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
Rockefeller College of Public Affairs and Policy
University at Albany
Peter Otto
School of Business
Dowling College
G. P. Richardson
AAHB, March 2006
1
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
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
2
The November Meeting:
Initial Problem Conceptualization
• Hopes and Fears
• Dynamics
• Policy options
• Historical
• Speculative
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
3
Defining the Problem Dynamically:
the Tobacco Use Sector
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
4
Idealized Graphs
(Reference Behavior Modes)
Interest in cessation
Smokers in the US
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
5
Tobacco Industry
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
6
Idealized Graphs
Awareness of TI behavior
Interest in cessation
TI Marketing Activities
Smokers in the US
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
7
Tobacco Control
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
8
Government Intervention
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
9
Idealized Graphs
Awareness of TI behavior
Smokers in the US
Interest in cessation
TI Marketing Activities
Funding for Tobacco Control
Strength of Tobacco Control Programs
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
10
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)
Rockefeller College of Public Affairs and Policy
University at Albany
•
•
•
•
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 2006
11
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)
Rockefeller College of Public Affairs and Policy
University at Albany
• 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 2006
12
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
Rockefeller College of Public Affairs and Policy
University at Albany
• 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 2006
13
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)
Rockefeller College of Public Affairs and Policy
University at Albany
• 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 2006
14
A Conceptual Map of the Tobacco
Control System
The Beginnings of a Systems View of
Tobacco Prevalence and Control
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
15
<Anti-tobacco
litigation>
Perceived importance of
other health programs
-
+
+
Any questions?
+
+Tobacco taxes
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
++
+
+
Trend in tobacco
company revenues
+
Tobacco
production
capacity
+
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
-
+
Tobacco marketing
activities -
+Gov. income
+
Funding for tobacco
health research
+
+
Smokers
+
Tax revenues
from smokers
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tobacco revenues
+
Anti-tobacco
constituencies
+
+
Health care costs
Anti-tobacco
litigation
Anti-tobacco
legislation
<Perceived importance
of other health
programs>
- Govt willingness to +
act against tobacco
Tobacco products
+
availability
xxx
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
16
<xxx>
Smokers
Tobacco
revenues
+
+
Smoking as a
social norm
+
+
People starting
+ smoking
+
+
+
Tobacco
production
capacity
Tobacco marketing
activities
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
17
<xxx>
Researchers
awarness of
tobacco health
risk
+
+
Smokers
Tobacco
revenues
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
Funding for
tobacco health
research
-
+
+
People starting
+ smoking People quitting
smoking
+
-
+
Public
awareness of
tobacco health
risk
-
Tobacco marketing
activities
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
18
<xxx>
Anti-tobacco
constituencies
+
+
+
Researchers
awarness of
tobacco health
risk
+
+
Smokers
Tobacco
revenues
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
-
+
+
People starting
+ smoking People quitting
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
-
Tobacco marketing
activities -
Funding for
tobacco health
research
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
19
<xxx>
Govt awareness
of tobacco
health risk
+
+
Anti-tobacco
constituencies
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
-
+
+
People starting
+ smoking People quitting
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
-
Tobacco marketing
activities -
Funding for
tobacco health
research
+
+
Smokers
Tobacco
revenues
+
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
20
<xxx>
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
++ +
+
Anti-tobacco
constituencies
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
-
+
+
People starting
+ smoking People quitting
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
-
Tobacco marketing
activities -
Funding for
tobacco health
research
+
+
Smokers
Tobacco
revenues
+
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
21
<xxx>
Govt willingness to
act against tobacco
-
+
Tobacco
taxes
+
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
++ +
+
+
Anti-tobacco
constituencies
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
-
+
Funding for tobacco
control programs
+
+
+
+
+
People starting
+ smoking People quitting
+
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
+
-
Tobacco marketing
activities -
Funding for
tobacco health
research
+
+
Smokers
Tobacco
revenues
+
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
22
<xxx>
Govt willingness to
act against tobacco
-
++ +
+
+
+
Tobacco
taxes
+
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
-
Funding for
tobacco health
research
+
+
Funding for tobacco
control programs
+
+
+
+
+
People starting
+ smoking People quitting
+
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
+
-
Tobacco marketing
activities -
Gov.
income
+
+
Smokers
+
+Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tax
revenues
from
smokers
Anti-tobacco
constituencies
+
+
Health care costs
Tobacco
revenues
+
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
23
<xxx>
Govt willingness to
act against tobacco
-
++ +
Anti-tobacco
legislation
+
+
+
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
-
Gov.
