G. P. Richardson AAHB, March 2006 1 Rockefeller College of Public Affairs and Policy University at Albany System Dynamics Mapping and Modeling for Tobacco.

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G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany System Dynamics Mapping and Modeling for Tobacco Control Working with Experts to Illustrate the Approach George P. Richardson Rockefeller College of Public Affairs and Policy University at Albany, SUNY April Roggio Rockefeller College University at Albany, SUNY Peter Otto School of Business Dowling College

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany The November Meeting: Initial Problem Conceptualization Hopes and Fears Dynamics Policy options Historical Speculative

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Defining the Problem Dynamically: the Tobacco Use Sector

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Idealized Graphs (Reference Behavior Modes) Smokers in the US Interest in cessation

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Tobacco Industry

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Idealized Graphs Interest in cessation Smokers in the US Awareness of TI behavior TI Marketing Activities

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Tobacco Control

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Government Intervention

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Idealized Graphs Interest in cessation Smokers in the US Awareness of TI behavior TI Marketing Activities Funding for Tobacco Control Strength of Tobacco Control Programs

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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 FCTC FDA 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany A Conceptual Map of the Tobacco Control System The Beginnings of a Systems View of Tobacco Prevalence and Control

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Any questions?

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Building Blocks of the Approach

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany What Can One Say at This Point?

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany A “Shard” of a Tobacco Model The Aging Chain of Smokers

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Simple arithmetic for the flows

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Endogenous structure

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Smoking initiation arithmetic

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Smoking behavior carries along as population ages

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Adult and elderly smokers have shorter lifespans

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting childhood initiation per year in half drops the children smoking population in half, but it takes a long time.

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting Childhood initiation has some effect on the Teen smoking population (but note the y-scale)

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …Almost no effect on the Adult smoking population

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …No discernable effect on the Elderly smoking population

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation per year in half

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation significantly reduces the Adult smoking population over time

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation significantly cuts the Elderly smoking population

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …and significantly lowers the fraction of the population who smoke (Cutting Adult smoking initiation behaves similarly)

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting all initiation rates by half significantly cuts the fraction of the population who smoke

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany Cutting all initiation by half has a significant impact on deaths from smoking

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany 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. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …More Teens smoking

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …More Adults smoking

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …More Elderly smoking

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …Greater fraction of the population smoking

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University at Albany …Lower death rate for a while, but more smokers eventually mean more smoking-related deaths

G. P. Richardson AAHB, March Rockefeller College of Public Affairs and Policy University 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