title: Estimating benefits of past, current, and future reductions in smoking rates using a comprehensive model with competing causes of death.
abstract: BACKGROUND
  Despite years of declining smoking prevalence, tobacco use is still the leading preventable contributor to illness and death in the United States, and the effect of past tobacco-use control efforts has not fully translated into improvements in health outcomes. The objective of this study was to use a life course model with multiple competing causes of death to elucidate the ongoing benefits of tobacco-use control efforts on US death rates.
  
  
  METHODS
  We used a continuous-time life course simulation model for the US population. We modeled smoking initiation and cessation and 20 leading causes of death as competing risks over the life span, with the risk of death for each cause dependent on past and current smoking status. Risk parameters were estimated using data from the National Health Interview Survey that were linked to follow-up mortality data.
  
  
  RESULTS
  Up to 14% (9% for men, 14% for women) of the total gain in life expectancy since 1960 was due to tobacco-use control efforts. Past efforts are expected to further increase life expectancy by 0.9 years for women and 1.3 years for men. Additional reduction in smoking prevalence may eventually yield an average 3.4-year increase in life expectancy in the United States. Coronary heart disease is expected to increase as a share of total deaths.
  
  
  CONCLUSIONS
  A dynamic individual-level model with multiple causes of death supports assessment of the delayed benefits of improved tobacco-use control efforts. We show that past smoking reduction efforts will translate into further increases in life expectancy in the coming years. Smoking will remain a major contributor to preventable illness and death, worthy of continued interventions.
authors: Department of Health Services, University of California, Los Angeles School of Public Health, Los Angeles, CA 90095-1772, USA. jeroenvm@ucla.edu
authors: Jeroen
authors: J
authors: van Meijgaard
authors: Jonathan E
authors: JE
authors: Fielding
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000428:Alcohol Drinking / Q000453:epidemiology / Q000401:mortality; D015992:Body Mass Index; D057191:Capacity Building; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D006306:Health Surveys; D006801:Humans; D008017:Life Expectancy / Q000208:ethnology / Q000639:trends; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000208:ethnology / Q000639:trends; D009309:National Center for Health Statistics, U.S.; D016272:Occupational Health / Q000706:statistics & numerical data*; D009790:Occupations; D015995:Prevalence; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology / Q000401:mortality* / Q000639:trends; D016540:Smoking Cessation / Q000208:ethnology / Q000523:psychology* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D012923:Social Class; D014481:United States / Q000453:epidemiology