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

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

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

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

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

6. Methods A population change model for the Province of Ontario, Canada
Population predictions from Statistics Canada for the period 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

7. Change in Prevalence

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

9. Change in Cigarettes per Day

10. Change in Cigarettes per Day

11. 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

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

13. 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

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