income
Funding for
tobacco health
research
+
+
Funding for tobacco
control programs
+
+
+
+
+
People starting
+ smoking People quitting
+
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
+
-
Tobacco marketing
activities -
+
+
+
Smokers
Trend in tobacco
company revenues
Tax
revenues
from
smokers
+Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
+
Anti-tobacco
constituencies
+
+
Health care costs
Anti-tobacco
litigation
Tobacco
revenues
Tobacco
taxes
+
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
+
+
+
<Anti-tobacco
litigation>
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
24
<xxx>
Perceived importance of
other health programs
-
Govt willingness to
act against tobacco
-
++ +
Anti-tobacco
legislation
+
+
+
+
+
Tobacco
production
capacity
Smoking as a
social norm
+
-
Gov.
income
Funding for
tobacco health
research
+
+
Funding for tobacco
control programs
+
+
+
+
+
People starting
+ smoking People quitting
+
smoking
+
-
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
+
-
Tobacco marketing
activities -
+
+
+
Smokers
Trend in tobacco
company revenues
Tax
revenues
from
smokers
<Perceived importance of
other health programs>
+Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
+
Anti-tobacco
constituencies
+
+
Health care costs
Anti-tobacco
litigation
Tobacco
revenues
Tobacco
taxes
+
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
+
+
+
<Anti-tobacco
litigation>
Tobacco products
+
availability
<xxx>
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
25
Building Blocks of the Approach
A Stock and its Flows
Smokers
+
People starting
smoking
People quitting
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
26
Reinforcing Loops
Smokers
+
Smoking as a
social norm
-
+
People starting
smoking
+
People quitting
smoking
-
Four views
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
27
Reinforcing Loops
Smokers
+
Tobacco revenues
+
Smoking as a
social norm
+
Four views
Tobacco
production
capacity
Rockefeller College of Public Affairs and Policy
University at Albany
-
+
People starting
smoking
+
People quitting
smoking
+
-
Tobacco products
+
availability
G. P. Richardson
AAHB, March 2006
28
Reinforcing Loops
Smokers
+
Tobacco revenues
+
Smoking as a
social norm
+
-
+
People starting
smoking
+
People quitting
smoking
+
-
+
+
Four views
Tobacco
production
capacity
Tobacco marketing
activities
Rockefeller College of Public Affairs and Policy
University at Albany
Tobacco products
+
availability
G. P. Richardson
AAHB, March 2006
29
Balancing or
Counteracting Loops
Researchers
awarness of
tobacco health
risk
+
Smokers
+
Public
awareness of
tobacco health
risk
+
Three views
People quitting
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
30
Tax revenues
from smokers
Balancing or
Counteracting Loops
+
Researchers
awarness of
tobacco health
risk
Smokers
Funding for tobacco
health research
+
+
+Gov. income
+
Public
awareness of
tobacco health
risk
+
Three views
People quitting
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
31
Tax revenues
from smokers
Balancing or
Counteracting Loops
+
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
Funding for tobacco
health research
+
+
Smokers
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
People quitting
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
Tobacco control
programs
+
+
+
Three views
+Gov. income
+
+
Health insurers
coverage of tobacco
quitting costs
G. P. Richardson
AAHB, March 2006
32
Anti-tobacco Constituencies
Anti-tobacco
constituencies
+
+
Researchers
awarness of
tobacco health
risk
Public
awareness of
tobacco health
risk
Two views
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
33
Anti-tobacco Constituencies
Anti-tobacco
constituencies
+
+
Researchers
awarness of
tobacco health
risk
+
Funding for tobacco
