1. G. P. Richardson AAHB, March 2006 1 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

2. G. P. Richardson AAHB, March 2006 2 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

3. G. P. Richardson AAHB, March 2006 3 Rockefeller College of Public Affairs and Policy University at Albany The November Meeting: Initial Problem Conceptualization Hopes and Fears Dynamics Policy options Historical Speculative

4. G. P. Richardson AAHB, March 2006 4 Rockefeller College of Public Affairs and Policy University at Albany Defining the Problem Dynamically: the Tobacco Use Sector

5. G. P. Richardson AAHB, March 2006 5 Rockefeller College of Public Affairs and Policy University at Albany Idealized Graphs (Reference Behavior Modes) Smokers in the US Interest in cessation

6. G. P. Richardson AAHB, March 2006 6 Rockefeller College of Public Affairs and Policy University at Albany Tobacco Industry

7. G. P. Richardson AAHB, March 2006 7 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

8. G. P. Richardson AAHB, March 2006 8 Rockefeller College of Public Affairs and Policy University at Albany Tobacco Control

9. G. P. Richardson AAHB, March 2006 9 Rockefeller College of Public Affairs and Policy University at Albany Government Intervention

10. G. P. Richardson AAHB, March 2006 10 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

11. G. P. Richardson AAHB, March 2006 11 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

12. G. P. Richardson AAHB, March 2006 12 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

13. G. P. Richardson AAHB, March 2006 13 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)

14. G. P. Richardson AAHB, March 2006 14 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!”

15. G. P. Richardson AAHB, March 2006 15 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

16. G. P. Richardson AAHB, March 2006 16 Rockefeller College of Public Affairs and Policy University at Albany Any questions?

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26. G. P. Richardson AAHB, March 2006 26 Rockefeller College of Public Affairs and Policy University at Albany Building Blocks of the Approach

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43. G. P. Richardson AAHB, March 2006 43 Rockefeller College of Public Affairs and Policy University at Albany What Can One Say at This Point?

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48. G. P. Richardson AAHB, March 2006 48 Rockefeller College of Public Affairs and Policy University at Albany A “Shard” of a Tobacco Model The Aging Chain of Smokers

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50. G. P. Richardson AAHB, March 2006 50 Rockefeller College of Public Affairs and Policy University at Albany Simple arithmetic for the flows

51. G. P. Richardson AAHB, March 2006 51 Rockefeller College of Public Affairs and Policy University at Albany Endogenous structure

52. G. P. Richardson AAHB, March 2006 52 Rockefeller College of Public Affairs and Policy University at Albany Smoking initiation arithmetic

53. G. P. Richardson AAHB, March 2006 53 Rockefeller College of Public Affairs and Policy University at Albany Smoking behavior carries along as population ages

54. G. P. Richardson AAHB, March 2006 54 Rockefeller College of Public Affairs and Policy University at Albany

55. G. P. Richardson AAHB, March 2006 55 Rockefeller College of Public Affairs and Policy University at Albany Adult and elderly smokers have shorter lifespans

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60. G. P. Richardson AAHB, March 2006 60 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.

61. G. P. Richardson AAHB, March 2006 61 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)

62. G. P. Richardson AAHB, March 2006 62 Rockefeller College of Public Affairs and Policy University at Albany …Almost no effect on the Adult smoking population

63. G. P. Richardson AAHB, March 2006 63 Rockefeller College of Public Affairs and Policy University at Albany …No discernable effect on the Elderly smoking population

64. G. P. Richardson AAHB, March 2006 64 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.

65. G. P. Richardson AAHB, March 2006 65 Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation per year in half

66. G. P. Richardson AAHB, March 2006 66 Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation significantly reduces the Adult smoking population over time

67. G. P. Richardson AAHB, March 2006 67 Rockefeller College of Public Affairs and Policy University at Albany Cutting Teen smoking initiation significantly cuts the Elderly smoking population

68. G. P. Richardson AAHB, March 2006 68 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)

69. G. P. Richardson AAHB, March 2006 69 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

70. G. P. Richardson AAHB, March 2006 70 Rockefeller College of Public Affairs and Policy University at Albany Cutting all initiation by half has a significant impact on deaths from smoking

71. G. P. Richardson AAHB, March 2006 71 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.

72. G. P. Richardson AAHB, March 2006 72 Rockefeller College of Public Affairs and Policy University at Albany …More Teens smoking

73. G. P. Richardson AAHB, March 2006 73 Rockefeller College of Public Affairs and Policy University at Albany …More Adults smoking

74. G. P. Richardson AAHB, March 2006 74 Rockefeller College of Public Affairs and Policy University at Albany …More Elderly smoking

75. G. P. Richardson AAHB, March 2006 75 Rockefeller College of Public Affairs and Policy University at Albany …Greater fraction of the population smoking

76. G. P. Richardson AAHB, March 2006 76 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

77. G. P. Richardson AAHB, March 2006 77 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