SimSmoke simulation models distinguished by race/ethnicity: past and future trends and the potential role of policy

Introduction Policy interventions to reduce racial/ethnic cigarette smoking and related health disparities are needed to improve health equity. Simulation models can be useful in gauging the impact of tobacco control policies on trends in smoking-related outcomes, but few have systematically analyzed the impact of tobacco control policies across racial/ethnic groups. Methods We developed 3 separate SimSmoke models for the non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic populations. Following a first-order Markov process, population projections evolve through net immigration and death rates, and smoking prevalence evolves through initiation, cessation, and relapse. The models incorporate policies implemented from 2011 to 2023 and are used to consider trends in NHW, NHB, and Hispanic smoking prevalence and smoking-attributable death and the impact of policies on those trends. Results The models indicate major differences in smoking trends and smoking-attributable deaths (SADs) among NHW, NHB, and Hispanic adults, with NHB males experiencing the smallest smoking decline through 2023 and having the highest 2023 smoking prevalence. The models predict major differences in the impact of tobacco control policies, especially the greater effect of cigarette taxes on NHB and Hispanic adults than NHW adults and the reduced impact of T21 laws on NHB compared to NHW and Hispanic adults. Discussion The models predict large differences in levels and rates of decline in NHW, NHB, and Hispanic smoking prevalence, leading to widening health disparities between racial/ethnic groups. Further study is needed on differential race/ethnicity impacts of tobacco control policies and the role of cigars, e-cigarettes, and other product use.