health research
+
+
+
Public
awareness of
tobacco health
risk
+
Funding for tobacco
control programs
+
Tobacco control
programs
Two views
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
34
Pro-tobacco Constituencies
Pro-tobacco
contituencies
+
+
+
Smokers
+
Tobacco revenues
Smoking as a
social norm
Two views
Tobacco
production
capacity
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
35
Pro-tobacco Constituencies
Pro-tobacco
contituencies
++
+
+
Smokers
+
Tobacco revenues
+
People starting
smoking
+
People quitting
smoking
+
-
+
Smoking as a
social norm
+
Two views
-
+
+
Tobacco
production
capacity
Tobacco marketing
activities
Rockefeller College of Public Affairs and Policy
University at Albany
+
Tobacco products
availability
G. P. Richardson
AAHB, March 2006
36
Pro-tobacco Constituencies
Pro-tobacco
contituencies
++
+
+
Smokers
+
Tobacco revenues
Trend in tobacco
company revenues
Two views
+
+
Tobacco
production
capacity
+
People starting
smoking
+
People quitting
smoking
+
-
+
+
-
Smoking as a
social norm
+
Tobacco marketing
activities
Rockefeller College of Public Affairs and Policy
University at Albany
+
Tobacco products
availability
G. P. Richardson
AAHB, March 2006
37
Government Awareness of Health Risks
Govt awareness
of tobacco
health risk
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
Smokers
Three views
Rockefeller College of Public Affairs and Policy
University at Albany
Funding for tobacco
health research
+
+
Public
awareness of
tobacco health
risk
G. P. Richardson
AAHB, March 2006
38
Government Awareness of Health Risks
Govt awareness
of tobacco
health risk
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
Smokers
Three views
Rockefeller College of Public Affairs and Policy
University at Albany
Funding for tobacco
health research
+
+
Public
awareness of
tobacco health
risk
G. P. Richardson
AAHB, March 2006
39
Government Awareness of Health Risks
Govt willingness to
act against tobacco
+
Gov. income
+ Govt funding of
tobacco control
Govt awareness
of tobacco
health risk
+
+
Researchers
awarness of
tobacco health
risk
Health care costs
+
+
Smokers
Three views
Rockefeller College of Public Affairs and Policy
University at Albany
Funding for tobacco
health research
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
+
Tobacco control
programs
G. P. Richardson
AAHB, March 2006
40
Government Willingness to Act Against Tobacco
<Anti-tobacco
litigation>
Govt willingness to
act against tobacco
-
+
+
+Tobacco taxes
Two views
Pro-tobacco
contituencies
Govt awareness
of tobacco
health risk
+
Tax revenues
from smokers
+Gov. income
+ Govt funding of
tobacco control
Anti-tobacco
constituencies
+
Funding for tobacco
health research
Anti-tobacco
legislation
Anti-tobacco
litigation
Rockefeller College of Public Affairs and Policy
University at Albany
+
Funding for tobacco
control programs
G. P. Richardson
AAHB, March 2006
41
<Anti-tobacco
litigation>
Perceived importance of
other health programs
-
+
+
+Tobacco taxes
Govt awareness
of tobacco
health risk
+
+
Pro-tobacco
contituencies
++
+
+
+
Trend in tobacco
company revenues
+
Tobacco
production
capacity
+
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
+
Tobacco control
programs
+
+
Health insurers
coverage of tobacco
quitting costs
-
+
Tobacco marketing
activities -
+Gov. income
+
Funding for tobacco
health research
+
+
Smokers
+
Tax revenues
from smokers
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tobacco revenues
+
Anti-tobacco
constituencies
+
+
Health care costs
Anti-tobacco
litigation
Anti-tobacco
legislation
<Perceived importance
of other health
programs>
- Govt willingness to +
act against tobacco
Tobacco products
+
availability
xxx
Rockefeller College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
42
What Can One Say at This Point?
