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Table 2 Tobacco reduction strategies

From: The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities

Scenario name Brief description of strategy Expected reduction in smoking prevalence* Duration of intervention and its effect Reference
Pharmacotherapy and counselling Pharmacotherapy intervention to stop smoking comprised of 12 weeks nicotine replacement therapy (NRT) and varenicline medication. Group and individual counselling was offered to participants to enhance odds of quitting. Content and duration of counselling sessions were obtained from a meta-analysis of smoking cessation interventions with individuals undergoing treatment or recovery and dosage of varenicline and NRT prescriptions were modelled as per Inuit and Canadian standards. 1.5% per year for 3 years One time opportunity for smokers to join pharmacotherapy and counselling programs. Benefit was assumed to last for 3 years (i.e., smoking prevalence falls at an annual rate of 1.5% for 3 consecutive years). Beyond this period the prevalence declines at the background rate of 0.8% annually. [46, 77, 78]
Pharmacotherapy, counselling and mass media Pharmacotherapy and counselling components of this strategy were similar to the above strategy. We used pooled risk ratios for cessation from two randomized trials involving Indigenous people in Australian communities receiving national tobacco campaigns supplemented by other Indigenous specific campaigns such as “Break the chain”. 1.9% per year for 3 years One time opportunity for smokers to join pharmacotherapy and counselling programs accompanied by a mass media campaign. Benefit was assumed to last for 3 years (i.e., smoking prevalence falls at an annual rate of 1.9% for 3 consecutive years). Beyond this period the prevalence declines at the background rate of 0.8% annually. [49]
Increased taxation on commercial cigarettes A legislative approach to commercial tobacco control through increased taxation which has no associated costs from the perspective of the healthcare system. To measure the impact of this policy change vis-à-vis commercial cigarette demand; we used reported price elasticity of demand (i.e., the extent to which cigarette use falls or rises after increases or decreases in price) 7% after 3 years increasing to 14% after 10 years One time 25% increase in tobacco taxation was assumed to have greater immediate effect in the first 3 years and the effect would then decline over time (i.e., smoking prevalence decreases by 7% over 3 years, and after 10 years it decreases by a total of 14%). Beyond this period the prevalence declines at the background rate of 0.8% annually. [12, 63, 79, 80]
All strategies (Taxation + mass media + pharmacotherapy + Counselling) Multifaceted strategy combining all the above strategies: the measure of effect of reduction in smoking prevalence is derived from the effect of increased taxation multiplied by 3-year effect (risk ratio) of pharmacotherapy combined with mass media 5.6% annually for 3 years and 2.6% annually for subsequent 7 years 5.6% annual reduction in smoking prevalence for the first 3 years followed by 2.6% annual reduction up to year 10 after one-time interventions. Beyond this period the prevalence declines at the background rate of 0.8% annually. [77, 78, 81]
  1. *This table presents annual rates of reduction in smoking prevalence resulting from once off interventions of pharmacotherapy and/or mass media whose effect lasts 3 years
  2. The effect of a once off 25% taxation increase on smoking prevalence is presented at year 3 and year 10, beyond this period, prevalence declines at the background rate of 0.8% annually