The Healthy People 2010 smoking prevalence and tobacco control objectives: results from the SimSmoke tobacco control policy simulation model (United States) David T. Levy 1, * Leonid Nikolayev 2 Elizabeth Mumford 3 & Christine Compton 2 1 Senior Scientist, Pacific Institute for Research and Evaluation Professor, University of Baltimore, Maryland, USA; 2 Computer Programmer, Pacific Institute for Research and Evaluation, University of Baltimore, Maryland, USA; 3 Associate Research Scientist, Pacific Institute for Research and Evaluation, University of Baltimore, Maryland, USA Received 2 August 2004; accepted in revised form 20 December 2004 Key words: Healthy People 2010, simulation model, smoking, tobacco control policies. Abstract Objectives: Healthy People 2010 (HP2010) set a goal of reducing the adult smoking prevalence to 12% by 2010. Smoking prevalence rates do not appear to be declining at or near the rate targeted in the HP2010 goals. The purpose of this paper is to examine the attainability of HP2010 smoking prevalence objectives through the stricter tobacco control policies suggested in HP2010. Methods: A tested dynamic simulation model of smoking trends, known as SimSmoke, is applied. Smoking prevalence evolves over time through initiation and cessation, behaviors which are in turned influenced by tobacco control policies. We consider the effect of changes in taxes/prices, clean air laws, media campaigns, cessation programs and youth access policies on projected smoking prevalence over the period 2003–2020, focusing on the levels in 2010. Results: The SimSmoke model projects that the aging of older cohorts and the impact of policies in years prior to 2004 will yield a reduction in smoking rates to 18.4% by 2010, which is substantially above the 2010 target of 12%. When policies similar to the HP2010 tobacco control policy objectives are implemented, SimSmoke projects that smoking rates could be reduced to 16.1%. Further reductions might be realized by increasing the tax rate by $1.00. Conclusions: The SimSmoke model suggests that the HP2010 smoking prevalence objective is unlikely to be attained. Although we are unlikely to reach the goals by meeting the HP2010 policy objectives, they could get us much closer to the goal. Emphasis should be placed on meeting the tax, clean air, media/comprehensive campaigns, and cessation treatment objectives. Introduction The U.S. Public Health Service issued the Healthy People 2000 (HP2000, [1]) objectives in 1990, which were later revised as the Healthy People 2010 goals (HP2010, [2]). They set objectives not only for reducing the burden of disease and injury, but also for behaviors that contribute to these burdens. Smoking is generally considered the leading preventable cause of death, and has been shown to be responsible for over 85% of lung cancer deaths as well as a large percentage of deaths from chronic obstructive pulmonary disease and heart disease [3, 4]. HP2000 originally set a goal of 15% for adult smoking prevalence [1]. Having declined considerably between 1964 (following the Surgeon General’s Report and surrounding publicity) and 1988 [5], adult preva- lence leveled off at about 25% and youth prevalence increased in the early and mid-1990s [5]. Nevertheless, HP2010 set a goal of 12% for adults in the year 2010. Although prevalence rates began to decline again in the late 1990s, they do not appear to be declining at or near the rate targeted by HP2010 [6]. Based on past trends, Mendez and Warner [7] have argued that the HP2010 goals are unattainable. Green et al. [8] countered that national trends and trends in states with advanced tobacco control programs indicate that the HP2010 goals are attainable. In particular, states, such as Arizona, California, Massachusetts, and Oregon, have implemented a comprehensive set of * Author for correspondence: David T. Levy, Ph.D., Senior Scientist, Pacific Institute for Research and Evaluation Professor, University of Baltimore, 14403 Sylvan Glade Dr., North Potomac, Maryland 20878, USA; Ph: 301-755-2733; Fax: 301-755-2799; E-mail: levy@pire.org Cancer Causes and Control (2005) 16:359–371 Ó Springer 2005 DOI 10.1007/s10552-004-7841-4