Agent-based Modeling in Tobacco Regulatory Science: Exploring 'What if' in Waterpipe Smoking

Assessing the effects of minimum floor price laws on tobacco use among youth in the state of Virginia, USA: an agent-based simulation approach

BACKGROUND

Preventing youth exposure to cigarette smoking is a public health priority. One of the most effective ways to reduce tobacco use is to increase the prices of tobacco products. Minimum floor price laws (MFPLs) are a relatively new but more feasible strategy that sets a price below which the product cannot be sold. We aim to examine the effects of minimum floor prices (MFPs) on tobacco use among youth in Virginia.

METHODS

An agent-based modelling (ABM) was developed from bottom-up to evaluate the influence of increasing the cigarette MFPs on middle and high school students' smoking behaviour in the state of Virginia. A rational-addiction model was integrated to model the smoking decision of youth under the dynamic utility maximisation framework within the ABM.

RESULTS

The model predicted that every 10% increase in the MFP in Virginia could prevent 2232 8th graders and 1890 12th graders from cigarette smoking, a 2.4% and 1.8% reduction in median smoking prevalence. For students who smoked, 8th and 12th graders would consume 0.36 and 0.45 fewer cigarettes per smoking day if experiencing a 10% increase in the MFP from the baseline US$7.50 to US$8.30. The MFP level that produces the maximal response was estimated to be between 10% and 30%.

CONCLUSIONS

MFPLs provide local jurisdictions with a potentially effective strategy to reduce tobacco use and mitigate-related harms among youth.

Economic research in waterpipe tobacco smoking: reflections on data, demand, taxes, equity and health modelling

Economic evaluation of tobacco control policies is common in high-income settings and mainly focuses on cigarette smoking. Evidence suggests that increasing the excise tax of tobacco products is a consistently effective tool for reducing tobacco use and is an efficient mechanism for increasing government revenues. However, less research has been conducted in low/middle-income countries where other tobacco forms are common. This paper presents insights from our work on the economics of waterpipe tobacco smoking conducted in the Eastern Mediterranean Region where waterpipe smoking originated and is highly prevalent. The specific areas related to economics of waterpipe smoking considered herein are: price elasticity, taxation, government revenue, expenditure and healthcare costs. This paper aims to provide practical guidance for researchers investigating the economics of waterpipe tobacco with potential implications for other novel tobacco products. We present lessons learnt across five thematic areas: data, demand, taxes, equity and health modelling. We also highlight knowledge gaps to be addressed in future research. Research implications include designing comprehensive assessment tools that investigate heterogeneity in waterpipe smoking patterns; accounting for cross-price elasticity of demand with other tobacco products; exploring the change in waterpipe tobacco smoking in response to a tax increase and analysing the equity impact of waterpipe tobacco control interventions.