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
43
xxx
Perceived importance of
other health programs
<Anti-tobacco
litigation>
- Govt willingness to +
act against tobacco
-
+
+
+Tobacco taxes
Govt awareness
of tobacco
health risk
Pro-tobacco
contituencies
++
Anti-tobacco
legislation
+
+
+
+
+
+
Trend in tobacco
company revenues
+
+
Tobacco
growers
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
-
Tobacco control
programs
+
+
Funding to support
tobacco quitting
efforts
+
+
Tobacco marketing
activities -
+
Funding for tobacco
health research
+
+
Smokers
+Gov. income
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
Health care costs
+
Tobacco revenues
Tax revenues
from smokers
Anti-tobacco
constituencies
+
+
+
Anti-tobacco
litigation
+
<Perceived importance
of other health
programs>
Tobacco products
+
availability
yyy
Rockefeller
College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
44
xxx
Perceived importance of
other health programs
- Govt willingness to +
act against tobacco
-
Anti-tobacco
legislation
+
+
+
+
Govt awareness
of tobacco
health risk
Pro-tobacco
contituencies
++
+
+
Trend in tobacco
company revenues
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
-
Tobacco control
programs
+
+
Funding to support
tobacco quitting
efforts
+
+
Tobacco marketing
activities -
+Gov. income
+
Funding for tobacco
health research
+
+
+
+
Tax revenues
from smokers
<Perceived importance
of other health
programs>
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tobacco revenues
Tobacco
growers
Tobacco taxes
Health care costs
Smokers
+
+
Anti-tobacco
constituencies
+
+
+
Anti-tobacco
litigation
+
<Anti-tobacco
litigation>
Tobacco products
+
availability
yyy
Rockefeller
College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
45
xxx
Perceived importance of
other health programs
- Govt willingness to +
act against tobacco
-
Anti-tobacco
legislation
+
+
+
+
Govt awareness
of tobacco
health risk
Pro-tobacco
contituencies
++
+
+
Trend in tobacco
company revenues
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
-
Tobacco control
programs
+
+
Funding to support
tobacco quitting
efforts
+
+
Tobacco marketing
activities -
+Gov. income
+
Funding for tobacco
health research
+
+
+
+
Tax revenues
from smokers
<Perceived importance
of other health
programs>
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tobacco revenues
Tobacco
growers
Tobacco taxes
Health care costs
Smokers
+
+
Anti-tobacco
constituencies
+
+
+
Anti-tobacco
litigation
+
<Anti-tobacco
litigation>
Tobacco products
+
availability
yyy
Rockefeller
College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
46
xxx
Perceived importance of
other health programs
- Govt willingness to +
act against tobacco
-
Anti-tobacco
legislation
+
+
+
+
Govt awareness
of tobacco
health risk
Pro-tobacco
contituencies
++
+
+
Trend in tobacco
company revenues
Smoking as a
social norm
+
+
Funding for tobacco
control programs
+
+
Public
awareness of
tobacco health
risk
-
+
+
+
People starting
smoking
+
People quitting
+
smoking
+
-
Tobacco control
programs
+
+
Funding to support
tobacco quitting
efforts
+
+
Tobacco marketing
activities -
+Gov. income
+
Funding for tobacco
health research
+
+
+
+
Tax revenues
from smokers
<Perceived importance
of other health
programs>
+ Govt funding of
tobacco control
Researchers
awarness of
tobacco health
risk
+
+
Tobacco revenues
Tobacco
growers
Tobacco taxes
Health care costs
Smokers
+
+
Anti-tobacco
constituencies
+
+
+
Anti-tobacco
litigation
+
<Anti-tobacco
litigation>
Tobacco products
availability
+
yyy
Rockefeller
College of Public Affairs and Policy
University at Albany
Pressure on tobacco
companies to reduce
marketing activities
G. P. Richardson
AAHB, March 2006
47
A “Shard” of a Tobacco Model
The Aging Chain of Smokers
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
48
elderly dying
adults dying
Children
births p year
<Fraction smoking>
children maturing
Teens
Adults
teens aging
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
new children
smoking
teen smokers
aging
new teens
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
new
adults
smoking
adult smokers
aging
Adult
smokers
dying
elderly
smokers
dying
new elderly
smoking
G. P. Richardson
AAHB, March 2006
49
Simple arithmetic for the flows
adult death rate
elderly dying
adults dying
child years
Children
births p year
<Fraction smoking>
children maturing
teen years
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
new children
smoking
teen smokers
aging
new teens
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
new
adults
smoking
adult smokers
aging
Adult
smokers
dying
elderly
smokers
dying
new elderly
smoking
G. P. Richardson
AAHB, March 2006
50
Endogenous structure
teen births
teen birth
rate
adult death rate
elderly dying
adults dying
child years
Children
births p year
<Fraction smoking>
adult birth
rate
adult births
children maturing
teen years
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
new children
smoking
teen smokers
aging
new teens
smoking
Rockefeller College of Public Affairs and Policy
University at Albany
new
adults
smoking
adult smokers
aging
Adult
smokers
dying
elderly
smokers
dying
new elderly
smoking
G. P. Richardson
AAHB, March 2006
51
teen births
