, deaths, and immigration by age group (12-19, 20-34, 35-44, 45-64, 65+). Smoking prevalence was obtained from the Canadian Community Health Survey. Change in cigarettes per day was modelled assuming that the effects on cigarettes per day was consistent with taxation increases driving population change, smooth rate of change

Change in Prevalence

Change in Prevalence 2.1 million, 2016 Expected: 1.9 million by 2035 Needed: 702,000 by 2035

Change in Cigarettes per Day

Change in Cigarettes per Day

Change in Cigarette per Day From 28 million cigarettes per day to 2.8 million per day Suggests that taxation increases should be part of an endgame strategy to maintain revenue Different levers may have different effects on consumption vs prevalence

Assumptions This finding is driven by the consistent empirical observation that price increases act roughly equally on consumption and prevalence Chaiton, Cohen, Frank, 2008

Dispelling Myths Prevalence changes are driven by structural changes that affect the likelihood of people smoking Under most circumstances, we should assume that changes will also affect consumption

Conclusions Revisit our assumptions of the tobacco endgame Expectation should be that interventions that affect prevalence will also affect number of cigarettes per day