teen birth
rate
adult death rate
elderly dying
adults dying
child years
Children
births p year
<Fraction smoking>
adult birth
rate
adult births
teen years
children maturing
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
teen smokers
aging
new teens
smoking
new children
smoking
new
adults
smoking
adult smokers
aging
Adult
smokers
dying
elderly
smokers
dying
new elderly
smoking
teens not
smoking
<Teens>
Smoking initiation arithmetic
fraction of teens
initiated per year
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
52
teen births
teen birth
rate
adult death rate
elderly dying
adults dying
child years
Children
births p year
<Fraction smoking>
adult birth
rate
adult births
teen years
children maturing
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
teen smokers
aging
new teens
smoking
new children
smoking
new
adults
smoking
adult smokers
aging
Adult
smokers
dying
elderly
smokers
dying
new elderly
smoking
teens not
smoking
<Teens>
fraction of teens
initiated per year
Rockefeller College of Public Affairs and Policy
University at Albany
Smoking behavior carries
along as population ages
G. P. Richardson
AAHB, March 2006
53
teen births
teen birth
rate
Children
births p year
children not
smoking
adult death rate
elderly dying
adults dying
child years
<Fraction smoking>
adult birth
rate
adult births
teen years
children maturing
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
new children
smoking
teens not
smoking
teen smokers
aging
new
new teens
adults
smoking
smoking
adults not
smoking
<Children>
fraction of children
initiated p yr
<Teens>
<Adults>
fraction of teens
initiated per year
Rockefeller College of Public Affairs and Policy
University at Albany
fraction of adults
initiatied per year
adult smokers
aging
Adult
smokers
dying
elderly not
smoking
elderly
smokers
dying
new elderly
smoking
<Elderly>
fraction of elderly
initiated per year
G. P. Richardson
AAHB, March 2006
54
Adult and elderly smokers have shorter lifespans
teen births
teen birth
rate
Children
births p year
children not
smoking
adult death rate
elderly dying
adults dying
child years
<Fraction smoking>
adult birth
rate
adult births
teen years
children maturing
adult years
Teens
Adults
teens aging
elderly years
Elderly
adults aging
fraction children
smoking
fraction teens
smoking
fraction adults
smoking
fraction elderly
smoking
Children
smoking
Teens
smoking
Adults
smoking
Elderly
smoking
child smokers
maturing
new children
smoking
teens not
smoking
teen smokers
aging
new
new teens
adults
smoking
smoking
adults not
smoking
<Children>
fraction of children
initiated p yr
<Teens>
<Adults>
fraction of teens
initiated per year
Rockefeller College of Public Affairs and Policy
University at Albany
adult smokers
aging
Adult
smokers
dying
elderly not
smoking
<adults dying>
fraction of adults
initiatied per year
<Elderly>
adult smoking
death multiplier
elderly
smokers
dying
new elderly
smoking
elderly smoking
death multplier
fraction of elderly
initiated per year
G. P. Richardson
AAHB, March 2006
55
Cumulative Populations
400 M
300 M
200 M
100 M
0
1980 1984 1988 1992 1996 2000 2004 2008 2012 2016 2020
Time (Year)
Children : smoking chain base
Teens : smoking chain base
Adults : smoking chain base
Elderly : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
56
Fractions smoking
0.4
0.3
0.2
0.1
0
1980
1985
1990
1995
2000
2005
Time (Year)
2010
2015
2020
fraction children smoking : smoking chain base
fraction teens smoking : smoking chain base
fraction adults smoking : smoking chain base
fraction elderly smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
57
Smokers
40 M
30 M
20 M
10 M
0
1980
1985
1990
1995
2000
2005
Time (Year)
2010
2015
2020
Children smoking : smoking chain base
Teens smoking : smoking chain base
Adults smoking : smoking chain base
Elderly smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
58
Total fraction smoking
0.5
0.375
0.25
0.125
0
1980
1985
1990
1995
Fraction smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
2005
Time (Year)
2010
2015
2020
dmnl
G. P. Richardson
AAHB, March 2006
59
Children smoking
600,000
Cutting childhood initiation per
year in half drops the children
smoking population in half, but
it takes a long time.
500,000
400,000
300,000
200,000
1980
1990
2000
Time (Year)
2010
2020
Children smoking : cut child init in half
Children smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
60
Teens smoking
5M
4.75 M
4.5 M
Cutting Childhood initiation has
some effect on the Teen smoking
population (but note the y-scale)
4.25 M
4M
1980
1990
2000
Time (Year)
2010
2020
Teens smoking : cut child init in half
Teens smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
61
Adults smoking
40 M
37.5 M
35 M
…Almost no effect on the
Adult smoking population
32.5 M
30 M
1980
1990
2000
Time (Year)
2010
2020
Adults smoking : cut child init in half
Adults smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
62
Elderly smoking
30 M
27.5 M
25 M
…No discernable effect on the
Elderly smoking population
22.5 M
20 M
1980
1990
2000
Time (Year)
2010
2020
Elderly smoking : cut child init in half
Elderly smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
63
Fraction smoking
1
0.75
0.5
0.25
0
1980
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.
1990
Fraction smoking : cut child init in half
Fraction smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
dmnl
dmnl
G. P. Richardson
AAHB, March 2006
64
Teens smoking
6M
5M
Cutting Teen smoking
initiation per year in half
4M
3M
2M
1980
1990
2000
Time (Year)
2010
2020
Teens smoking : cut teen init in half
Teens smoking : cut child init in half
Teens smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
65
Adults smoking
40 M
35 M
Cutting Teen smoking initiation
significantly reduces the Adult
smoking population over time
30 M
25 M
20 M
1980
1990
2000
Time (Year)
2010
2020
Adults smoking : cut teen init in half
Adults smoking : cut child init in half
Adults smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
66
Elderly smoking
30 M
27.5 M
25 M
Cutting Teen smoking initiation
significantly cuts the Elderly smoking
population
22.5 M
20 M
1980
1990
2000
Time (Year)
2010
2020
Elderly smoking : cut teen init in half
Elderly smoking : cut child init in half
Elderly smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
67
Fraction smoking
0.4
0.325
0.25
…and significantly lowers the
fraction of the population who smoke
0.175
(Cutting Adult smoking initiation
behaves similarly)
0.1
1980
1990
Fraction smoking : cut teen init in half
Fraction smoking : cut child init in half
Fraction smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
dmnl
dmnl
dmnl
G. P. Richardson
AAHB, March 2006
68
Fraction smoking
0.4
0.325
0.25
Cutting all initiation rates by half
significantly cuts the fraction of
the population who smoke
0.175
0.1
1980
1990
Fraction smoking : cutting all initiation
Fraction smoking : cut adult init in half
Fraction smoking : cut teen init in half
Fraction smoking : cut child init in half
Fraction smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
dmnl
dmnl
dmnl
dmnl
dmnl
G. P. Richardson
AAHB, March 2006
69
Smokers dying
2M
1.75 M
1.5 M
1.25 M
Cutting all initiation by half
has a significant impact on
deaths from smoking
1M
1980
1990
Smokers dying : cutting all initiation
Smokers dying : cut adult init in half
Smokers dying : cut teen init in half
Smokers dying : cut child init in half
Smokers dying : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people/Year
people/Year
people/Year
people/Year
people/Year
G. P. Richardson
AAHB, March 2006
70
Children smoking
800,000
700,000
What happens if the tobacco industry
introduces “safe” tobacco products,
cutting the health risk in half?
600,000
500,000
400,000
1980
More children will start smoking
since the risk is less.
1990
Children smoking : safer tobacco
Children smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people
people
G. P. Richardson
AAHB, March 2006
71
Teens smoking
6M
5.5 M
…More Teens smoking
5M
4.5 M
4M
1980
1990
Teens smoking : safer tobacco
Teens smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people
people
G. P. Richardson
AAHB, March 2006
72
Adults smoking
40 M
37.5 M
…More Adults smoking
35 M
32.5 M
30 M
1980
1990
Adults smoking : safer tobacco
Adults smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people
people
G. P. Richardson
AAHB, March 2006
73
Elderly smoking
40 M
32.5 M
…More Elderly smoking
25 M
17.5 M
10 M
1980
1990
Elderly smoking : safer tobacco
Elderly smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people
people
G. P. Richardson
AAHB, March 2006
74
Fraction smoking
0.4
0.35
0.3
…Greater fraction of the
population smoking
0.25
0.2
1980
1990
Fraction smoking : safer tobacco
Fraction smoking : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
dmnl
dmnl
G. P. Richardson
AAHB, March 2006
75
Smokers dying
2M
1.75 M
1.5 M
1.25 M
1M
1980
…Lower death rate for a while, but
more smokers eventually mean more
smoking-related deaths
1990
Smokers dying : safer tobacco
Smokers dying : smoking chain base
Rockefeller College of Public Affairs and Policy
University at Albany
2000
Time (Year)
2010
2020
people/Year
people/Year
G. P. Richardson
AAHB, March 2006
76
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
Rockefeller College of Public Affairs and Policy
University at Albany
G. P. Richardson
AAHB, March 2006
77